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mediassist India

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Tamil Nadu

Consumer complaints and reviews about mediassist India

nandha.elect
 
Nov 9, 2015

how can we reimbursement the previous year claim?

Hi,
how can we reimbursement the previous year cycle claim.
My wife admitted in the hospital on June29, 2015 for maternity. But my hospital gave bill and discharge summary on july end. Due to some hard personal reason i am not able to claim this bill 2014-2015 year cycle. i claimed this on september, 2015. And i have sent the documents and forms to delhi. Without my knowledge they send my bills to my home back, it is happened on october.
After i have contacted them to asked about this, they said it is in the previous cycle. so we are not able approve this.
can anyone you please, let me know if there any possibilities to get my reimursement.

My mail id: nandha.elect@gmail.com
DS KOCHAR
 
Nov 6, 2015

NON SETTLED OF CLAIM

,PNB ROYAL MEDICLAIM POLICY NO 191200/48/2015/866
,CLAIM REF NO 11413075,A/C BHAJAN KAUR SETHI ,
MEDIASSIST TPA PVT LTD
PENDING OF CLAIM FROM LAST FOUR MONTH

ALL THE FORMALITIES HAD BEEN DONE, STILL THERE IS NO RESPONDS REGARDING TO SETTLEMENT OF CLAIM. MY MAIL ID IS kocharbhilai@rediifmail.com
MOB.NO= 9926990500
mandeepjaiswal
 
Nov 4, 2015

Claim Denial

My father owns a policy of Medi Assist Policy Number 252400/48/2016/3900, PA No :11832822 on name of NK Jaiswal.
My Father is admitted at Sir Ganga Ram Hospital,New Delhi for treatment,after 2 days of queries and inquiry by the TPA panel, today the cashless claim approval has been denied with no specific reason mentioned.
The denial letter says :-
"We plead our inability to approve for cashless facility & in the meantime we advice you to apply for a possible reimbursement with supporting documents/reports/bills. prescriptions in respect of the related claim.

The point is why are they harassing the patient by delaying the claims /approvals, which they intend to deny lately also when in the case the hospital and doctors are providing the details what else best do the company needs.
It seems the company is only interested in taking the premiums and do not intend to entertain claims in lieu of it.

Mandeep Jaiswal
9999930420

Details Listed Below :--

Search results:
CLAIM ID:
11832823
Claim Details:

Claim ID: 11832823
Claim amount: Rs.1,60,000/-
Approved amount: -
Admission date: 02-Nov-2015
Claim received date: 30-Oct-2015
Claim denied date: 04-Nov-2015
Claim type: Cashless
Pre-Authorized amount: -
Claim status: Denied
Discharge date: 05-Nov-2015
Claim approved date: -
Hospital name: SIR GANGA RAM HOSPITAL
Denial reasons

Denial Clause: OTHER Denial Reason:
Missing documents

None

Deduction Details

None
Manish Chandwani
 
Oct 19, 2015

Fraud Company in Medical Insurance Sector

Hi,

This one the biggest fraud company we have ever seen under Insurance sector, After taking the premium they even don't know who are you.

I have submitted my father claim on surgery, At first the denied for the cashless, with giving the reason that its a pre existing disease. After that I have given the letter duly signed on hospital letter pad from concern, that it not a pre disease with all proofs of CD's of surgery and went for the possible reimbursement. Still they have denied for it.

All the doctors who are checking the claims for reimbursement are not a certified doctors, even they do not have the proper knowledge of the disease.

