Medi Assist India Complaints & Reviews

My claim is approved but payment not recevied waiting from more than 15 working days

Medi Assist happens to be the TPA for my corporate health insurance policy. For planning hospitalisation for my mother, they are asking for a histopath report. However, no such test was adviced by the doctor at the hospital in regards to the ailment my mother is suffering from. The doctor has adviced admission based on other tests and diagnosis which have already been provided to Mediassist. This is resulting in a delay for the pre auth request to get approved, resulting in delay in my mother's hospitalisation.

All docs provided and answered all query still not got reimbursement

I have submitted my claim on 7March2023 for a 3 day hospitalization because o[censored]rethral urethrotomy. this was a existing condition and I had dilation in past, so no pre assessment was required, we went directly for cystoscopy and urethral urethrotomy. I filled a claim for this procedure and hospitalization cost.
Medi assist keep asking me for ultrasound report which never happened, nor my bills include any claim for ultrasound.
I haven't got response even after 2 mails and multiple calls.
Every time I call I get to hear is it's been prioritized but still no response.
From my last call with Binish I got a tag Id[protected] on 2May.
But still nothing has changed.
I want to escalate my case and complain.

Claim Id[protected]
Ticket no's[protected]
[protected]

I put my medical for reimbursement the almost deduct 50% from the total amount. They are considering Lasor operation as an advance therapy so they cannot covered under policy.
There are too many hidden conditions they I have seen after I put my medical claim.

India's worst worst medical insurance company.

I would highly recommend to all not to opt as medical insurance partner as medi assit.

They don't do medical reimbursement as per their commitment as well.

They have committed 3 times saying that your reimbursement will be credited to your account, however still not done even though 2 months completed and they do give false commitments.

To claim our paid money from medi assist it is very challenging, so please don't opt medi assit as medical insurance partner.

Medi Assist not processing multiple claims after providing all the medical claim documents.

Now, they have stop responding to emails and call. Below are the claim details:

Claim No 1 : 31189027
Claim No. 2: 32184110

This is to bring to your notice regarding pre hospitalisation claim raised for my illness (conservative treatment) miscarriage surgery Dilation and Evacuation happened on 6th Dec 2022.
I had raised the hospitalisation claim on 29th Dec 2022 but was not able to upload the pre hospitalisation claim expenses on the portal (but shared them on email then) but only the partial claim was processed since documents shared over email was not considered.
After that the portal was down on 2nd Jan 2023 and is still down hence that is the reason, I shared the hard copies of the pre and post claim to your office on 3 rd Feb 2023.
Claim for reference - TP[protected].
In the year 2021, I had raised similar claim - CCN#[protected], everything was approved (Pre, Hospitalization expenses)
In 2022, I had raised claim for same surgery again - CCN#[protected]. Only Hospitalization was approved. As per Medi assist, I didn’t share the pre and Post bills, which I had sent it on email separately and then hard copy as well on 3 rd Feb 2023. But it is more than 30 days now and still the
claim has not been processed.
Kindly note that this is pre and post expense for my illness conservative
treatment (missed abortion) hospital expenses claimed earlier.
policy number –
[protected], Member ID - [protected]

Outstanding Claims
Claim Number [protected]Insurer Claim No. TP[protected])
Claim Number [protected]Insurer Claim No. TP[protected])
Claim Number [protected]Insurer Claim No. TP[protected])

Hi,
One month ago I have done my wife's laproscopy.Nurshing home gave me room charges, nursing charges and other charges invoice.But surgeon procedure charges amount gave me the money receipt with sing, stamp and NMC no.
medi assist reject my complain as due to cash receipt is not printed .

Note : I am working in Tractors Nepal Pvt Ltd and insurance company is Shikhar Insurance Company Limited, which is TPA of medi assist.
Policy No- POL/10000/HEA/22/23/31/00103, MA ID-[protected].

I ordered a medical test package with medibuddy and the order was assigned to Tenet Diagnostic Karkhana. As part of the package, 2 tests Dietician consultation and Dental consultation were denied as they DO NOT offer those services.

I have been in constant touch with Medibuddy customer care but I am not getting any help, when asked for a refund of those services.

Dear sir
my claim id:30238344
i have many complain in medi assist but still not receive my payment
my claim approval on 4 november today 28 december but not credit my amount

Inspite of providing all the valid documents my claim was repudiated by insurance company. I didn't avail the TPA facility as the hospital charge high amount in TPA case and at the time of discharge I have to pay the unapproved amount. No proper reason was provided for denial inspite of several followups. Claim no.[protected]

I have family health insurance from Medi buddy.. My father was admitted in the hospital after submitting all the documents and replying every queries, insurance company Repudiated the claim...

Claim Number[protected]
Employee ID : 50107848
Company Name : Reliance Retail (Quick supply chain Pvt Ltd)

Sir my claim is pending from[protected]
no one telling me the status of my claim
claim id 28192407
member id [protected]
name priya gangwar

yor employee saying again and again...ho rha hai, ho rha hai

i treck my claim status via tollfree no.[protected]
then i found out my claim has been closed without settlement

I have been following up with Medi Assist Jp Morgan corporate number. Sent 20 emails and called several times. Opened too many tickets and sent all the requested documents. However Claim was repudiated. No idea why I was harassed for 2 months

My claim no. Is 98403533. I am submit a claim to rembersuiement in 2019. I am send all document to company . Company said that
document not received. Then i visit to hospital and request please provide document for claim rembersuiement . I send again document to company and tracking no. Is rh[protected]in

but my claim not rembersuiement yet.

