Medi Assist India Complaints & Reviews

Name of company/service: New India Assurance Company – TPA , MediAssist India Pvt. Ltd- Mediclaim Policy

Dear Sir/ Madam,
I have one Mediclaim policy with New India Assurance Company, the polcy no. is[protected] and TPA Ref . No. 2302939. My wife was hospitalised due to Ectopic Pragnancy. The Total Claim is Rs.70000/- .We have Submitted the claim as per their rule to MediAssist India Pvt.Ltd, at Andheri Office. After one weak they replied us that your claim was rejected due to clause no. 4.3.

But as per New India Assurance Company`s Clause No. 4.4.13 says that “Treatment arising from or traceable to pregnancy, childbirth,miscarriage, abortion or complications of any of these including caesarean section , except abdominal operation for extra uterine pragnancy (Ectopic Pragnancy) which is proved by submission o[censored]ltra Sonographic Report and Certification by Gynecologist that it is life threatening ”

If there is clause no 4.4.13 is available regarding to this disease, then How TPA rejected the above claim ? Please lodge my complaint and give me good judgement. My mobile no is [protected]

Hello
I am having Reliance Healthwise policy on my name. On 21st May Cashless facility was requested from a network hospital (Metas Adventist Hospital, Surat) of TPA i.e. Medi assist and it was rejected with a reason that Room Charges are high, but a question arises when Insurance Company’s policy has given a feature that there is no caption on room charges than how can TPA question or reject on that basis. Secondly Medi Assist TPA is not giving any services to hospitals or Individuals as major hospitals in Surat are denying to offer Cashless facility from this TPA even after they are in List of Network Hospital of TPA and Insurance Company because their old dues are still pending. TPA Customer care number is not responding or it’s always busy; even if it gets connected it’s on IVR which is very less helpful in case of emergency. Thirdly When I called at Reliance General Insurance customer care they also didn’t take a complaint against TPA and told they can’t do anything in regards to TPA working. I want to ask who has selected the TPA and whose responsibility it is to handle TPA, Customer or Insurance Company. I talked to XXX and she was not ready to take complaint, and told me TPA decision is final. I would like to suggest to think twice before taking any Medi claim who is offering Medi Assist India TPA Pvt Ltd as TPA.

Thanks

I am employee of Future generali india life insurance company ltd.I have group medical policy of National insurance co. Through the Mediassist india company ltd.I have submit my father claim to them just after 37 days .They said we have 30 days TAT to submit the claim & I have request them I have reason for delay submission as My father was admitted in other hospital & due to serious condition we have to consalted to different doctors,I have proff of this,
But they have decline the claim,Now pl suggest how I can get my claim,
Contact no.-[protected]

I am tata consultancy employee ans my mediassist employee code is 328488. Domiciliary Claim Details reimbursement claim is pending since december 2010. The medi assist is not receiving any calls for the enquiry. the matter couldnot be clarified by the helpline and have expressed their helplessness...
its too irritating to call them again and again. The clain status is settled on the mediassist site but not received a single penny yet. attaching the screen shot ..plz look into the matter..

Regarding insurance claim of policy number #721200/34/10/01/00200137
Reference No: CCN#6183646
We had made claim for the hysterectomy surgery and provided all the requisite documents to Mediassist Coimbatore. They were seeking for details which the hospital authorities denied to provide. The Mediassist of Coimbatore repeatedly asked us to provide minute details which could not be provided by the hospital authorities. This attitude and distrust which the Mediassist shows on its customers has made us realise that we made a grave mistake in taking up this insurance policy.We had sent a letter asking for return of all documents provided so that we may take this matter with appropriate authorities/ channels.We have not received any reply from them so far.We request you to take up this matter at the earliest.

My wife had gone under surgerry for "Dermoid Cyst Removal" because of pain in her stomatch, the claim has been filed for "Dermoid Cyst Removal" and the Insurance agency unreasonably relating the case with infertility. I request you to check this case with experts; and reminding again that this treatment is only done for Dermoid Cyst Removal. I am asking for the expenses for the same.