Below are all the mails which they sent to me:-


Medi Assist India TPA Pvt Ltd
47/1,Sri Krishna Arcade,1st Main,9th Cross,Sarakki Industrial Layout,
J P Nagar 3rd Phase,Bangalore-560078

To,
Chandwani Manish
DB VPP
DB House, Hazarimal Somani Marg
Fort Mumbai
Mumbai-400001

Dear Insured,

Claim No :11568631
Policy : 920000/34/14/05/00000011 Policy Period:01-11-2014 to31-10-2015
Patient Name : Dilip Chandnani Policy Holder Name : DB VPP
Claimed Amount : 168680 Final Diagnosis : Atherosclerosis
MAID : 5016833274 Hospital Name/City : HEART AND GENERAL HOSPITAL
DOA : 29 Jul 2015 DOD : 01 Aug 2015


Subject: Denial of claim 11568631 under 920000/34/14/05/00000011

We refer to your claim submitted for reimbursement Hospitalisation expenses, the claim was referred to insurer for their opinion and advice. As per the instructions of The New India Assurance Co. Ltd, the claim is being denied on account of the following:

On perusal of the claim documents submitted, this claim pertains to Mr. Dilip Chandnani. As per the medical documents submitted, patient is a known case CAD - TVD, Old PTCA 2010-Apr.2014. PTCA with Stent to LAD done. As per the policy terms and conditions Any condition, ailment or Injury or related condition(s) for which signs or symptoms, or were diagnosed, or received medical advice / treatment prior to the inception of the policy does not fall under the scope of policy coverage. Hence, we regret to inform you that this claim stands denied under the policy.

The denial clause/s with description is/are reproduced below for your ready reference:
Clause Description.
Misc. Pre Existing Ailments/ Conditions
Since the claim does not fall within the purview of the Policy terms conditions, we regret our inability to admit the claim. If you have any other information or documents to substantiate admissibility the claim, please provide the same within 15 days of receipt of this letter.

If you are not satisfied with our denial reason,you may write to Grievance Redressal Cell of the The New India Assurance Co. Ltd at its policy issuing office, concerned Divisional Office, concerned Regional Office or the Grievance Cell of the Head Office of the Insurance Company.

If you are not satisfied with the decision of the Grievance Cell/Dept of the Insurer, you may approach jurisdictional Insurance Ombudsman (located across 12 cities) and established by the Central Government for the redressal of grievances of Individual Policyholders.
Authorized Signatory,
Medi Assist India TPA Pvt Ltd.

THIS IS A SYSTEM GENERATED CORRESPONDENCE. PLEASE DO NOT REPLY TO THIS EMAIL.



Hi Manish
With available records , Patient is known case of Coronary artery disease - Triple vessel disease (LAD, LCX, RCA) Old PTCA to LAD , LCx in 2010

Now lesion is proximal to previous stenting (LAD) and planned for stenting for the same . CAG done on 2010 confirms LAD is affected vessel and present lesion is on the same vessel hence its preexisting and our denial is in order.

Thanks
Abhishek Agrawal
+91-9928553223


From: Manish Chandwani
Sent: 01 August 2015 16:24
To: 'INFO - Medi Assist'; 'cashless@mediassistindia.com'; 'cc@mediassistindia.com'
Cc: 'hnghmediclaim@gmail.com'; Abhishek-A Agarwal
Subject: RE: [Ticket#2015080115546808] REMINDER !! Regarding Your Denial Letter of Mr. Dilip Chandnani Claim No.-11470477
Importance: High

Hi,

Could you please update on the same on priority basis.

Regards
Manish Chandwani
7688888808

-----Original Message-----
From: INFO - Medi Assist [info@mediassistindia.com]
Sent: Saturday, August 01, 2015 05:54 PM Malay Peninsula Standard Time
To: Manish Chandwani
Subject: Re: [Ticket#2015080115546808] REMINDER !! Regarding Your Denial Letter of Mr. Dilip Chandnani Claim No.-11470477

Dear Manish Chandwani,

Thank you for your request.

Sorry for the inconvenience.

We have shared your request to the concern team, we will revert you once we receive the update.

Note :-
SMS "CLAIMS <claim number>" to +91 96631 49992 to know the claim status
Eg: CLAIMS 99999999 and send SMS to above number (Charges Applicable as per customer tariff)

Regards
Medi Assist India TPA Pvt Ltd.



