Oriental Insurance Company — unlawful rejection of cashless claim: janak gupta claim pa[protected]

Dear sir/ma'am
I, rohit gupta, had admitted my mother janak gupta (Insured) aged 58 years with rg stone hospital, pitampura delhi and hospital duly applied for cash less claim with mediassist tpa on 22 august 2019.
I would like to bring to your kind attention for redressal of my grievance as regards mishandling and mismanagement of cashless claim lodged vide pa[protected] for my mother janak gupta covered vide oriental policy no. 215402/48/2019/2926
The policy is taken by my brother mr. Rajneesh kumar gupta ([protected]@gmail.com) for my parents and his family to safeguard the family in cases of medical emergencies. We have been paying hefty premiums to oriental insurance for mediclaim since 2011. However, the way oriental insurance company and tpa mediassist is processing my claim with total recklessness and mindlessness is totally alarming and disgusting.

The claim was lodged on 22nd august with all the documents and complete copy of the policy which amply discloses on its last page previous polices. Also, on medibuddy app, last 4-5 policies are already captured.
However, for processing of cashless claim, the mediassist tpa has chosen to reject the policy on the ground that this is the first year of policy and claim shall be allowed from 2nd year which is totally false and bereft of any truth.

Exhibit of reply received from [protected]@mediassistindia.com vide mail dated 23 august 2019 at 6.02 pm.
"we regret to inform you, that we are unable to extend the cashless facility for this claim due to the following reasons:

Cholelithiasis in 2nd. Yr. Policy year not admissible as per policy t & c."

Even a simple inquiry by mediassist team would have produced last year policies to ensure seamless processing of claim.
But mediassist tpa and oriental insurance company limited has chosen to harass the insured who have taken the policy on the promise of hasslefree cashless claim procedure.

Firstly mediassist harasses the insured an their families by taking unnecessary long periods of time for adjudicating the claim. And secondly, it rejects the claim on fictional and baseless reason leaving the patient (Insured) and his/her family to fend for themselves.
Further, i have sent emails to [protected]@mediassistindia.com and also called them several times today 24 august at [protected] and at [protected] between 11 am to 11.45 pm but still none has responded and listened to me for reconsidering the cashless claim.

I want strict action against the concerned staff of mediassist tpa who have recklessly denied cashless claim to the insured and immediate restoration of cash less claim.

Regards
Rohit gupta