[Resolved] Medimanage — Not approving my claim | |||
I have a corporate Mediclaim policy with MediManage (Mediassist) team, Recently i was diagonsed with an ACL tear and doctor suggested me to go for the surgery Since they have a Cashless benefit i spoke to Medimanage team on how to proceed since it takes time for approval and also we have a 20% cap for members. I had to undergo surgery on 16th April-14. I had both mediassist team and Sunshine hospital(secunderabad) insurance team talk with each other. Medi Manage team was complete aware of the complete package which include ACL reconstruction Arthoscopy and Grafting totaling upto 75, 500 + implant cost which was around 15k more. After my surgery was over Insurance people started contesting against the hospital for the treatments and its cost while clearly it was told to them before. Please help as this guys are taking me for a ride and not ready to reimburse the same My details: Bishwajeet M [protected] Was this information helpful? | |||
Aug 14, 2020 Complaint marked as Resolved | |||
 1 Comment | |||
We have learned about your complaint at this platform and neither at our Escalation Contacts nor from HR of your company M/s Mphasis Ltd. We would have appreciated getting this escalation thru the well-published & mutually agreed channels of communication.
Nevertheless, our Cashless Coordination Team Head has gone thru the details of the case & has resolved the same for you. Here is brief synopsis of the case. This is not a short payment by Medimanage or Mediassist but clear-cut deviation by Sunshine hospital from their agreed negotiated rate chart for the procedure undertaken.
1. The pre-authorization request was received from Sunshine Hospital on 10th April & Mediassist had raised query about additional charges shown by Sunshine Hospital. This was responded by Hospital only on 12th April.
2. On 19th April, final bill approval thru cashless was given for Rs. 61, 336 & TPA clearly informed thru their authorization that there are excess charges shown in the bill which are not as per agreed package tariff & the same should not be collected from Patient. Despite of these clear written instructions (we can share copy of this communication with you), Sunshine Hospital collected additional Rs. 15, 000 from you which was over & above the co-pay of Rs. 15, 334 payable by you.
3. Now, Mediassist has once again spoken to hospital & informed them that this additional payment should be refunded back to you. We are happy to inform you that Sunshine Hospital has agreed for the same. Request kindly get in touch with Mr. Abhishek of Sunshine Hospital (Mobile No. [protected]) & get this amount refunded from them.
4. In case of any issues, you could write to our Claim In-Charge Dr. Neelam on neelam.[protected]@medimanage.com
Hope we have resolved your case to your satisfaction. Look forward to your continued patronage.
Thanks & Regards
Sudhir