Medi Assist India Complaints & Reviews

Hi Team,

My employee ID is: 102719 and I work for Tangoe India Softek Pvt. Ltd. I have submitted the hospital Documents for Re-Imbursement on 9th Jan’17 and I received a confirmation message on 11th Jan with the Reimbursement Claim ID as: 93496394 along with the track URL. But, whenever I track, I am not finding any data. I tried calling to the Toll Free number, where as I got a response telling that even they are not finding this Claim number online.
Hence, Can you please check this and let me know what is the status on this as it’s been more than 20 days now.

Dear Team

My wife is undergone for Laparoscopy and histroscopy due to "A2 with abnormal uterine bleeding". But i have received reply from team that it is related to xxx. i informed them that my wife got 1 normal pregnancy in June 2015 and second time ectopic pregnancy in May 2016 which is mentioned clearly in the Discharge summary. But so far, they are not replying or approving my claim.

Kindly help.

Thanks,
Srinivas

Hi Team,

Claim no :[protected]

Really disappointed after submitting all the relevant documents n sent my entire medical file but nit getting proper respond from the Medi Assist. attached are the some documents which i had sent to Mediassist. Whenever i am calling to customer support of Mediassist advisor doesnt have sense how to speak with customers nor escalation team have sense how to speak, Last Wednesday...

Hi,

My father has been a diabetic patient for the past 8 years. He was admitted for treatment of diabetic odema which is a result of diabetic liver decomposition and not alcoholic liver disease.

Further, my father has never had a alcoholic history. He has quit alcohol 16 years back. Even the discharge summary of Poona hospital does not mention the primary reason of liver decomposition to be alcohol abuse.

This is a clear case of denying the claim for frivolous reason.

I request you please look into this matter immediatly, or else I will have to go to the consumer court and file a complaint for wrongly denying my claim.

Thanks,
Sumeet Chavan
Assistant Operations Manager Legal
JPMC
On 19-Jan-2017 1:00 PM, Team Medimanage wrote:
New reply for the ticket #MM00130984

Hi Sumeet,

We regret to inform you that, your reimbursement claim is processed and denied. Please find the denail reason below for your reference.

On persual of Policy document it has been noted that the claim pertains to a person 65yrs old hospitalised for Anasarca in Decompensated Alcoholic Liver Disease. And as per policy terms and conditions use of intoxicating drugs/alcohol not covered.hence we are unable to consider the case.The claim stands denied.

#MM00130984

Thanks & Regards,
Team Medimanage

Last Contact Reply
From: Query
Date: Wed, Jan 18, 2017 at 08:52 PM

Hi,

I have submitted a reimbursement claim on 22/11/2016 and I have received SMS confirmation that the claim is registered with # 13753064.

This claim is not showing on my active reimbursement claims dashboard, hence I am also not able to check the claim status.

Request you to kindly address this.

According to mediassist policy, claim for cataract is Rs. 30, 000 per eye but at
Dr Shahs Eye And Laser Centre, Ambarnath(Maharashtra) they say that the policy is changed and it's just Rs. 20, 000 per eye and the rest Rs. 10, 000 I have to pay by cash. No such change in policy can be seen in mediassist portal. Please let me know what has to be done.

It is very painful to inform you below service which we have received from you.
My aunt has undergone cataract correction in her right eye In Disha Eye hospital on 7th Jan 2017. Hospital has raised the pre authorization request(Claim #[protected] on 2nd Jan. Nothing was informed to us from that day. On 6th Jan we have got the for first SMS and from that I was continuously following up with you people and hospital multiple times. But till now it has not been resolved.She has gone through the surgery from her own pocket. It is very difficult for such old age people to multiple follow up with you people and hospital and at the end of day if they have to pay their own, then there is no meaning for cashless service. So requesting you from going forward smoothen the process.

I am suffering from tingling and other problem i have sent the approval for insurance to medi assist bangalore. They are not proving my approval so that i can get admitted and start my treatment. Doctor has advised to get admitted and start treatment immediately. My husband is not working from last few months just to take care of my health. As i have got very serial neuro problem. Mediassist is not at all giving any update and not approving my admission in hospital. I am suffering everyday and do not have money to get admitted and do the treatment. My company is paying to mediassist from last 12 years for my insurance. Now when i need help after 12 years medi assist is cheating me not approving my claim. I am frustrated with mediassist now. If anything happens to me only medi assist is responsible for everything. I am the only earning member in my family and if anything happens to me only medi assist is responsible and they only have to take care of my family after me. As they are cheating me in this critical situation. I am attaching all the screen shots where it shows the critical situation of my health problem

The claim# 13519248 was submitted against the post hospitalization charges and claim was approved on 9th nov'16 by medi assist (Attached proof). It's been more than 60 days but still the amount has not been credited to my citibank account.

