Medicare TPA Services Complaints & Reviews

Dear Sir/Mam,
I have a Mediclaim policy of Oriental Insurance and TPA is Ericson. I get admitted my son in Sachin Hospital (Palwal, Haryana) from 28th Feb 2023 to 2nd March 2023 in an emergency & due to critical situation a had to continue the treatment of my son in this hospital instead of it was not on panel, same thing i had informed to my agent and as per TPA guidelines i submitted all the documents but instead of a huge followups i got only 50% amount (15000/-) out of total bill of more than 30, 000 rupees.
So kindly get resolved the issue & get disbursed the pending amount.

Regards
Digamber Singh
Mob [protected]
Policy # 272400/48/2023/9235
Claim ID# 306519

Hi, I am Darshan Bharat Adhia son of Bhanu Bharat Adhia,

We have admitted my mom on Thursday 06/01/22 to Riddhi Vinayak Hospital Malad,

It has been 4 days and today my mom was suppose to get discharged but still the initial level of acceptance for my moms medi claim is not processed. We had opted for cashless there is no reply from medicare also the numbers and website available on google doesn't seem to work at all. Kindly help

We have purchased this policy from Union Bank of India Malad West Mumbai 64. We are continuously paying premium from past 4 years.

We currently need a support in getting this claim settled ASAP to hospital so that i can bring back my mom home.,

Hoping for your kind attention.

Yours Truly
Darshan Adhia : +91-[protected]

Policy no. [protected]-04
mail recieved from [protected]@mediassistindia.com
* details of ailment attending doctors to confirm hospitalisation is mainly anxiety or not ?
* Pre numbered paid reciept for the amount collected from the patient on[protected] for Rs.11930.
The details of Ailment attending Doctors were mentioned in Discharge Summery report enclosed with the claim form. DR rajeev Joshi, Dr. Lodaya M. and Dr. Sameer Desai.
The paid bill no. IPBL154 with authorised signature and seal from the hospital for r
Rs. 11930 was sent with the claim form.
please look in to it and consider my reiumbursement claim.

My Medicare claim form was submitted along with requisite documents at Jorhat divisional office in Dec /2019by agent of. LIC.
Policy number H044/[protected]/04.
BUT STILL IGNORING BY YOURSELF. please answer me early

Hello Team,

I have submitted all the original invoices which I have paid for hospital via DTDC with all required documents and I have not received any update so far.

Policy Number:[protected]-02.

please reach out to me ph: [protected]

please help me with this.

Regards,
Kiran Kumar

Hello sir,

This is Rajasehar Rao S/o Ainala Nageswara Rao, My father is applied a Claim Regarding his Health Insurance on July 2019 policy No[protected] Still more than one year is gone, we have not received any money from you .we have all ready submitted all the related medical documents .But we are not understanding where is our fault, even we didn't got any clarity from media assistand sbi general insurance team from Berhampur, so finally i request to you kindly look into issue and solve it asap.

I have submitted all my original documents to mediassist bengluru office on 4th august 2020 having acknowledged no blr01123897. It is more than 20 days passed but they are not providing claim id. I have called them and write them but no proper answer. Even they are telling your policy is expired. I have already attracted copy of my renewed policiy with claim documents. Kindly do needful

Hi,
I am saurabh kumar insured in mediclaim under of new india insurance. My wife having lungs problem. When ever i am going to yog mata pilot baba hospital haridwar the behavior of the tpa management is not good and very untolerable. I didnot satisfied. As per doctor instructions today my wife discharge at 10 o clock but tpa and hospital staff not responding me last 3 hours

Kindly take the initiate action and resolved my problem as soon possible.

