Medi Assist India Complaints & Reviews

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.

I had submitted for my hospital reimbursement to Medi-Assist which was
received to them on 28-Jun-2016.

they generated to claims numbers as below:

Claim no[protected]
Claim no[protected]

Claim No[protected] has been settled.

but Claim no 12879201 is showing "Canceled" and no other info like

very disgusting it is, I have faced lots of problem with Medi Assist.

Myself Ishan Patel a oriental insurance company mediclaim policy holder with policy number 151200/48/2016/17408 my medi assist ID is [protected] I was admitted in SAIMS hospital Indore on date 18/07/2016. Mediclaim section of SAIMS hospital has contacted with medi assist on date 19/07/2016 the claim ID generated by medi assist was 12971647 for cashless. But I was recover on date 21/07/2016. Till 21/07/2016 the approval was not receive for cashless claim so that, I have decided to take reimbursement. Doctors of SAIMS hospital gave me discharge on 21/07/2016. As I have not availed the cashless benefit of policy so that I have send all the original hospital document and reports to the Mediassist via courier and I have get an acknowledgment on 6/08/2016 via Mediassist for reimbursement claim ID 13063312. As from above case it is clear that cashless benefits were not availed by me, and also reimbursement claim is not receive by me till date . So many times I was contacted with Medi Assist customer care call centre, their reply was that your cashless claim was not settle till that so your reimbursement claim is put on hold. In one conversion with call center they reply me that initial clame request was not cancel by mediassist and they require the the cancellation request from SIMS hospital
SIMS hospital also send the initial cancellation request on date 15/09/2016. but till date 26/09/2016 there is no action taken by mediassist.

With media assist and dr shroffs eye hospital Kailash colony.
We are having a horroring experience with you all - in getting a normal insurance processed.
We will never advice to buy insurance with you.
Sad that we had to part of it
Disgusting ...
It has taken three days to process a simple insurance for senior citizen retina surgery.
The hospital is unhygienic and the staff especially the TPA desk is the worst.bad choice and decision in our part...

Dear sir/madam,
My name is sumit kumar i admitted in bhagat hospital during 12 august to 15 august 2016 because i was suffering from fever. I have a oriental insurance policy.
Policy number is 272900/48/2016/23443
Ma id [protected].
Claim id 13095729
I have admitted through this policy on 12 -15 august 2016 by my claim is denied of amount 19915 i paid the total amount to hospital. After that doctor gave the justification in written to mediassist tpa for the reimbursement.. I have sent my all documents to delhi branch by ondot courier.
Dod - 17/08/2016
Pod number[protected]
But mediassist tpa is approved of amount 9000 against the claim amount 19915. L have attached supportive documents for your convenience.
I have mentally harassed a lot for this. Please do the needful as soon as possible.

I requested for my cashless claim on 14/September/2016. Every day the hospital is receiving query. My surgery was planned for 21/Sep/2016. But due to delay in approval my surgery got postponed. It is difficult for me to understand why every day a new query is generated? When I approached the customer care, they say like "this is the last query and your will receive approval by end of day" but again a new query comes. The process is highly frustrating. Every day I have to call to customer care and have to complain again again for my cashless request.

Dear Team,

I have applied my wife Mediclaim from your company worth amt Rs 10417/-only . but i have received credit only amt rs 5567/- rest amount is not payable by u. I have seen the reason for the same in my portal which is mentioned below. But the same is not a valid reason because the hospital from where my wife was operated there was not any sharing rooms. So that's why they charged from us single room charges. So, you are requested to please settle my full amt for the same as on urgent basis.

I also want to inform you that the charges which was charged by the hospital is very lower side as compare to the other private hospital.

So, Please process my full claim amt as on urgent basis.

Reason -

Non payable amount: Rs.4, 850/-

Reason: 220/- PROMOLAC PEDR, 290/- LACTOGEN PWDR.180/- V WASH, 450/-BIO OIL.110/- BETADIN SCRUB, 5/- INJ.VIT K, 30/-DETTOL, 450/- COTTON ROLL, 50/-+66+47/-BABY DROPS, 100/- BETADIN DROPS.BABY DROPS.PAYABLE AS PER TWIN SHARING ROOM.4156:23/08/2016:Rs. 650/- Not claimed by the claimant.6039:20/08/2016:Rs. 200/- admission charges.TWICELY COUNTED

Regards
navjot singh
Axis bank Ltd
[protected]

I had submitted a claim for surgery expenses around 1 months ago, since then they are delaying the process with any stupid reasons and asking for the same documents again and again.

I have submitted all the relevant documents . Medi assist raised a ticket but no further action has been taken .

Ticket number :- 550517

I am HPE employee and I have been advised to send email to " Swagat Patnaik " for any complain or updates but even he is not responding . I sent couple of emails to him .

Sorry but I am very disappointed with poor response from MediAssist team .

Hopefully after this complain some one action this case asap.