Medi Assist India Complaints & Reviews

Hi Team,

This is RamBabu Tadiboyina,


Claim No: 12086187 &[protected] same claim)


Subject: Mediassist closed my claim due to previous year claim with un professional way.


Now iam explaining you what i have faced issues by Mediassist.

I have couriered all the docs in the month of October 2015, In November they requested few more additional docs like indoor case sheet and prescriptions and i have submitted those docs in December 2015. Actually in my hospital, doctor not maintained any indoor case papers, the same also doctor stated in his letter pad clearly, and that doc i have sent in December. The same now i attached in this mail as Witness.

After wasting of 2 months time period they requested again indoor case papers i.e in February 2016.

Due to doctor non availability i have submitted docs in May 2016, in meantime i regularly communicated mediassist by customer care and raised queries in mediassist portal. They have given assurance like " no need to worry when ever doctor came, please submit those docs along with statement given by doctor of late reasons " i got these replies from them, still i have proofs of that attached in this mail PFA.

But in May, they closed my claim.


Iam not happy with decision by mediassist, i felt its completely cheating. Before it self they have given assurance after submission of docs they have closed my claim with reason of last year claim. Doctor went to USA in that scenario what should i do?? i informed the same and got assurance but later cheated by mediassist.
If it comes under last year claim reason to cheat candidate then why are you not informed me? if yes please show me proof?

In claim form also every doc mentioned but indoor case papers not mentioned. If doctor not provided what should i do? he given statement why he is not provided case sheet? then why not considered mediassist? and later i have submitted indoor case papers this time why told reason as last year with out processing??

Even i have given doctor contact no also for assistance. why that is not considered??

For investigation also they have taken 3 months time period< in this scenario who wasted time? In investigation report also completely blunder. my hospital is sri krishna hospital, tenali, guntur dist but in report mentioned as sree raja raghavendra nursing home, pulivendula, kadapa dist...Please find this proof i have attached in this mail. Its completely blunder and irresponsible. I requested many times to correct this but still they did not. even investigator provided false information. only once he visited hospital and doctor busy with his work told wait for 30 min . but he went. but investigator provided he visited frequently and doctor not cooperated


Iam not happy with mediassist, i completely felt its a fraud company. i found them as defaulters.

Now iam planning to take action against them either by accenture or IRDA Grievence or Consumer court or legal action. I had each and every proof.


Please find all proofs attached in this mail.

Please resolve ASAP.


Regards,
Rambabu Tadiboyina
[protected]
[protected]

Subject : regarding the payment of mediclaim of mrs. madhurisrivastava, maid-[protected] dated[protected]. of rs.62, 621.00

Refer : your ccn[protected] under policy no. 221504/28/14/p-1/04957877

Dear sir,

I undergone my surgical operation for “total knee joint replacement b/l” done between[protected] to[protected] at primus hospital.

I am also vovered under cghs.
The primus...

I have submitted my claim with claim id 12522673 covering pre and post hospitalization expenses along with the hospital discharge summary with hospital stamp. I have send all the documents i the month of April 2016 ; tpa has received the same.

But whenever i verified for the status, i am getting the information that it is in progress and i has submit all documents i.e bills, discharge reports, all reports and bank details, but against they are raise quarry for submisstion of reports again and again, .

Now it is nearing a 3 month; no reply for the reminder mails. I tried with the help line also; result is the same.

Please be informed that i hold a corporate insurance from medi assist india and its details are as follows:
Name: sitesh kumar padhy
Medi assist id: [protected]
Claim no.: 12609663

I had opted for a non-network hospital of medi assist india as my wife expecting a child on 09.04.2016. As per the procedure i had submitted all the relevant documents for reimbursement claim purpose through our corporate office at kolkata which was received by medi assist india on 30.04.2016. On 16.05.2016 i received a mail from them stating that the discharge summary submitted my me does not include the admission & discharge date of the patient and they asked me to submit a proper one. However i managed to obtain another rectified copy of the same from the hospital and submitted it to medi assist india through our corporate office once again which was collected by one of their officials on 27.05.2016.

