Medi Assist India Complaints & Reviews

Hi

This is regarding maternity claim 15-20 times i have called mediasisst for amount still not received i have escalated the issue still no response not yet received this is really unbearable very bad customer service please help me to receive my claim amount.

Claim number : 13433196

For maternity child's delivery

Claim was approved on : 22 october 2016.
As per procedure mentioned in the website for the payment to be done it takes 7 working days.
Its already 7 working days got over i have stil not received the payment.
Approved amount was 50000 rs.
Please team help me getting the amount as already sla has been breached.

Details of hospitalisation :

Hospital name: lakshmi maternity home
Address: 15th cross, margosa road, near-telephone exchange, malleshwaram, bengaluru, karnataka 560003
Date of hospitalization: 10/10/2016
Hospitalization : maternity child delivery
Beneficiary name: vaishnavi r
Medi assist id: [protected]
Employee code: 60016004
Relation: self
Primary insured: vaishnavi r
Policy holder: hewlett packard enterprise
Policy no: 072400/28/15/p1/11579696

I can be reached on +91 [protected]
Email id: vaishnavi. K. [protected]@hpe.com/[protected]@gmail.com

Thanks & regards
Vaishnavi

I am a policy holder of New India Assurance Co policy No.[protected] (customer No. PO[protected]. On 07.09.2016 I submitted a claim for Rs.21000.00 to M/s. Medi assist India TPA Pvt Ltd as reimbursement of expenses incurred in connection with my treatment. My claim No is 92940580.
They sent a letter requesting to submit further details/documents to process the claim and the same replied on 27.09.16 and received at their end on 01.10.16. On 04.10.16 and 24.10.16 I send reminders for settling my claim but regret to inform you that there is no response from them.

Hi team,

Employee number: 11173904
Employee name : nickson raja selvamony
Policy holder : accenture services pvt ltd
Maid : [protected]
Claim number : 12989207
Policy number : 421300/48/2016/427

I have submitted my claim on[protected]. After that i have received mail from medi assit team need required additional document like
1. Require detailed original discharge summary containing presenting complaints with duration, past history with duration, diagnosis and detail line of treatment
2. Need original pre numbered cash paid receipt for rs25970/-
3. Need all investigation reports for rs5880/- usg obs scan, nst, ward test, usg early pregnancy, usg nt scan).

For 1 & 3rd document i have couriered on aug 16th its already updated in my portal.

For 2nd document i have couriered on aug 4th but it’s not reflecting in my portal. But i have submitted pre numbered cash paid bill for rs25970/- not a receipt.

Regarding this issues i have submitted affidavit certificate on 24th oct. But still i didn't get any information from medi assit.

Please process on high importance.

Hospitalisation Claim Form(Employee Id : 558677) Claim No : H[protected]E001

and I was an employee of TCS i submitted hospitalisation of my father on 8th of sep 2016. My last day at 10 Oct. So many times i tried to connect the mediassist team over email but they told we will inform you about the claim. As this is the valid claim and i have submitted the whole policy amount. When i will get my Money?

Email:- [protected]@gmail.com

Dear sir,

I have not received the cash less cards for the following pnb-oriental mediclaim policies :

1. plolicy no. - 242502/48/2017/26 prem devi sethi

2. plolicy no. - 242502/48/2017/111 nirmal kumar sethi

3. plolicy no. - 242502/48/2017/28 naresh kumar sethi

Insurance company tell me to contact with you.

Please look in the matter and do needfull at earliest.

Thanking you,

Naersh kumar sethi

[protected]

Dear sir,

This has reference to my claim ref. No. 13344950 in the name of ria kapoor admitted at gambhir hospital on 17.09.2016 & discharged on 24.09.2016 with reimburse claim amount to rs. 54, 429.00. I would like to inform you that i had submitted all original bills & discharged documents, bills etc on 01st oct., 2016 at your bahadur shah zafar marg, delhi office personally & received acknowledgement from your office for the receiving of all documents through sms.

All verifications are also done from my residence & through gambhir hospital, but till date i don't have receive my claim amount. After so many reminders on your customer care no. [protected], they always assured its under process, but as per your policy terms amount should be reimbursed within 21 days, i don't have receive any claim status from your side, kindly let me know when i can receive my payment, you are requested to release the payment on priority.

Kindly send your reply through revert mail.

Thanks & regards.

Anupama kapoor
M-[protected]

I am very regrettable inform to all my (claim id :[protected]claim amount has been approved on 31 August 2016 but not settled the amount till now and already two months was over still they did not settled my amount.