I have written many emails to medi assist support team and grievance officer but there is no response/update from them. Medi assist provides pathetic service to customers. I really don't understand if there are any humans in medi assist office or only fools sitting and doing nothing. Do they really need 3 months to close a claim?

If i don't get my claim amount in next 10 days then i will involve legal team to pursue my case in consumer court to pay with interest charges for causing inconvenience and mental agony to the patient.

Regards,
Ashwin s m

This is Rahul here from Bangalore. Sep 1st - 5th, 2016, I was hospitalized for Dengu and Jaundice. Before hospitalization – I spoke to Medi Assist and I explained them for what reason I was going to admit and exactly what it happened to me. They explained me all the formalities and I did the same.
The amount of INR 75000 had been pre-approved from their end and it was cashless. But during the time of discharge, the pre-approved amount was declined and they said it was not active line of treatment. After 12 days (Sep 17th, 2016), I submitted all the necessary documents to Medi Assist support desk for reimbursement (INR 65, 000 approx.) and as per Medi Assist policy it takes 25 working days. Today is 29th December 2016 – but still I have not received not a single positive updates from their side. Bundle of mails and calls had been done so far from myside. Nothing happened. While i am calling to customer care they are telling we are escalating to concern team.Wait for 2weeks. I was not expecting that type of poor services from Medi Assist. Very worst customer support, no technical persons available to speak properly. Please let me know, what should I do now. Thanks.

I am complaining about my medical claim which i had submitted on 2nd of august 2016. As i had undergone a major hip joint surgical operation as I have claimed for that via LIC OF INDIA Jalpiguri Division . I have undergone operation dated 07.07.2016.

N.B.-If I dont get my claim money in 30 days I will be forced to sue a case against your reputed company .

CCN#92847973
Policy#120300/34/15/05/00000002
Name-Alip Ranjan Singha(Agent, LICI, MDRT)

Dear Sir,

I have corporate Mediclaim Policy under MEDICARE TPA Srevices. Policy No. 920000/34/16/04/00000001

Kamla DEVI
MAID: [protected]
Claim Number H[protected]F[protected]

Initially, I went for cashless treatment, and it got a query was which was answered by Doctor/Hospital and by late evening it was approved.
But Hospital had already given the discharge summary, and if I had stayed for more they would have charged again and a new discharge summary was to be issued(as per hospital billing). So, I paid the bill and applied for later
reimbursement.

First they asked a query - Why the patient was admitted as the treatment could have been done on OPD basis. Doctor/Hospital answered that as the patient had severe anemia and required blood transfusion immediately so need to be admitted.

But, now after one month of applying for reimbursement, I get the email that the claim has been denied.

Reason for denial:

On scrutiny of claim documents, it is found that patient Kamla Devi received conservative treatment (Blood transfusion) for the condition of severe anemia, RA and osteoporosis, patient was admitted primarily for anemia,
confirmed in query reply provided by hospital. As anaemia is not payable as per current policy terms and conditions, claim stands denied. We regret our inability to process the claim.Since the claim does not fall within the purview of the Policy terms & conditions, we regret our inability to admit the claim. If you have any other information or documents to substantiate admissibility of the claim, please provide the same within 15 days of receipt of this email/letter.

When it was approved while cashless, how come the same can be problematic later, as the treatment was same. While the patient was admitted they even visited hospital to check and gave a "get well soon card", and now at the end claim denied, In-spite of paying for this medical insurance for many many years for four people, this is what one get when the need arises. What a shameless act of deceiving people.

Thanks
Sudhir
[protected]

I have submitted the claim of my dad on 12/11/2016. The claim number is 10401285. The employee number who assisted me is l[protected]. Its almost 2 months and i havent received any message or any refund. I even visited their office and all they responded was it will be done sir. The claim name is "pathi. Himagiri". I tried contacting their customer care and they told it is refunded already. And i havent got a single rupee from them. Kindly revert back.