Since then i have been regularly following up with them and every time i raise
A query regarding my claim status, they come up with the same reply that i need to submit the proper discharge summary which was in fact already submitted as mention above. I have already written more than 10 mails to them regarding the same and it has been over a month since i have submitted those documents but there is still no progress on this matter yet.

I am pretty much harassed by the way medi assist india is handling this matter as they seem to be totally unprofessional. Now it feels like my words have been falling in deaf ears all this while.

Hence i would request you to kindly intervene in this matter and do the needful so as to arrange to settle my claim at the earliest.

Regards,

Sitesh kumar padhy

CCN# 12698573

I had done my LASIK surgery on 15/04/2016, i had informed them 07 days prior that i am undergoing this surgery.

After 15 days and several follow-ups they sent their CLAIM FORM which needs to be filled online. The whole summary was given to them including the surgery details.

After which I was told to courier the documents to them. I couriered all the originals to them after which i got second email mentioning the query and the letter of explanation for delay.

I sent the hard copy to them after which they told me that the back end team is working on it for more that 20 days.

And they replay saying it is not covered hence the claim has been declined.

Medi assist is the most pathetic tpa i've ever seen!!!


I have summited my claim no.12568962 documents in the month of apr 20th 2016, till the date they are giving me only assurance to sattle this in in next 3 working days, but till date it's not slatted, i will take a legal action against it.. Can you please sattle this matter within week.. Either i will sent you a legal notice on 21st june.

Thanks,
Sunil nayak

I have submitted my claim with claim id 92336593 covering pre and post hospitalization expenses along with the hospital claim. I have send all the documents on 8th may 2016; tpa has received the same on 10th june.
But whenever i verified for the status, i am getting the information that it is in progress.

Now it is nearing a month; no reply for the reminder mails. I tried with the help line also; result is the same.

Being a elderly person, i am coming to the conclusion that thetpa is trying to discourage people for submitting the hospital bills.

In such case the insurer should not recommend the tpa for the settlement of claims.

Further the policy should incorporate the clause, that the claim will be settled as when they like; or will not be settled at all.

I hope that the grievance from a elderly person like me will be taken care.

Further people go to hospital only to get rid of the illness; not for sending the claims.
The health insurer has the responsibility to see that the tpa is doing their work properly; they should wash their hands assuming that tpa
Has been with the task of settling the claims.

Hope that a early action will be highly appreciated.

In spite of this complaint, if there is no action, then the matter will be referred to the ombudsmen for further action.
Thanking you,

Ramdoss

Sir, am a medical policy holder of reliance life insurance, policy number bearing : 52342894, client i'd: 92893973. My son abhinav manu admitted on 31st may at bishop benziger hospital, kollam.. Despite of the repeated mails from the hospital authorities, till now no steps had taken from the med assist for the cashless procedure.. As the discharge date was 6th june. Pls look in to the matter...

We bought two oriental bank mediclaim policies which starts from 29th jan, 2016. Details are given below...
Name om parkash batra
Policyno 233300/48/2016/5427
Address 189-a, kamla avenue
Fatehgarh churian road
Amritsar (Punjab) 143001
Email [protected]@gmail.com
Mobileno [protected]


Name sonia batra
Policyno 233300/48/2016/5428
Address 189-a, kamla avenue
Fatehgarh churian road
Amritsar (Punjab) 143001
Email [protected]@gmail.com
Mobileno [protected]
Please send us cards as early as you can.

My wife underwent a surgery in a hospital. When she got admitted which were available was with a room rent of 5500 INR per day. She we had no other options we took knowingly that room rent claim will be only 1000 INR per day. After 4 days of stay post surgery when she got discharged the total bill came to 72, 221. To our surprise we got a claim for only 18, 806. Many charges such as LAB Charges, OT Charges, Consultation, Surgery charges are deducted drastically with reason stating "Claimant opted higher room rent than the eligible category, Hence Lab Charge are Proportionately deducted as per proportion as admissible rate per day ( as per policy clause 3.1. (a) – 3.1 (d) ". This is a misleading clause and how can one link higher room rent charges to LAB, Surgery. OT etc. This is cheating. Many o[censored]s are aware only about the room rent slab. But how can one line higher room rent with other charges. Nothing is highlighted when we take a policy. Morethan that Mediassist does not support cashless claim in many hospitals. I do not know about other TPA.

