Medi Assist India Complaints & Reviews

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.

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)