I am a employee of TCS and member of HIS provided by New India Assurance as a part of Corporate Group Insurance policy, for which TPA is Mediassisst. My Emp Id is 121158.

This is regarding the mentioned Health Insurance Claim for Hospitalization (H[protected]E002), which has been unjustly denied to me by the insurer.

This is clearly a shocking response after incurring heavy expenses for my fathers treatment. He is a Heart Patient having Coronary Artery Disease and Hypertension and was admitted to Hospital on 20/11/16 under severe and critical health condition. I would like to mention that I am not satisfied with this denial and I don't think such cases should be denied under some pretext that no surgury was done. This has put enormous financial liabilities on me now. Enough proof and document for medical condition and treatment provided thereof were provided, but in spite of that is really a shocking verdict which is next to impossible to accept.

So in this regard I would like appeal against this unjust and arbitrary decision by the TPA / Insurer against a corporate client like TCS; that too for a valid medical emergency. If my father wasn't admitted or treated on that date we don't know what would have been his fate today. So I would like to strongly appeal against this decision and would request you take necessary action and provide me your necessary assistance and guidance in this regard.

Your quick and response and action would be highly appreciated.

Dear Sir,

MY ID NO 202793 H P PARWANATH phone no [protected]
email hpp.[protected]@gmail.com.

I can login with my ID [protected]@ibacobr, But not able to generate the ID E CARD of my self and by dependent.
policy no 500100/28/16/P1/09920973 PERIOD FROM 01.10.2016 TO 30.09.2017.
Kindly contact me over phone mobile and guide/help me to generate the Ecard. please treat the matter most urgent. I have to submit the claim paper with E card.
With regards

HP Parswanath no [protected]

Dear All @ Medi Assist,

My father Mr.Dilip R. Jani has forwarded reimbursement of Mediclaim. Details are as below :

Beneficiary Name : Mr.Dilip R. Jani
Claim ID : 13411576
Claim Received date : 14/10/2016
Claim Amount : Rs.29, 088/-
Admission Date : 05/09/2016
Discharge Date : 07/09/2016

Claim has been received on 14th Oct.’16 and till date there has been no update on the status of the same, while the claim status is reflecting as “IN progress” on your portal.

(www.medibuddy.in)

What is the exact status of the claim ?
How much time do we require ? What should be the TAT ?
By when can he get the claim amount ?

Awaiting for your revert at the earliest. Will be constrained to escalate the issue to higher authorities if no revert is received within 2 days.

Regards,
Keyur Jani
+[protected]

Dear sir
My ma-id [protected] not aligible to claim as per med assist discussion. I am work in vistaar finance pvt ltd. But i am leave / risingation this co. My policy validity is july 2017 why i am not aligible tis policy claim and plz tell me policy term and condition in hindi language.

Regards
Ravindra namdeo waditke
Mob. [protected]
Email. [protected]@gmail.com

They don't understand patients.They just follow useless rules.They asked lab reports for processing my claim but I requested them to accept photocopies of docs as I need them for continuing treatment atleast for 1 year.They did not accept & kept my claim on hold and asked me to send original docs within a week.
Please have some humanity and understand the reasons for which claim is submitted.Totally incapable o[censored]nderstanding the situations.
Please appoint the approvers, who has atleast 1% knowledge of medical field.

Respect Sir/Madam,

This is regarding an enquiry of medclaim that I had filed on 8th of October 2016 and I haven't received any information about the passing of my claim.

Requesting you to please let me know the status or if there is a procedure to get the status.

Details:
Name - Jagdish Kumar Doda
Branch - LIC Abohar (152116)
Agency code[protected]

Best regards,
Jagdish Kumar Doda

Hi i had applied for claim on 11th nov'16 on same day i had submitted my doc to mediassist... Just i rcvd document received confirmation on 22nd nov'16 after that i am continuesly following up wid customer care of mediassist but yet i didnt rcvd any claim no nor claim amt... Advisor were sitting over der in call center are very rude n they r not transferring the call to der superior if we demanding.. They are saying like they are the seniors over there... Spk to us...

M/s medi assist india has declined by mediclaim reimbursement and the denial letter says that the hospital does not have 15 beds. As per clause 2.1, the hospital should be either registered or it should meet other specification defined by irda. I have received the bith certificate from bbmp, which is proof that the hospital is registered one. But medi assist is not responding to my emails and they have blocked my email id.

M/s medi assist india should be blacklisted by irda.