My medical claim is under of mediassist. After 4-5 months they given me some money. When I communicated with them regarding deducted money they told me that I need to collect all original bills.Within 20 days I collected all original bills and want to submit but Krishna told me that my claim was closed by insurer.

My discussion is that why they told me to collect original bills and they should be informed me about my claim close date.

Last two months everyday I communicated with them regarding my claim but they always deny to reopen my claim.

Really bad experience with mediassist. They closed my claim without informing me.

We have cleared all the documents as per Policy But Claim has not been approved by company and giving back unnecessary Remarks which already resolved multiple times earlier. This company is not taking any responsibility against my Issue and rounding Me every time. I have decided sue against my policy Conditions . kindly guide me to resolve it .or provide any similar options for same. do the needful. This is the second reminder to u too .

One of the worst consumer service ever been gone through, even after requesting from last 24 hrs.for the work to be done in 3-4 hrs.
i wanted discharge final bill approval, for my sisiter has she was admitted for urgent operation, and then needed discharge willingly, from medi assit, for which i kept on calling from 27th may 4:30 afternoon till 28th may, 6:00pm evening, i wanted the discharge as 29th was sunday, and they kept me lying that the work is under investigation and will be solved in next one hour.even the branch manager... if they would have informed me in the morning that the work will not be done in the morning it self, i would have arranged money from somewhere...
i m gonna file complaint against them in consumer court. I have all the call detail;s..each and every people reciving call in their customer care service are useless and helpless.

Hi,

i am very disappointed with the services, would it be the time taken and the kind of question being asked and the kind of effort medi assist took to process my claim. i am not sure why Hemalatha M, who is such an unprofessional is handling the corporate queries inlcuding her response to customer as "who needs money, it is is you (customer).

please confirm why there has been partial payment despite the requested documents been provided as requested and confirmed as valid by the medi assist.

To
The manager
Medi assist india


Sub: partial approval of claim no. 12502972

Ref: cashless claim no. 12427766 & 12598515

Dear sir/madam

I am submitting my complain about denial of approval of crohn’s disease related expenses during hospitalization claim no. 12502972

I have submitted a claim of rs. 28, 766/- on dated 05.04.2016. And against this claim i have received only rs. 950/- on 06.05.2016 (Neft no.[protected]joz1912)

In explanation there was a list of non-medical expenses which includes tooth brush, hand rub etc. As not payable. This is quite justified.

But with my utter surprise this list includes all pathology, biochemistry tests and ct whole abdomain during hospitalization.In the discharge summary dated 22.03.2016 final diagnosis it is clearly expressed 1) left tubercular pleural effusion, 2) crohn’s disease. And patient (Dr. Suva hom roy) was admitted under gastroenterologist dr. Sanjay banerjee. He even got no phone of query from you about admission & treatment details and you final denial decision own accord by speculation; (Cashless claim no.[protected]

Again my patient admitted in ils hospital on 26.4.2016 & discharge on 28.04.2016 and final diagnosis is crohn’s disease. Against claim no. 12598515 you approved rs. 14840/- against claimed rs. 15961/-

So, why your denial reasons “crohn’s disease related expenses np” in claim no. 12502972

In that situation i request you to review my claim no. 12502972 and please re-consider a justified approval for it.