I have sent many mails to Medi Assist but they are deniying the case and relatin it to infertility treatment. the claim number and details are:
Reg # :MA-[protected]- CCN : GRV140/2955/2011 CCN 5947978

https://www.mediassistindia.com/index.html

I have enough mails for suport, if required.

I am the Permanent employee of HCL Tech. Ltd. Gurgon location, we have medical insurence facility provide by HCL with Medi Assist india Pvt. Ltd. every month my salary is deducted depend on the dependented specified in My HCL. so far around two years of my exp. with HCL, I never submit even single bill by the god is grace, around six month ago My father had accident with bike and he admitted in CMC Hospital Hissar, For claim this bill bill I have submitted all the details along with orginial bill, than after sometime they asked me some other doc. I also submitted the same. but still there is no responce, they say that the bill is rejected. so Please can you help me for my justic.

Regards
Krishana

i wanted to lodge a complaint against very poor service of medi assist india pvt. ltd, TPA to Reliance general insurance. my claim id is 5879862 and the same was submitted to them in april, 2011. after various correspondance, i replied to all their queries and submitted the desired documents to them in august. so far they have not cleared my reimbursement account and repeated calls to their mumbai office have failed to speed up the reimbursement process. kolkata office is transferrring the blame on mumbai office and mumbai office is not clear as to why the delay is taking place.

From :
Mrs. N Parvathamma
C/o. Mr. R Umesh
215/3, Sampige Road,
Malleshwaram,
Bangalore - 560 003.


Ref : Claim no. : 5914438
Policy : 671601/34/10/11/00000324

With reference to the above, we had submitted the Hospital bills Rs.6080/- for the reimbursement, on this we had received only 5280/- the balance amount Rs.800/- is not taken in to the account and it is said that non admissible reason. if you wanted the lab charges report you would have asked us, you had had the address, Mobile No. But, directly you are not taken into account.

Kindly re-imburss the balance Rs.800/- as soon as possible.

sir,
My name is md salam, employee in zee 24 gantalu news channel in hyderabad, i have reliance health policy, third party is mediassist , no is, [protected]. I was claimed my mother operation money at four months ago, and submitted needful certificates also, my claim no is, 5765135 . Till now i did not get any money, several times i had enquired & approached to them but they did not responding.
Please do favor...
Thanque...

From : Mitesh B. Bhatt
C-1/5,Mahavirnagar Appt
Nr. Hariomnagar Bus Stop
Opp.Subhanpura Water Tank
Atmajyoti Ashram Road
Vadodara- 390023
Dated:3/5/2011
To,
The Manager
Medi Assist India Pvt Ltd
701, Kaivanna Building
Beside Ahmedabad Central Mall
Nr. Panchavati Circle
Ellisbridge, Ahmedabad – 380 006

Sub : Medical Reimbursement Claim – to be reviewed and reopened.
Ref : 1. Policy No : [protected]
2. Claim No: 5780041
3 Email dated :[protected]Copy attached)
Sir,

I was surprised to get an email mentioned above, rejecting my claim for the re-imbursement of the medical expenses incurred towards the treatment of my wife Mrs. Naimesha M. Bhatt. I was not formally informed by TPA or Reliance General Insurance Company till today. It is because of my follow up and perusal I could get the e-mail stated above.

I understand that my claim which is very genuine and original has been rejected on the basis of “False Statement” and “Duty of Disclosure” as per personal investigation and report by Dr. Bimal Desai of your Company.

I had taken my wife to Chandan Hospital. Vadodara on 1/2/2011 and she was diagnosed and treated by the Dr. Prakash M. Shah on an OPD basis. We were also not prepared to immediately admit at the Hospital (when told to do so) as it was not anticipated even though Doctor advised. However, after taking the Preliminary Medicines and treatment on OPD basis on 1-2-2011 as advised by Doctor of Chandan Hospital, Vadodara, I admitted my wife to the hospital the very next day i.e. on 2-2-2011 and treatment continued upto[protected]. It may be noted that my wife Mrs. Naimisha M. Bhatt was is an ordinary citizen who does not understand any medical terminology and do not have any medical knowledge. When she was asked the questions as the part of the investigation by Dr. Bimal Desai, my wife stated the reason for weakness due to Viral Hepiatities with Jaundice which was diagnosed by Dr. Prakash M. Shah, M.D Physician, Vadodara After investigation, Dr. Desai asked for indoor case paper (ICP) and job attendance certificate from the organization where my wife is serving. These documents and certificates were sent to Dr. Desai by Registered Post.