Hi sir i am renewed my policy on[protected] so far i have not received my insrance card. As i am sent through their link and bnk also deducted of rs.10800/-in view of this matter several times i contacted custmer care but they are answering we not received so far and yet to solve my problem so far query. Hence i request to kindly look into matter and expedite my policy
Mathew abraham

Sir
I had a health insurance policy bearing policy number[protected], with member id sbig8430574. The policy started on 30/9/2018. I have opted for auto renewal. I have contacted the helpline and was informed that it is auto renewal and will be renewed automatically. I had sufficient money in my account. Even then it was not renewed. I contacted yesterday in the helpline number and informed about the situation. I was then informed that it is expired. I told them that it is not my fault, so it has to be renewed. They informed me that i will be contacted and will look into the matter. But have not yet contacted me. So i request that necessary action may be taken to renew the policy and inform me
M. Shanavas
...

Attention team,
Please refer claim no. T[protected] against which no settlement details sent to me, under the circumstances stated above you are requested to forward the settlement details / statement at your earliest for reconciliation with claimed amount, as i have to furnish the same to appropriate authority of income tax department. Please do the needful as early as possible..

Attention Team,
Please refer claim no. T[protected] against which no settlement details sent to me, under the circumstances stated above you are requested to forward the settlement details / statement at your earliest for reconciliation with claimed amount, as I have to furnish the same to appropriate authority of Income Tax Department.

Please to the needful as early as possible

With reference to the above, i wish to intimate that, i am going to undergo phaco surgery (Right eye) on 12.09.2019 as details below:

1) name : bikash pal
2) policy no : 0105002019484100000204809. Valid upto 31/01/2020. Sa-rs100000 (Arogya raksha policy o[censored]iico)
3) date of admission :12/09/2019
4) disease : cataract
5) name of hospital/phone no: b b eye foundation. (Phone no:[protected]/6608,[protected], cell - [protected]/[protected]. Email id: [protected]@gmail.com)
6) my mobile no: [protected]
7) my address: 5 b/2 jagannath ghosh road. Po: kasba. Kolkata-700042

Please take note of the intimation and acknowledge the same.
I shall submit the claim for the residual amount after settlement of the another policy with necessary documents after discharge in due course.

Kindly send me the necessary claim form.

Regards
Bikash pal

Complaint against Claim Delay

Hi Team
I'm so upset and frustrated with the whole experience of putting my claim through Mediassist. Just too much..
I booked a consultation through the mediassist app for my daughter's dental care. Post diagnosis she was advised root canal for kids knowns as pulpectomy. Extract nd filling.
We have been through almost four visit as a dental day care stuff. I spoke to one representative in.mediassist who advised me to submit it as dental Day care.which is also mentioned on your website. I cancelled the previous domiciliary claim and submitted a day care hospitalisation since beens spending almost an entire day on each visit. Due to the nature of each visit I kept mediassist informed.
Now post submitting the bills claims in June after 16 days I was informed by Anshuman that put it as a domiciliary and not hospitalisation. As they wont give me my entire claim..What a lie!!!
This is extremely disappointing and just alot of falsification of the policy I hold
I haven't utilised the policy in five years from my organisation this is the only year where I am using it and been through so much
I request my corporate Team to look into this issue distinctively and assist me genuinely.
I appreciate any information you require from me I am ready to provide you.
I have attached the call recording in June I had with Mediassist. If possible plz escalate to through TATA to let me know where I have been wrong and where the insurance company has gone wrong. My Organisation will not let me down. I want to lodge a complaint against each individual who gave me incorrect and incomplete information.
Thanking you in anticipation.

Dear sir
I tarique jamal hasan indian passport no. P-6305626 have done my medical fitness at kaifak medicare 4/18, tulsiyani chamber free press journal marg nariman point mumbai contact no 022, 22822186. On vide gamca slip no. - gcc/29/188/29/17559045 dated 29/08/2018. And medically fit and report was issued and valid till 30/11/2018. To me after updating mofa e[protected] due to some technical problems of visa its stamped and the second mofa e[protected]given to the above said doctors for updation which they have rejected not updating demanded to issue a letter from recruiting agency who is processing for this all that formalities has been done by us on dated 21/11/2018 and also mailed at their email address [protected]@kaifakmedicare.com/[protected]@kaifakmedicare.com. But they have refused not to update and advised to go for new medical. I have paid approximately 6000/-rs. For this and my medical is valid till 30/11/2018 that doctor is doing dictatorship and misbehaving at his centre and saying that go for complaint, is it right on gcc guidelines, some doctors updated their reports if 1-2 days remaining and here is 8-9 days remaining in expiry.