01/08/2015 11:50 - Manish Chandwani wrote:
Any update on the same ????

Regards
Manish
7688888808

-----Original Message-----
From: Manish Chandwani
Sent: Friday, July 31, 2015 08:57 PM Malay Peninsula Standard Time
To: 'cashless@mediassistindia.com'; 'cc@mediassistindia.com'
Cc: 'hnghmediclaim@gmail.com'; Abhishek-A Agarwal
Subject: FW: Fwd: Regarding Your Denial Letter of Mr. Dilip Chandnani Claim No.-11470477

Hi,

Could you please describe the reason of rejection. As I have attached a detailed letter from the hospital that it is not a PRE DISEASE.

Patient has the heart blockage issue in the different pipe of his heart not in the last one which we claimed and that claim is also received from my floater not from my top up.

I have paid for the Top-up plan for my entire family for this year. If I will not received proper response from your side, then I will not continue any policies from you company in future.

I have called to your customer care executive several times even they have not responded on the same. Just only your Doctor team says that this is a pre disease I will not take this for granted because my doctors from the hospital are ignoring it.

There are different type of disease in the heart. As per your remarks it is not considerable at all. I have spend my money on your policies and I want the proper services from your side.

Kindly treat this mail on prior basis. I need the complete feedback from your side and agreement from both Hospital and your doctors team that it is a pre disease. If not then I need total cash less claim.

Hope you respond on it very soon.

Thanks
Manish Chandwani
7688888808

-----Original Message-----
From: Heart Hospital [hnghmediclaim@gmail.com]
Sent: Thursday, July 30, 2015 08:20 PM Malay Peninsula Standard Time
To: Manish Chandwani
Subject: Fwd: Regarding Your Denial Letter of Mr. Dilip Chandnani Claim No.-11470477


---------- Forwarded message ----------
From: Heart Hospital <hnghmediclaim@gmail.com>
Date: Thu, Jul 30, 2015 at 5:44 PM
Subject: Regarding Your Denial Letter of Mr. Dilip Chandnani Claim No.-11470477
To: cashless@mediassistindia.com


Thanks & Regards,
From
Heart & General Hospital, Jaipur
Phone No.- 0141-2370271
Fax - 0141-2378859


---
This e-mail may contain confidential and/or privileged information. If you are not the intended recipient (or have received this e-mail in error) please notify the sender immediately and destroy this e-mail. Any unauthorized copying, disclosure or distribution of the material in this e-mail is strictly forbidden.

Privacy of communications
Please note that, in order to monitor compliance with legal and regulatory obligations and our policies, procedures and corporate compliance programs, we reserve the right to review the content (including any personal data and customer information) of emails and instant messages passing through our IT systems, and to record telephone calls routed via our telephone systems. We will only do so, however, in accordance with and to the extent permitted by local laws and regulations. Kindly bear this in mind when communicating with our staff. In some countries please refer to your local DB website for a copy of our Privacy Policy.
tanuj12485
 
Oct 8, 2015

Status of Claim for Policy 231200/48/2016/372

Hi Sir,
My parents have taken the Mediclaim policy from Oriental Insurance i.e (Mediassist under policy no-231200/48/2 ). 2 weeks back my mother has got her surgery done from Max for fibroid in uterus we have submitted all the documents to the TPA present in the hospital but after continous followup's they have rejected the cashless mentioning that they cannot undergo surgery before 3 years.
At the time when we have purchased the policy we have not told all this and even in the policy papers these treatment doesnot comes under afer 3 years bracket. we have sent many emails but no outcome. we tried to contact all the customer care and tried to contact nodal officer no one is responding. I would like to escalate this maater to media and log a complaint in consumer court and national and international grievance cell.This is causing mental torcher.
If any more details are required kindly contact.