“Normally any patient, who may be very serious would not have prepared to admit the hospital immediately on advice, as they would not have mentally and financially prepared for the same. This is a natural fact which a common man can understand. However, on the basis this reason the company has straight away rejected my claim for reimbursement which is not prudent and against the natural justice. Please note that I have not claimed any bill for the treatment incurred on 1-2-2011. (Doctor’s Clarification Certificate is Enclosed).

I enclose the Clarification certificate issued by Dr. Prakash M. Shah, M.D General Physician, Chandan Hospital & ICU, Vadodara for your ready reference after getting the information that my claim for sanction has been rejected through the Email on[protected] based on the investigations and report by Dr. Bimal Desai. I have personally collected the report from Branch Manager, Reliance Insurance Company, Vadodara on 2-5-2011.

On the basis of the certificate issued by the Doctor and on the basis of the above stated facts, I once again request you to re-open my case and sanction the reimbursement amount with immediate effect.

Your immediate action is anticipated failing which I will be forced to take legal action against you.
Yours Faithfully

(Mitesh Bhatt)

Encl :1. Copy of Clarification Certificate by the Dr. Prakash M. Shah.
2. Email Copy of inability to admit liability
3. Report Copy of Dr. Bimal Desai

Copy f.w.cs to :
1. The Branch Manager
Reliance General Insurance
Vadodara

2. The Officer
Medi Assis India TPS Pvt. Ltd
Bangalore

My wife undergone for piles surgery the name of the sugery is called cryosurgery,in nov 2009 at apoorva dianostic centre in indiranagar, it is a 10 bedded day care centre with minor sugeries takes place.in the month of nov 2009.
I submiited the documents for claim on 30-11-09.they replied ur claim is not done due to minimum requirements of the said hospital.in the same hospital one of known person's wife undergone for same case in same hospital there claim was settled.i dont know why they did like this in my case.the people will loose the faith in insurance especially in health matters.no body is there to take action on them ...at last i came to know that, if we file a complaint in this site they will take action on them.i hope so it will be solved as soon as possible and help the needy peolple..
thanking u chandrakumar

Hi,
DS for babby is also included with Mother DS, but mediassist is not accpting same DS for both Mother and Babby.
At the time of delivery they can provide single summary for Both Babby and Mother. But i dont know why it is not accepting by Mediassist.
Now they are intrested in giving cliams for Babby and also they are not sending back my Orginial Bills and Lab reports.

So please think before submiiting the documents in Mediassist.

Regards,
Rajesh

I have been a customer for Medi Assist India from past 5 years because of my employer. I have faced lot of problems in submitting the claims to Medi Assist India, the web site https://www.mediassistindia.net/Claims/WebClaimer/Login.jsp doesn't work most of the times. It looks like or indirectly they are avioding the customers to submit claims.

Hi,

I have submitted a total claim amount of 6695 out of that I received only 2100/-

with following breakup:
1. 2100 -- got claimed
2. 2500 -- CoPay
3. 2095 -- No Bill Available

Inspite of submitting all original bills to Medi Assist they are saying that bill are not submitted for Rs. 2095/-

This is a clear cheating case and avoiding to pay claimed amount.

I have submitted bills (2095 bills)
1. 1260/- Piramal Diagnostics Receipt no.[protected]
2. 400/- Biopsy Tests bills
3. Rest medical bills

My Claim Ref No. 1805959 Date:20 Nov 2010, Company: ITC Infotech

Please think before going for Medi Assist (Cheaters....)

