Medi Assist India — harassment by making claim delayed claim# 19184296 and finally processed the wrong amount

Address:

lohana building raopura vadodra, Vadodara, Gujarat, 390001

Sir kindly go through the below complaint which i have reported to mediassist india however neither they ever replied nor they finally processed the claim correctly.
Pfb the complaints which i addressed to medi assist over the email:-

Dear sir/madam,

As per above mentioned subject i would like to report you the
Harassment that i had to face due to delay processing (Still pending)
Of said claim# 19184296 which is for my mother smt. Leela sharma and
Claimed for congenital heart defect - asd closure.

The details related to said claim is under:-

1. I have applied for planned hospitalisation on 15/03/2019 and
Hospital at their level sent initial request on same day 15:37 pm and
Also provided estimate with their tariff schedule and break up of that
For rs. 2, 70, 000.00

2. Initial request was finally processed on 14/03/2019 for rs.70, 000/-
Against rs. 2, 70, 000/-

3. On 15/03/2019 i admitted my mother to hospital and all remained
Good and we are discharged from hospital on 18/03/2019 and hospital
Has sent discharge summary and final bill to mediassist on 15:32 pm on
Time they did not make delay at their level.

4. From 15:32 pm to 20:53 pm there was no query (During 5 hrs 21
Minutes) from processing team of mediclaim department/person, (Since
Same i was tracking on medi buddy application, and i suppose it
Provides correct information).

5. I called even toll free no.[protected] till 8.15 pm and they keep
Saying that there is no query till that time and also told me that it
Will be processed within 20-30 mins.

6. When it was not processed then finally i have to call mr. Jaimin
(Medi assist representative sitting at my hrm) on 08:23 or 08: 24 pm
And he told me that there is unreplied query on this claim means query
Has already raised and not replied (As per his words) however before
08:50 pm or 08:53 pm i was not able to see any query at medi buddy
Application. Nor hospital received any email till that time regarding
Any query till that time.

After 08:52 or 08:53 pm when i was sitting before hospital
Representative then only a mail came to mediclaim department stating
Some query.

Now,
I request mediassist team, please make me aware of -

What is your tat (Turn around time) or duration of checking claim
For raising first query, if required or completing the process of
Claim as final approval???

When you have raised the first query on this claim and if it was
Raised after 4 hrs (Since every representative on toll free no. Is
Giving me tat as 4 hrs) then kindly explain me the
Reason of delay??

How you deal or get the claim processing done at late night hrs when
There will not be any representative of mediclaim department
(Designated) as due to your late reporting of query this situation has
To face that none of representative (Designated/specialized) was
Available at 09:00 pm and due to that claim processing has remained
Unprocessed and who is responsible in this case when you raised the
Query almost after 5 hrs 21 minutes (As per medi buddy application
Interface) since even after discharge i could not take my mother from
Hospital??

I would say this is as harassment because this is second time due to
Not timely processing i have waste one more day in the hospital to get
The claim process completed and take my mother back to home from
Hospital and also its a prestige issue being an employee of such
Reputed bank that we are in the hospital even after discharge because
We availed cashless facility (Or in this case i must report it as
Difficulty rather than facility) and we are even asked to deposit
Money and go home and since it was too late to arrange money at night,
It made as feel humiliated just because of your processing delay of
Cashless claim.

I called (Almost 9.30 pm) and raised issue before mr. Jaimin and also
Make him aware that due to delay processing of this claim my mother
Has to stay at hospital and one more attendant has to stay at hospital
Even after discharge and it is possible, hospital is going to take
Room charges or other charges for extra stay, i got a surprised answer
From him that whatever charge is hospital going to take claim them as
Post hospitalization charges,
Kindly make me understand why i should claim those
Charges as post hospitalization charges while neither it was advised
By any authorised person (Doctor etc) and why i should bear this
Charges out of my available limit of mediclaim???
And how these charges going to be justified before you to reimburse???

When i called on toll free no.[protected] at 10.33 pm that time call
Ref# 4308026 the representative was saying me this is specific claim
By quoting "congenital disease" means he clearly indicated that
Intentionally my claim (I even recorded every calls) is being hold and
Intentionally we are being bothered, why??? As per our corporate
Communication which came in 2015 in which its clearly stated
Congenital disease are covered also cost of implants are other
Medicines examinations (Lab reports) etc are covered that has came in
Picture in 2015, now what has become specific in this??? While
Pre-authorisation has already been processed then how can you claim
This claim as specific and not processing this in 4 hrs tat??? Are you
Considering in this case other than what is communicated as per "iba
Medical insurance scheme""??? Are you considering my policy out of
Scope of iba medical insurance scheme???

If its so then immediately let me know as i will report it to my
Reputed organization and if possible, i will request my corporate to
Cover me with other available option as per our internal
Communication so that we can enjoy industry level medical insurance
Scheme that is called iba medical insurance scheme.

In the last cashless claim# 19184296 just because of your processing
Error i has to face pain while settlement claim and faced trouble
(However) and even i had to take leave from office (Which was
Purposeless) and have to waste my time again due to your delay
Response (If you would have raised the query on claim # 19184296, on
Time) again i have to take leave for tomorrow just because of your
Working style, to settle hospital claim and to get the things done.

You have wasted my two days and medi assist is only responsible for
This since its march ending and we need to be more active.

Also i would like to know when last updated tariff plan was shared by
Hospital to you (Since i can see your last query is based on that) so
That i can understand the details of package that i opted was already
Available with you or not???

I request you to come with a reasonable response on my queries so that
I can analyse whether its a facility for us or difficulty??

Thanks and regards,

Sachin sharma
Primary policy holder
Canara bank raopura