I was already spoke with Mumbai office and customer care also but nobody taken response regarding in this matter. Even my policy also under corporate employee policy in the name of company OMYA India pvt Ltd.

please take appropriate action and to settle the money as per policy terms.

Hospitalisation bills in r/o hospitalisation in sunder lal jain hospital as per final bill no. sib012142 dated 10.10.2016 – ipd no. sip013404 pt. code-sp615171

Policy no. : 272900/48/2017/3261 ma-id no. [protected]

Your ref no.[protected]
Beneficiary name: mrs. shakuntla sharma w/o mr. gianendra sharma
Age: 66 years
Address: flat no.5, block no.7, pocket-b, phase-iii, ashok vihar, delhi-110052

Doa: 04.10.2016 dod: 10.10.2016

The above claim was submitted to you alongwith all the original bills and discharge certificate of the hospital for rs.235566.00.

The following information is available on net:
Non payable amount: rs.2, 35, 566/-
Reason: as per policy not covered, so pre existing deniel.

The claim amount has been wrongly denied as the disease was not pre-existing as certified by the treating doctor of the hospital; which was also submitted alongwith the claim. the doctor clearly mentioned as under:
“she has no previous history of any medical condition or risk factor for cad”.
A copy of the said certificate is embedded hereunder on next page no.2 for your information.
In view of above, please reconsider your decision as the hospitalization was on account of sudden acute heart attack.
Thanking you,
Shakuntla sharma
(insured) dated: 03.11.2016

Hi,
My child born with spina bifida with tethered cord syndrome. Due to this my had to have a surgery to correct the malformation.
At the time of birth my baby is having turf hair on her back which is symptom of spinal cord malformation.

By showing the turf hair, my health insurance provider deny my request stating it's congenital external ailment. But my consult doctor certified it's a internal anomaly.

Request your help me get the claim.

Dear Team,

Myself Ranjit Gill I want to know about the Reimbursement of my wife Kirandip kaur. Claim ID is 12089237 & the ID Number is [protected]. I had already submitted all the original bill along with claim form as well as all the documents which you required for Reimbursement which are submitted at your vadodara branch, gujarat on dated 18.02.2016. & i had also contact to your customer care for the same but they told me that they didn't received any claim i had contact at ahmedabad office phone number [protected] i had contact to baroda branch contact number[protected] as well as chennai branch [protected] & [protected] no one pick up the phone and no one respond me

now you are requested to solve this problem at your end as already nearest one month completed.

I hope you resolve this issue as soon as possible.
Encl :
1) received slip of acknowledgement of submitted claim (Attached)

I am Trisha Saha. My previous company and present company both have mediassist policy insured for myself. So I have paid premium twice in the same year for both the companies.after leaving my first company and before joining the present company in the gap of 2 weeks I have fallen sick and was hospitalized and paid 1lakh rupees. When I tried to file a reimbursement the insurance company declined saying as I was not working at the very moment so im not eligible. I was offered offer letter to join but as I was not able to join due to jaundice and mediassist declined my request. Its totally unfair that you collect money twice and when the real need comes insurance company give all non sense reasons to close the request. It was not my fault that I fallen ill that time. So I want mediassit take proper action and get my money reimbursed.
Trisha Saha

Dear sir,

I Hitesh Kalra had applied for claim of my father Sh. Davinder Kalra (Claim id no[protected]. As we had submitted the claim in 1st week of May, 2016 but till date we have not received any amount till date. as in website I track the claim it shows the status in Progress with all amount but not disbursing till not. now 6 months are over and we are still awaiting. we is the fun of taking these policies if we can get the claim on time.

we do the needful

Regards

Hitesh Kalra
[protected]

My reimbursment claim amount has been approved on 31 april 2016 but amount not credited in my account till now.
I have tried many times and spoke with customer care personnel and concerned persons. Till i did not get any response from their end.
They have mentioned in their website claim will be settled within 15 days from the approved date. As my case they have taken more than 50 days and not yet credited any amount.

Thanks,
N. Priya
Claim no: 12982149
Mobile: [protected].

Background
The patent had to undergo a procedure under general anaesthesia as recommended by the regular gynaecologist and confirmation by the regular GP of the patient. The procedure is specifically covered in the policy document.
My simple reasoning is that if a procedure is specifically covered under the mediclaim policy and the doctor decides that a patient needs to undergo the procedure (because there is no other alternative!), then the Insurance Company is liable to pay for the cost...