GRV120/1102/2010

ITC Infotech India Ltd

ITC Infotech Park, No 18, Banaswadi Main

Pulkeshi Nagar Post

Bangalore

560005


WITHOUT PREJUDICE
Date:[protected]>


Dear Sir/Madam,

Re:Our Claim No: 1632276 Under Policy No: 431301/48/2010/1340
Policy Holder: ITC Infotech India Ltd Beneficiary: Nabin Ch Maji
Claim Amount: Rs. 44250/- DOA: 23/12/2009 -DOD: 25/12/2009
Hospital Name:NETAJI SUBHASH CHANDRA BOSE CANCER RESEARCH INSTITUTE City Kolkata
AilmentName: case of multiple liver lesions


We refer to your letter dated[protected]in the above connection.

This claim pertains to the treatment of case of multiple liver lesions at NETAJI SUBHASH CHANDRA BOSE CANCER RESEARCH INSTITUTE from 23/12/2009 to 25/12/2009 for the claim amount Rs.44250/- .

We have had a review of the documents by a panel of experts,and as per their opinion, we regret that we are unable to consider your claim for settlement.
The reason(s) are as follows:

AS per discharge summary the insured is admitted to hospital for pain abdomen. As per records it is noticed that Only Investigations done with out any active line of treatment during the period of hospitalization.on verification of indoor case papers it is noted only oral medication advised during admission period and no such related treatment has been done to the patient for which he has been admitted. Instead of basic investigations patient has been directly taken for PETSCAN ( whole body scan) and a small excision of mole over right cheek has been done under local anesthesia. This PETCT Investigations can be done on OPD basis and the diagnosis and treatment given does not co-relate. Patient also claims for the medicine purchased during post hospitilisation period in which major expenses are rendered for protein powder.The treatment is at a hospital which does not confirm to requirements of policy condition .Hence claim stands repudiated under the Op Clause and 4.10 of the policy. We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.

In view of the above facts, we regret that we would not be in a position to consider your request for review of the claim and the claim remains inadmissible for settlement.
We also reserve the right to repudiate the claim under any other ground/s subsequently available to us.The Insured person shall have right to appeal to the Insurance Company if not satisfied with the decision of the TPA.

Thanking You,

Yours faithfully,
For Medi Assist India TPA Pvt. Ltd.

CC:Oriental Insurance Co. Ltd.
CBO-7 HYD,IST FLOOR, JAIN ESTATE, OPP:NANKING RESTAURENT,PARKLANE
Secunderabad-


Medi Assist India TPA Pvt. Ltd. #49, 1 st Main Road, Sarakki Indl Layout, 3rd Stage, J.P.Nagar, Banglore-560 078


=======================================
Response to point numbers as indicated/ marked in the Redenial Letter

(1) “..no such related treatment ..’; “.. diagnosis and treatment does not co-relate” :
Response: In accordance to the requirement perceived by the attending doctor at that point of time, admission and supportive care was undertaken for three days. The patient was not in good condition to be able to receive any chemotherapy drugs. Since, the doctor would not give any treatment in excess to the appropriate requirement perceived at that point of time. Thus supportive care taken for these three days, was in fact "active treatment" as perceived by the attending doctor (Dr. R Pandey, MD in Medical Oncology), in order to rejuvenate the health of the patient. Subsequently oral chemotherapy tablets (capecitabine 500mg) have been prescribed, but since they were prescribed, after & outside the duration of admission, I did not submit their bills. Do let me know if these bills are also admissible, then I would submit the same.

(2) “Only investigation done … Instead of basic investigations patient has been directly taken for PETSCAN” :
Response: Preliminary investigations were done on the days previous to the admission, i.e. outside the duration of admission, thus not claimable, hence not submitted along with the claim. USG whole abdomen & Liver Function Test (LFT) were done two days before admission, at SSKM Hospital, Kolkata. Report attached herein.
(3) “The treatment is at a hospital which does not confirm to requirements of policy condition.” :
A case of multiple liver lesions, diagnosed to be malignant in nature, with unknown primary, admitted at an institute dealing exclusively with such cases only. Treatment under a doctor who is an MD in Medical Oncology. There is no disparity or mismatch in the profile of the patient and the treating institute.