So that i am requesting you to take appropriate actions in this matter to resolve this issue to avoid new medical and control doctors dictatorships

It's been more then 7 months after the approval of my claim and still the claim is not settled, number of mail exchanges took place and the last message i received was on 20/07/17 below is the excerpts of the message received, tpa team is unable to explain about the delay... And they are not lifting the phone calls even and no reply to any of my mail communication. My mediclaim insurance term is about to expire by march end.

Looking forward to hear on the subject matter please.

Your claim t[protected] has been processed, neft will be done shortly."
Above massage was received on 20.07.17

I have admitted to Baptist hospital Bangalore.for I have admitted to Baptist hospital Bangalore.for hernia operation.for claim Baptist hospital send all the documents related to sergery but finally Medicare tpa rejected.i have already paid 3 instalment of 6000 they rejected saying policy inception date is 25/1/2016 and patient diagnosis is umbilical hernia since 2013 as per submitted documents.my wife has consultanted in 2013 related to RMV treatment referred by Dr George.after that
I consulted Dr Venkat on26/10/18 advice d to sergery on 22/2/18.our doctor has opened previous file of my wife file in that he has written for sergery ie Medicare doctor is saying that you had umbilical hernia on that date ie 2013 saying previous history operation.for claim Baptist hospital send all the documents related to sergery but finally Medicare tpa rejected.i have already paid 3 instalment of 6000 I will go consumer court

Policy no. 570200/46/16/[protected], tpa claim number : t[protected],

Reference to above i following up from approx 6 months, all the documents are provided, i also received confirmation mail ie. Amount would be credited in 7 working days. (1st nov. 2017) but till date nothing is received. Please look into matter.

I called several times to tpa as well as insurance office, i have been told that their is server issue. U will receive your payment shortly. But till date no response.

My name is gayatri sarkar, age 65, a senior citizen. I have national mediclaim policy no.-103000/50/16/10004055 with t. P. A. Id no. 01/01415911a. It is hereby informed that only a meager rs. 20, 763/- is approved for payment against claimed sum of rs. 36, 308 /- against my claim no.- t[protected]. While i submitted complete documents for claim and no shortcomings have been intimated from your side, it is really surprising to see such a huge deductions on claimed amount.
At this point, i wish to bring to your kind notice that i had undergone cataract operation with same procedure (Phaco+iol) on my left eye during december, 2016 (Under medi assist tpa) when i was refunded 86 % of the claimed amount. But, at this time it is a meager around 55 % of the claimed sum received for the right eye cataract operation with similar procedure (Phaco+iol) held on 05.10.2017!!!
I am a senior citizen and it is very difficult and painful to follow up such higher deductions while i am completely in dark about the reasons and grounds for such deductions. I hereby request you to kindly look into the matter with priority to refund further with less deductions. Otherwise, kindly inform me the reasons and grounds for such huge deductions against each break-ups. Thanking you, sincerely, gayatri sarkar (Insured)

Dear sir,
I would like to apprise to you that i have medi claim policy with united india insurance company ([protected]-raajkumar mahour) his tpa vipul medicorp. I admitted in hospital 25-aug-2017 and i made call to vipul medicorp 26-aug-2017 on customer care and customer care personal confirm that i didn’t receive any e-mail from hospital and but hospital send e-mail many time and also made call from my self but they didn’t give approval till discharge day this policy was cash less but vipul medicrop didn’t care. I paid all bills from my pocket. And i had sent all document related my treatment and they had received on 05-sep-2017 but they will not refund my money till.
Sir tell me what meaning of cash less policy. I totally disappointed from vipul medicorp. I will go consumer court and i will file case again vipul medicorp and i will request to court canceled his license.
Sir, it is not end from my hand i will teach you. And what is meaning of cash less mediclaim.

Raajkumar mahour
Policy no:- [protected]
Mobile no :- [protected]