Medi Assist India — Unprofessional and Dishonest ....Ticket no 144619 pending for over 10 months

Address:	560025
Website:	www.mediassistindia.com

Background
The patent had to undergo a procedure under general anaesthesia as recommended by the regular gynaecologist and confirmation by the regular GP of the patient. The procedure is specifically covered in the policy document.
My simple reasoning is that if a procedure is specifically covered under the mediclaim policy and the doctor decides that a patient needs to undergo the procedure (because there is no other alternative!), then the Insurance Company is liable to pay for the cost...

The original claim was seems to have been processed by a person with little or no medical knowledge/ background or even ability to comprehend the contents of the policy document. Among the reasons for rejection were
- Bleeding was not a serious problem (!!!) requiring medical attention
- Procedure should have been treated in an OPD (even though it could only be done under General Anaesthesia)
- Procedure was not covered under the policy (though it is specifically covered)

I asked for reconsideration, refuting or rebutting each of the reasons that were raised to support the decision to reject the claim but the matter pending for more than 10 months. There is no response after dozens of followup calls and email reminders other than "matter referred to the concerned department and we will respond shortly" or words to that effect.
Despite many promises to arrange a call back, none has materialised so far.
At least on two occasions I was informed that a response has been sent but none has been received so far.

I was informed many times that Mediassist had referred the matter to the Insurance Company and are awaiting an answer but this information does not seem to be accurate because at different times I was also told that the answer has been sent to me or the matter will be referred to the Insurance Company.

Though the persons manning the call centres sound genuinely concerned and interested, it turns out to be practised deception. I have spoken to at least 10 different call centre executives and 3 or 4 supervisors - some on multiple occasions, and each time I get the run around that the concerned person is busy and we will arrange a callback in 2/24/48 hours or some such deadline.But nothing happens!!!
The MediAssist call centre Supervisor is unable to provide the contact details of the ombudsman of the Insurance Company or even the person to whom such complaints can be referred in their own organisation!

It is frustrating dealing with totally unprofessional and dishonest people in any organisation especially one which is in the Healthcare industry.