[Resolved]  Medi Assist India — Error in Cash Less claim processing

Address:

EON IT park , Pune

Im a corporate policy holder and works with Credit Suisse India Pvt Ltd.
Emp id - 6574513

- 19thJune ’21 - I was hospitalized at Dr. LH Hiranandani Hospital, Powai for my Knee Ligament & Meniscal repair surgery.
- Pre authorized claim for amount 2Lakh was approved by Medi assist before admission.( refer attached )
- 21st June ’21 my discharge Summary was submitted to Medi assist with Gross amount of INR 578688 and net Bill INR 461041 after deducting hospital discount of INR 117647.
- Medi assist erroneously processed my claim on gross amount with incorrect hospital discounts ( refer attached document )
- As there is no mention of dedicated contact number anywhere specific to CS employees not even on signatures, after multiple rounds of calls I got the Contact of dedicated help line –[protected]
- I had to call them at least 15 times to brief them about as call was getting disconnected due to technical issue at their end
- After multiple round of calls I was told your case has been escalated and you shall get the response within 1 hour.
- No response was received and I struggled for 8 hours in pain and stress after surgery.
- At last I paid sum of INR 35142 post negotiation with the Doctor who treated me and later discharged on 21st June ’21 night @ 10pm after a long battle . The actual amount hospital was asking to pay INR 60, 000.
- Hospital Accounts department has already mentioned they will not entertain any refund queries once you get discharged and said to follow-up with Medi assist for reimbursement of amount I paid ( 35142 ).
- 22nd June ’21 I received a revised letter from Medi assist with correct bill amount and discounts.
- I have been following up with Medi assist since last 21st June and I’m yet to get a resolution.
- Medi assist has agreed it was an error from their end in claim processing and keep asking for more time on resolution.