Regards
Tanuj Sahni
Avinash Kapoor2009
 
Sep 24, 2015

Inaccurate Approval

Dear Sir/Maam,

My wife was admitted in Khanna Nursing Home for delivery and we were blessed with baby girl on 7th of Sep-2015 at 4:50pm and on 8th Sep-2015 we were referred to Orchid Hospital as wife was unable to breath and pain in chest.

I got a Maternity claim for orchid Hospital wherein delivery was done by Khanna Nursing home... and surprise to see i have a sum assured amount limit of 2 Lakh and now i am getting redirected from one to another to get my complete claim.

Claim Amount for Khanna Nursing Home was : Approx 65K (Cash Paid by Me, No claim received)
Claim amount for Orchid Hospital Was : 72 K ( Amount Approved Only 47500 for maternity wherein no delivery done by orchid).

Also there is no details available on website to share the concern with higher management. i .e Mr. Vikram Chhatwal (CEO).

I Went to Noida Office and Met with Mr. Manish , Mr. Inder but unable to get satisfactory answer.

I have also give this feedback to my corporate HR team that not to continue with medi assist further with such a poor services and suppport.

Regards
Avinash Kapoor
(9899133552)
aravind230590
 
Jul 28, 2015

Denied without reason

I'm working for TCS i have raised a claim under mediassist and submitterd all my original documents and scan reports but now the status is denied letter sent . No one is picking the call worst response . My claim number is 91103786 .I din receive proper clarification form them regarding my claim this is frustrating .. I need lodge a complaint Please help me .
manzTCS
 
Jul 21, 2015

Mediassist is the worst TPA

My father had cataract surgery in hospital on 22 Jul at 8:30 am, and the hospital sent all the documentation on 20 Jul. The PreAuthorization was in pending from 21 Jul.

As my parents were traveling from outstation, sp I called MediAssist folks (had to try hard to talk to their Customer care number posted on the site) few times to confirm if the approval will be done before the scheduled appointment. They gave false promises that approval will be done in 1 hour (blah blah...) and my parents had to wait in the hospital for hours together on 22 Jul and approval never came.

I called their customer care and as usual they gave excuses, and they don't have escalation manager or Floor lead in charge to listen to the problem. They promised me for callback, but I never got a call back.

This is frustrating. Think of patients who are admitted and need urgent assistance.

I work for TCS and I am not sure why our company still continues with this kind of unethical TPA.
Karthik GS
 
Jul 13, 2015

Cliam got denied

I'm working in TCS. Please find my details below.

Employee ID: 574445
Name: Karthik S
Contact no: 8124096465
As I was hospitalized from May 26 to May 30 in this year but in two different hospitals as below.
1. 26 May to 27 May in Apollo hospital.
2. 27 May to 30 May in Royal balaji hospital.
So I have raised two hospitalization claims.

I have missed to choose Pre-hospitalization in 1st claim so this has been rejected as not completed 24 hours.

And in 2nd claim I have provided all the required bills, discharge summary etc but they are denying it mentioning that they they require self explanatory letter, original scan copies and treating doctor's letter regarding my illness. I will be able to provide self explanatory letter and scan copies. But my treating doctor confirmed to me that he will not able to give it as he provided everything clearly in discharge summary. Also I have called a mediassist guy named Ramasamy gave it my treating doctor once again he mentioned clearly that he will not give the letter.

Please help me to process my 1st claim as Pre-hospitalization and 2nd claim. The mediassist is really worst in helping the insurers.
chinnavc
 
Jul 1, 2015

Need Terms and conditions Page

I am planning under go surgery , i am trying to find the terms and condition page before admiting, because we will believe you (Medi Assist) and we visit super speciality hospital for a treatment, once done you people will be rejecting the claims. so i need to go through Terms and conditions.

please share the page link.