Date-wise sequence of events

DATE Place Activity
18.12.2009 “Doctor’s Chamber”, Bansdroni Visited Consultant General Practitioner, for acute abdomen pain. Advised USG abdomen, LFT, and blood tests
21.12.2009 SSKM Hospital Conducted blood tests, LFT and USG abdomen. Tests “allowed free” through a reference MO.
21.12.2009 “Doctor’s Chamber”, Bansdroni Visited Consultant General Practitioner with test reports. Referred to NSC Bose Cancer Research Institute.
23.12.2009 SSKM Hospital Visited SSKM Hospital for second opinion. Referred to oncology & radiotherapy department
23.12.2009
To
25.12.2009 NSC Bose Cancer Research Institute Visited Dr. R. Pandey, MD (Medical Oncology) at NSC Bose Cancer Research Institute. Got admitted for further investigation and treatment.

Name: SANDIP K MAJI
phone: [protected]
email: sandip.[protected]@itcinfotech.com
=============================

medi assist is f#@k all company. m using these words bcoz they hv cross the limits. its been 2 months m struggling to get the claim money. hv send all the necessary documents though they ll ask sumthing or the other. doctors panel in this company are genious who r good $$$$ nothing. they send sumbody else letter of the same name to me and asking us to revert where as the patient doesnt hv dat problem. hv gone hosp. for getting the stamp signature or for sum report endless time. i dont knw wether this complain will help or not. plzz do sumthing

Dear Team,
My self Shraddhanand Nikam,
working with Mediassisit india PVT ltd for more than 2 Yrs(2007 to 2009),I left the organisation in Dec 2009 and applied for PF withdrawal in May 2009.But I have resubmitted new form in Aug 2010 because wrong form was submitted initially.
Pls let me know how many days it will took to process this procedure.
Its really my urgency to have money.
Pls do it on priority basis to help me out from my financial crises.

Thanking You.
Shraddhanand

I PURCHASE A MEDICLAIM POLICY OF NATIONAL INSURANCE CO THROUGH FUTURE HEALTHCARE.POLICY NO-354900/46/09/[protected].AS PER POLICY BENIFITS I CAN TAKE 10% BENIFIT OF SUM ASSURED AT ATIME OF MATRNITY.ON 4 JAN 2010 MY WIFE ADMIT IN ASOK HOSPITAL KRISHNA NAGAR DELHI-110051.TPA MEDI ASSIST TELL ME THAT YOUR CASH LESS IS APPROVED BUT HOSPITAL MANAGEMENT DENAI.HOSPITAL CHARGED ALL BILL PAYMENT FROM ME AND HE DID NOT GIVE ME ANY DOCUMENTS RELATED TREATMENT.I DOUBT THAT HOSPITAL CHEAT TPA AND ALSO ME.SO I REQ TO TPA MANY TIME FOR STATUS OF CLAIM BUT TPA MEDI ASSIST IS NOT INTERESTED IN REPLY.SO I THINK SO THAT HOSPITAL MANAGMENT AND TPA ARE BOTH EQUAL IN CHEATING.THERE ARE NOT ANY AGENCY WHO CAN HELP ME IN PROVIDE CLAIM AND STOPING IN CHEATING OF TPA AND HOSPITAL.

I had applied for mediclaim reimbursement. I had submitted my claim in month of July 2010. It now almost 2 months but the claim is still not processed. Previously they use to say we haven’t got any info from your company we have demanded some data of your from your company. Now in last week when I give a call they give false commitment 'I am still looking for the updates call after 15 min’. In a day I called almost more than 15 times. Finally I have been committed that my claim will be processed by Wednesday (15/slept/2010).

Nor does their representative Amit ([protected]) answer the call nor does I get proper updates from Laxmi ([protected]). Finally their boss don’t know name have his cell number ([protected]) has committed me that my claim will be process by Wednesday (15/slept/2010). It’s really pathetic to know that Meddi Assist is so bad at commitment and providing services to their clients. They are very bad at follow-up of claim. Each one different person picks up phone and no one has proper updates. Once I had dropped a mail from their website but no action was taken. It’s really a fact that Meddi Assist has a very poor service .