The original claim was seems to have been processed by a person with little or no medical knowledge/ background or even ability to comprehend the contents of the policy document. Among the reasons for rejection were
- Bleeding was not a serious problem (!!!) requiring medical attention
- Procedure should have been treated in an OPD (even though it could only be done under General Anaesthesia)
- Procedure was not covered under the policy (though it is specifically covered)

I asked for reconsideration, refuting or rebutting each of the reasons that were raised to support the decision to reject the claim but the matter pending for more than 10 months. There is no response after dozens of followup calls and email reminders other than "matter referred to the concerned department and we will respond shortly" or words to that effect.
Despite many promises to arrange a call back, none has materialised so far.
At least on two occasions I was informed that a response has been sent but none has been received so far.

I was informed many times that Mediassist had referred the matter to the Insurance Company and are awaiting an answer but this information does not seem to be accurate because at different times I was also told that the answer has been sent to me or the matter will be referred to the Insurance Company.

Though the persons manning the call centres sound genuinely concerned and interested, it turns out to be practised deception. I have spoken to at least 10 different call centre executives and 3 or 4 supervisors - some on multiple occasions, and each time I get the run around that the concerned person is busy and we will arrange a callback in 2/24/48 hours or some such deadline.But nothing happens!!!
The MediAssist call centre Supervisor is unable to provide the contact details of the ombudsman of the Insurance Company or even the person to whom such complaints can be referred in their own organisation!

It is frustrating dealing with totally unprofessional and dishonest people in any organisation especially one which is in the Healthcare industry.

Dear All.

I Rajesh MV working in HGS Bangalore complaining about the bad policy of mediassist India..
My wife has been admitted in hospital due to pregnancy and when the hospital sent request for preauthorization letter the insurance company revert stating maternity treatment does not come under their top-up policy hence we need to pay. the total sum insured as per the policy is 1.5lkhs and I topped the account for 5lkhs (4500 for 3 months) so that I don't get any financial problem when my family gets admitted. but today all of the sudden the insurance company states that it is their policy. why dint they mention the same clearly while we are doing the top up. because of them I am in deep trouble where I don't have money to pay the bills.. please suggest how to go on this

Claim no.13138071 d. O. Admission[protected]
The claim is neither settled, despite of having sent all the bank details and cancelled cheque, not once, but thrice, thru speed post, and scan thru e - mail, twice, nor is the status being updated, the reimbursement claim, now pending for last tword months, no response from tpa, despite having sent a dozen of e mails.

An employee of state bank of mysore i am unable to download e card since 4 days as my husband has to undergo an operation immediately please do advise me as to what to do i had tried it earlier but did not take a print out now i am getting a message as my employee id is invalid please do advise me as it is very urgent how do i downloaf thr e card which the hospital authorities are asking for submission my bank has a group insurance with mediassist...

Hi,

This is regarding the claim # 12777523 for amount 28, 206/- which I have made 4 months back. Till now the claim amount is not processed and I haven’t got the money which I claimed.

I totally don’t understand is there any resolution time at all..!!

This is one of the worst examples of how efficient you are in resolving the claims.

Please give me the resolution within 1 or 2 days.

I can't wait on this any more.

I hope you understand the seriousness.

Thanks,
Prakash

Hello Sir,

I am Ramesh Rao B M father of Miss. Ramesh Nisha your mediassist policy holder. My daughter met with an car accident on 19.06.2016 and her left leg was amputated. Now she is at home and recovering.She has to be provided with artificial limb. Kindly arrange to provide the details regarding the financial assistance from the policy. The details of the policy are below.

Policy holder: Novozymes South Asia Pvt Ltd.
Med Assist ID : [protected]
Employee Code: 310586
Policy No. : 1415/[protected].
Name : RAMESH NISHA.

My claim number is 13187807. I raised a query in mediassist portal on sep 09 .But I am not getting any proper response till date.I was hospitalized for breast abcess surgery on 26 Oct.mediassist approved my cashless claim.again I got admitted on 31 Oct since I was diagnosed with MRSA bacterial infection and admitted again.but mediassist rejected my claim stating that it comes under post maternity expense and I have already exhausted the limit.

So I have raised a query that bacterial infection does not comes under post maternity expense.but they are not responding to my query.when I called customer care, they say"we have forwarded your query to concerned team and wait till EOD.but I am not getting response after that.

I asked them to send original bills if they could approve so that I can claim from some other insurance.but they are taking long time and no response till now for that.

Kindly settle my amount as soon as possible.