NOTE: IF MEDI ASSIT IS DOING SERVICE GENUINELY PLACE THE TERMS AND CONDITIONS TAB SEPARATELY AND ASK THE CUSTOMERS TO GO THROUGH THAT >>

INSTEAD OF HIDING (OMG)
nitinprakash3
 
Jul 1, 2015

Never Go for Mediassist TPA

This is useless TPA, they denied my claim twice with false reasons. This time I asked for policy copy and they don't have a policy copy either. Once their customer care says something and later somebody else will say whatever said previously was incorrect. I really doubt their credibility.
arif619
 
Jun 23, 2015

Non Approval Of Claim

My father(MOHD BASHIR) has been hospitalised for last 4-5 days in ajnata hospital(lucknow).
MA ID-5005548269

the claim firstly settled upto 20k then cancelled.
i need complete information regarding the cancellation pls forward me the soft copy as well.
i need the policy terms and conditions as well in soft copy on what basis the claim ha sbeen denied.
i except positive response form your side please co-operate to settle the claim but if not pls provide me the documents which i asked .
i have to move further to submit my application into consumer forum.

Mohd Arif
satmanyu
 
Jan 20, 2015

inconsistent and absurd reason for rejecting hospitalization claims

Mediassist had approved 2 claims for treatment of prostate cancer but later started rejecting claims with same treatment which are continue monthly.Now there are 2 claims(90285972,90325697) denied which is not at all consistent with previous claims(90053934,90105765)
ushataneja
 
Oct 24, 2014

Denying cashless treatment without knowing the actual facts

Hi,

My name is Usha Taneja and my ma-id is 5009973630, medi assist has a history of denying cashless claims. I am a patient of breast cancer and now the cancer has spread to my liver & I need urgent chemotherapy but medi assist is denying the claim on the groung of pre existing disease. They approved for surgery for same disease and denying for chemotherapy for same disease on the ground of pre existing disease don't know what logic they follow. I don't know why we have TPA like Medi assist they should have name like Medi Reject. They are not the helping hand rather they are worst TPA that I have seen so far. They always deny your cashless treatment. They want you to suffer more and more and die before u caim them for medical expenses.
Nikitha G.R
 
Sep 29, 2014

Reset the Password

I forgot my password to login mediassist. When give forgot password option, It asks my date of birth then nothing has been displayed and no password has been sent to my mail ID.
Kindly check on this ASAP and revert to nikitha.9@tcs.com
Sujathab
 
Mar 28, 2014

login error for TCS employees

I am TCS employee (id is 472599) unable to login and not able to retrieve the password using forgot password link. Pls do the needful. Appreciat your help
prashantk143
 
Mar 13, 2014

Declined the Claim

Our patient is hospitalized in the Aditya Verma Medical center and this hospital is in the network list so the cashless claim was forwarded to the insurance company however firstly they asked for patient ID proof then they confirm final bill will paid when patient will discharge and at the time of Discharge there response received was that the Typhoid is not covered, hence cashless declined.
So we need to understand more on this if the disease like Typhoid is not covered then what is covered in the policy and in the policy Terms Exclusion no where mentioned that Typhoid is not covered in the first year of policy and also wanted to know the policy details where it clearly states that the Typhoid is not included.

Secondly if disease is not covered in the policy then in first go why TPA has not reject the claim. And also receive the message from TPA Cashless declined and submit for possible reimubursement.

