Denial of My Health Insurance Claim by TPA Mediassist
Claim No. Received On Policy Number Policy Holder Relation MAID Beneficiary Clm Type Clm Amt App Amt Claim Status
1317653 07 Oct 2008 16:47 710405/34/07/11/
00001826 S S Jeyakkumaran Mother [protected] S Malar Mani Reimburs 23418 0 Denial Reveiw Waited
This is with reference to my claim submitted for reimbursement of expenses incurred towards my mothers treatment during her hospitalization, under individual medical insurance scheme of The New India Assurance Company Limited of which Mediassist Healthcare Services (Third Party Administrator).
I have submitted a claim of total Rs 23418/-, with all the bills and other necessary documents, on 07th October 2008.
After Continuous follow up with mediassist on 4th November 2008 I got a reply by way of a mail that my claim has been denied for reason “T2DM, Costo Chondritis, AGE - med management. Only Investigation done with oral medication” – The treatment is done my Doctors. The purpose of insurance has clearly said that even for a day you admit the reimbursement of hospitalization claim can be made. I really don’t understand why these TPA is denying it
Since then I visited their office in Chennai to reconsider my request many times did not get any satisfactory answer.
After more than a month has passed I finally requested them to return my bills, the customer care executives there failed to give me the correct status of my returning the bills they were keeping on saying that they will send courier but eventually nothing had happened. Finally on January 19th 2008 I have got my bills back.
I had earlier done a claim bearing number 1314619 on 30th September 2008. The hospitalization for this claim and the hospitalization for claim no 1317653 is for same reason but still the TPA has denied my claim after writing several explanation mails to them.
I request you to interfere and get my claims
Hence desperately writing this complaint.
Looking forward for your response - Jeyakkumaran
Aug 14, 2020
Complaint marked as Resolved
If you want peace of mind with cashless claim, please don’t go with Medi Assist TPA.
We ( I, my wife and new born baby) had to wait in the hospital lobby for 8 hours; thanks
to Medi Assist’s lethargic inhuman service! The fax for enhancement of the cashless claim was sent at around 4:00 PM. Every hour, I was calling the customer service of Medi Assist and the hospital administration was also contacting them in between. Every time, the claim was under process and will be completed by 6:00 PM, 7:00 PM, 8:00 PM, 9:00 PM... Thanks to merciless customer care executive, finally, we called it a day and paid the cash by ourselves and got discharged from the hospital at 10:00 PM.
The claim was finally settled after 2 days!!! Now, I have to visit the hospital to collect back the money I had paid upfront.
Lessons learnt:
(1) Please don’t ever rely on Medi Assist. It is severly understaffed and customer care executive have no common sense. ( same case with all of them. I had talked with Sagar, Reddy and Kumar during this time and all have same no sense attitude.)
(2) Don’t believe 24 hour call centre services unless you test before hand. Try your self for medi-assist call centre:[protected] and if you get someone to talk to you in less than 5 minutes, I would say, you are extremely lucky!!
(3) Have enough cash with you to pay upfront and possibly claim later.
Please spread this word to your friends and collegues so that they would avoid such treatment of making their loved ones to wait in the hospital lobby for several hours swallowing infections.