Ticket No:[protected]
claim Id: 28931894.

I am asking the final settlement letter to medi assist team through customer care email address but they are not responding properly yet so when I was contacting them via their customer care number, they are saying like that is in process. This thing was happening from July. Kindly ask them to provide the final settlement letter.

Many of time their customer care number is not working so i am very struggling for contacting them...

I am writing the compliment to their grievance but they are also not responding me.

Dear Team,

This has reference to the below details :

Employee Number : 527239

Employee Name : Mikeshow Pinto

Beneficiary Name : Jacintha Pinto (Mother )

Claim No.[protected] dated 22nd September 2022

My Mother was admitted to the hospital for a day care procedure (Chemotherapy) on 22nd September 2022. However, until today the hospital has not received the settlement / acceptance letter of the approved amount of Rs.22985 from Medi assist.

Ideally the approval should have been done on the same day.

Since the approval was not sent to the hospital, we had to pay cash for the amount as deposit and discharge my mother.

Now the hospital is trying to encash the deposit to settle the bill. May I request you to please send the settlement letter as soon as possible. Even if you are facing technical issue, can you send an email to the hospital directly.

I would like to highlight the below points as well.

1) On 22nd September, we made 12 calls to mediassist helpline –[protected]. Every time they kept saying that it will be done in some time, but it was never done. I even asked for a Supervisor call, waited for 30 minutes only to hang up as no one came in

2) On 24th September, Once again I called the helpline, spoke to the supervisor as well who promised that it would be done in 2 hours but till now nothing has been done.

3) On the IVR, it clearly says that if the procedure is done in a network hospital, then cashless is compulsory. Then why in this case mediassist has failed to provide the required confirmation to the hospital. What a poor customer experience it is.

All this causes a lot of trauma to the employee and the patient as well.

Request you to please look into this matter with high priority so that hospital returns our deposit money.

Regards,

Mikeshow Pinto

My I'd 28870931
I made a claim for reimbursement regarding insurance, that company said that it will be processed in 7 working days from the time of making the reimbursement, it has been 87 days now, there is no response.

Hi,
My father, a senior citizen, In July 2022 underwent Cataract Surgery & submitted my claim(Claim No:[protected] for Rs 55, 816/-(including pre-post hospitalization charges)

we are a Cigna TTK customer from the year 2019 onwards and renewed our health insurance policy diligently each year. also, we don't have a single claim in these 3 years except this one.

I submitted all the docs prior to hospitalization and the cashless claim was approved for 38000/- and the hospital (L.V.Prasad Eye Institute, Madhapur) proceeded with the operation which cost 54, 000, and the hospital applied for a final settlement for 54, 000. However, the TPA denied the cashless claim from the hospital. I had to pay the amount from my pocket even though I hold an insurance policy with clean previous record history.
Then I had to apply for reimbursement. Then again, the TPA came in and denied the claim saying two points:
We have received claim documents for, claimant Mr. Rama Rao admitted at L V Prasad Eye Institute - Hyderabad hospital from 15 Jul 2022 to 15 Jul 2022 with the complaints of RT Eye cataract Claimant is covered under ManipalCigna Health Insurance Prohealth Group insurance Union Bank customers - Floater policy since 11 Jun 2019As per the available documents patient had K/c/o Pelvic girdle pain 4 yrs which is material to policy decision and was not disclosed in proposal form at the time of policy inception. Had these conditions been disclosed in the proposal form which forms the basis of the policy contract, we would not have issued the policy to this member at all. Claim stands denied under policy condition VI.1 duty of disclosure. We regret our inability to admit this liability under the present policy conditions. We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.

The points to be noted are,
"how come My father has Pelvic girdle pain ??" as far as I know this pain will be a post symptom for pregnant women! and they denied telling the same reason!
and PGP refers to Previous glasses prescription.

This is so disappointing that none of the call center guys have any clue on what needs to be done because of the inactions of the backend team. They kept promising that it would be reimbursed & a complaint was also raised against it. at last, the claim is denied (CashLess and Reimbursement as well)
This is really pissing us off. We carry the health insurance policy to cover all our health needs in spite of the problems being pre-existing or post-discovered diseases after policy inception. This is like threatening the customers and disrespecting us after we diligently renew and pay for the policy.

I doubt the senior management is aware of these issues because, the overall SoPs seem to be substandard & at this technology era, we are forced to call the call center multiple times with no proper update/progress...it's literally going into a black hole...they kept on asking us same questions again & again & again.
and would circulate and escalate calls among many divisions !!!
It's so surprising how management was able to tolerate such inefficiencies for such a prolonged period of time.

This is such a foolish mistake of one of the people (s) from Medi Assist who set the wrong information which led to my claim denial and policy termination.
I doubt the sincerity of both the Insurance Company & TPA in settling this claim, hence we are forced to be harsh and look for resolutions.

FYI:
Ticket nums: [protected], [protected]
Claim No: 29268767
Policy No:[protected]/03/00

Regards,
Abhilash,
S/O Ramarao