Name-Tara Dutt
Policy No.-221500/48/13/06/00000822
PA No-9856342
mobile:9868144392
prakashvelamkar
 
Feb 13, 2014

denial of claim

Dear sir,
With the reference to MAID: 5009120816, claim no. 2987139 for claimant, Madhuri and prejudice views emailed to me on 28.01.2014 which led to the rejection of claim, I would like to bring to your kind notice the following facts-
1) The patient was admitted in the hospital from 15.8.13 to 17.8.13 for loss of movement of hand and loss of speech for 10-15 min. which is the case of TIA and it was not pre-existing disease like RA, DM.
2) The HTN was first detected on 21.9.12 which was less than a year ago and patient was on medication since then.
3) Please refer the attending doctors certificate dated 31.12.13, all indoor case papers of hospital dated 20.2.12, 27.07.12, 14.8.12 which were before first detection and outdoor case papers dated 26.11.12, 11.12.12 after first detection of HTN. These documents were already produced to your Baroda Office.
In view of above, I had once again requested Medi Assist to go through all papers submitted on 26.8.13, 16.9.13 & 31.12.13 and email correspondence with Mr. Nayan Purani of Ahmedabad office and settle the pending claim urgently. But there is no reply so far.

With thanks and regards,

Prakash Velamkar
796840@tcs
 
Oct 21, 2013

unable to login

forgot password when entered it says user account logged out.
Minakshimp
 
Oct 1, 2013

WORST RESPONSE AND SERVICE FROM MEDIASSISTS

Medi assist is providing world's worst service for cash less treatment. Patient is admitted yday, although all details faxed to them yday evening, till morning no revert. Morning After calling them 51 times they told no id changed .hospital tried faxing 20 times and getting failed
im not able to get patient discharge d yet
988047199
Shabana7
 
Sep 12, 2013

Medicine Replacement

I am corporate employee of Wartsila. I Place an order for medicine on 28 August 2013 and I have still not recieved the medicine. So Many times I had called at call center and they are just giving an excuses that it will delivery it now. Could you please check the issue and revert

Name Shabana Samdani
email ID: sshabana7@yahoo.com
uday.maley
 
Aug 20, 2013

claim denied with false reason

My claim number 7986934 was denied saying lab reports are not submitted. But i submmited all the original bills and lab reports . I tried calling them from last 3 days but no one is lifting the call.I tried calling them more then 50 times but no one is answering the call.I'm an employee of tcs.

email id :- maley.uday@tcs.com
Number :- 8499096096
name :- uday maley
MOHAMMAD RAASHID
 
Mar 17, 2013

claim

my policy no. 221500/48/11/06/0000/1490 and claim amount 725 RS. SO MANY TIME I CALL MEDI ASSIST OFFICE AT NOIDA EVERY TIME HE TOLD ME WE WILL SEND YOUR AMOUNT AS SOON AS POSSIBLE AND FOUR TIME I VISITED AT NOIDA BRACH BUT NO RESPONSE TILL NOW
gitu_279
 
Feb 21, 2013

Wrong hospital name

21.02.2013
Wrong hospital name

In the above mentioned complaint I have forgot to mentioned my details. I am working in TCS,
My contact no is 9980490614
gitu_279
 
Feb 21, 2013

Wrong hospital name

21.02.2013
I wanted to do avail the cashless facility for my father; but hospital authority is telling that they can not give any cashless facility
because they donot have any connection with mediassist. But the corresponding hospital name is included NIA network
hospital list. Hospital name is given below-
Hospital ID Hospital Name Address
68517 PRAGATI HOSPITAL&RESEARCH CENTRE N.H-37,BYEPASS,JENGANIKATIA,SIVASAGAR,ASSAM.

According to hospital authority they never a part of medi assist. The worse part was that I treied to contact mediassit bangalore
toll free no,but did not get any positive feedback. Many times they hold my call for checking but after sometime it got disconnected automatically.There is a huge gap between hospital authority and mediassit, none of them are ready to solve the issue. At last around 2 pm I got one lady no who is responsible for Assam region, but she never picks up my call. I was deeply frustrated
whom should I contact. This is not only one hospital , I tried many hospital in Dibrugarh,sibasagar and sivasagar. But same reply
every time, none of them ready for cashless facility. I have only one question if there is connection between the hospital and mediassist than why they are simply keeping
those hospital name in their list???? Is this the way of giving support to people....... I am deeply frustrated, does not know where to go now?????/

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