Medi Assist India Complaints & Reviews

Dear Sir/Ma'am,
this is a complaint letter against MediAssist India Pvt. Ltd, a TPA Insurance company located in Andheri East, Mumbai.
Myself, Kanhaiya Maheshwary, underwent a surgery for Pilonidal Sinus on 30th April, 2013 at CritiCare Mutli Speciality Hospital, Juhu, Andheri West, Mumbai. A few days before the surgery, I had intimated the above mentioned insurance company with which I hold a MediClaim policy.
The officials from the above mentioned insurance company even visited the hospital to confirm all the details.

After my surgery, I submitted all my original documents and claimed for reimbursement. However, a week after filing the insurance claim, I received an email stating that my claim has been rejected since there's a waiting period for the condition for which I've been operated.
So here's my first question - If I had intimated the insurance company prior to my operation, why didn't they inform me that I cannot file a claim for the above mentioned condition?

Secondly, I had submitted a withdrawal claim in order to get back all the original hospital bills and documents since I have another mediclaim policy under which I want to claim. I had filed the withdrawal on 20th June, 2013 and was informed that I will receive my file within 8 days. It has been 15 days since then, and there's no answer from their side.
1. I call daily, but am informed that the file hasn't come.
2. Whenever I call, the executives cut the call even without listening to me.
3. The executives informed me that the file has been dumped in the godown. If the file is supposed to be given back to me, why is it dumped in the godown!?

My time for filing the claim under the second insurance policy is running out, and If I'm not able to submit my original papers in time, I will incur a loss of almost Rs. 50,000. All this will be due to the negligence by MediAssist India Pvt. Ltd.

And here are my details:
1. Claim Number: 2794442
2. Policy No. 131300/48/2013/19731

Also. Attaching herewith a screenshot copy of the email I had sent to MediAssist India for withdrawing my original documents.

- Kanhaiya Maheshwary

I have a corporate Mediclaim policy with MediManage(Mediassist) team, recently my father age 69yrs was diagnosed with Prostrate issue and after a months time he was suggested to undergo a Laser treatment. Now i had been suggested to go S.L.raheja hospital where they told me around 1.85L approx cost.
Since they have a Cashless benefit i spoke to Medimanage team on how to proceed since it takes time for approval and also we have a 20%...

Ive a terribly bad experience with Medi Assist which is supposed to be the worst company Ive even dealt with. Completely Unethical & unresponsive. They make your suffereings even worst when you needed them the most. This is in regard to my Medi assist no. [protected]. They took 48 hours of time wasting on undue queries & ultimately rejecting it on baseless reasons. Due to this I was not even able to avail my other insurence.
.

I had raised two domiciliary claims on mediassist tcs portal on 5th and 6th may 2012 for total amount of Rs 5000/- . But till yet claims have not been settled. Its been around 4 months since i raised my claims. I even had contacted them and e mailed them thousand times to ask the status of my claims but they didn't provide any update. I requested them several times to settle these claims as these amount of money are very crutial to me...

I have been trying to open the website "https://www.mediassistindia.net/Claims/WebClaimer/Login.jsp" since last two days but the URL of the site is not working. Each time I tried to open the site an error of "Tunnel connection failed" comes up to me on the screen. I am in URGENT need as to check the status of my claim. Please help in this regard....

The one biggest mistake I ve made financially is to opt for this insurance scheme by Mediassist. I had a worst experience with them . I have submitted domicilliary claims twice and a hospitalization claim once , But I have not got claimed amount for any of the 3 claims. They are always looking for some or the other reason to reject the claim. I am not sure how useful this complaint will be. But I am sure that it is atleast going to help people who read reviews before selecting this company for health insurance. I am extremely disappointed by their service. The only thing they do rightly is deduction of premiums from my account every month.

I will list all the bad things that I noted about them

1. They have a very bad customer service team.
2. They don't receive calls at all.
3. They reject all the claims without giving proper reason.

I work for one of the companies of a big group(I shouldn' t tell the name publicly) in India. I am not sure why our group endorses this company when we already have a insurance division of our own. I am certainly planning to take this issue to the notice of the higher authorities in my company.

Dear Sir/Madam,
.
My friend Omkar Kulkarni was admitted to Aditya Birla Hospital, Pune with complaints of stomach pain. He was diagnosed and is fit to be discharged today. However the hospital TPA desk had sent the bill details to MEDI Assist insurance company for approval at 3.13 p.m today.. ... When we called the MEDI ASSIST people they are saying that they didn't receive the fax itself whereas the status of the fax was sent...... Our whole day was wasted in waiting for the approval from insurance company. Please take strict action on the insurance company as I observed that this is happening with many patients around here...

Thanks,
Deepak.

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