Medi Assist India — Grave Concerns with processed claim (CCN#[protected]Policy##[protected]

Address:

Bangalore

This is to formally register my complaint and disappointment with the way my claim has been handled by the mediassist team. The processed claim mail is mentioned in the mail trail below.

I have been a policy holder with National Insurance regularly paying my insurance premiums for over 20 years. This is the first time I've had to make a claim due to a serious knee injury which I'm yet to recover from.

I'm sad to say that Medi Assist has dealt with my claim in the most unprofessional and unsatisfactory way possible. Throughout the process there has been a deliberate attempt to ensure the patient is unable to claim their rightful dues.

To start with, the processed claim email mentions my procedure treatment planned as ' Laparoscopy other procedures on the appendix'. I was shocked to see that a person who's evaluated the claim would not know this basic detail of the procedure done. I have little faith left in the competence and sincerity with which my claim has been processed.

I have been trying to reach out to Mediassist through the portal repeatedly requesting them to call me to explain the queries. So far I haven't received any call from any member in spite of repeated requests.

The queries have been excessive & poorly worded with no specifics mentioned. In spite of this, I have responded to each query coordinating with the hospital authorities even while recovering. All requested information has been submitted on the portal as well as offline. There were no follow up questions after I submitted the hospital responses. It is natural for me to assume that you are satisfied with the responses. In case the person handling had issues, he/she should have asked follow up questions for the doctor and the hospital.

The process claim reference email came as a complete surprise. It has no explanation for comments like " under customary and reasonable" and " part of OT" for which deductions have been made. Please share how you've arrived at these conclusions. I have checked with several leading orthopedics and they feel this is justified given the nature and extent of the
injury.
In view of the gross discrepancies and violation of the norms in handling my claim, I request you to kindly re-assess it through a more competent person.

I have tried to raise the issue with the helpline number of Mediassist. Unfortunately they flatly refused to consider my complaint. No acknowledgement was provided and in fact I was told there is no way to escalate an incorrect claim processing.

I'm deeply troubled by the lack of process, quality checks, customer unfriendliness and this deliberate attempt to deny people their claims by burdening them through excessive and unclear documentation. I request you to kindly look into this so that other honest policy holders are not denied their rightful claims.