Thanking you

Susmita hom roy (Paul)
P. No. 311700/48/2016/9989

Patient name : dr. Suva hom roy
Mid no. [protected]

My policy no [protected]p10146649 i have submitted the claim on 15th april 2016 and additional details as required have been couriered. i have sent mail of my courier sent on[protected] receipt no and also receipt documents duly stamped and sign of delivery of courier at medi. still you people are not acknowledging the receipt of documents instead of talking to so many persons and giving of so many mails no action is taken and our claim is not settled . we can not expect such things from medi assist. there should be some one to attend and respond . your people only listen and forget . they do not take any action they do not enquare why additional document sent is not taken on record pl do something otherwise i will complain to other higher authorities.. tel no [protected]

Sir/Madem,
I Vshnu dutt apply for claim but i didnot recieve the calim against incident .I have medi insurence through you. I submitted all of documnet many time through speed post . documnet recieved by company. i hospitalised from 20/09/2015 to 25/09/2015.claim amount is 35311 only that is not issued by you.this is last effort making by me other wise i will go to court.
thanks
Vishnu Dutt s/o Deen Dayal Sharma
reference no .[protected]
policy number - 242308/48/2015/48
MAID : [protected]

Forwarded message —
From: walter rodgers
To: hal
Sent: saturday, 7 may 2016 4:55 pm
Subject: claim not yet settelled

Respected sir
Me mrs. E. R. Rodgers is spouse of ex employ of hal hindustan aeronautics ltd nasik maharashtra
I have posted my doctors prescription and bills amounting rs. 3499/- on 09/03/2016 by indian speed post pod no. Em[protected]in.
To
Medi assist india tpa pvt ltd
Tower d (Hal team) 4th floor ibc knowledge
Park 4 bar 1, opp:- dairy circle fire station
Bannerghatta road, bengaluru - 560029
Board : +[protected]
Email : [protected]@mediassistindia.com
Website :www.mediassistindia.com

But none of your officials are co-operating with us my maid number is [protected]
My husbands ex permanent batch number was 4387
Bank of maharashtra
Nasik road branch
A/c no. [protected]
Ifsc code. Mahb0000123

My address is

Mr. R. W. Rodgers
Flat-51, 4th floor, d' wing, anand vijay sankul,
Opp:- st. Anns church & bishop house,
Central jail road, nasik road, nasik, -422 101
State:- maharashtra
(M) [protected], [protected].
Email id:- [protected]@yahoo.com

Please co-operate


Yours sincerely
Mrs. E. R. Rodgers

R s kannan ex. Staff no. 14429 canara bank medi assist india pvt. Ltd., bangalore
Claim ref no. 12459670 ack no. [protected] dt.25.3.2016.
I have submitted a claim for rs. 19465/ for hospitalisation. I was under
Hypertension problem because of that left nose blood bleeding was there. I have consulted nearby residence doctor and then ent specialist. It has not been stopped and hence he has recommended to admit in madras ent research foundation, raja annamalaipuram chennai . As per the doctoer advice i have consulted the doctor and i had treatment., it was not stopped and then i was admitted in the hospital on 8.3.2016 at5 4 pm and discharged on 9.3.2016 at 6pm. Only after stoppage of bleeding of blood in my left nose i was discharged. In the history it was mentioned as hypertension and because of that nose blood bleeding was there.
I have submitted the bills to medi assist india pvt. Ltd., bangalore and i t has
Been rejected by them fror the reason that the hospitalisation is not necessary for that treatment. Please note that hospitalisation should be
Decided by the doctor and not by the insurance company. It is clear in the
Bank circular that under item no. 13 hypertension treatment is also available
For hospitalisation and also domicilary treatment. I have been denied the
Same by medi assist india pvt. Ltd., hence it is due to negligence of staff it has happened. Hence my genuine claim should be sanctioned immediately.
I have tgaken policy under united india insurance iba medical care and the
Bank has directly debited in my account.
Report by r s kannan

Claim : 12414354
Maid : [protected]
We have intimated about surgery in one week advance. Documents submitted within 10 days of discharge.
Even they have not approved the claim by saying non receipt of intimation. Neither they replied on mail nor customer care number picked up.
We have sent the require documents again by courier which was reached to mediassist, bangalore office on 29th april but no acknowledgement.