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mediassist India

India,
Tamil Nadu

Consumer complaints and reviews about mediassist India

chan2chain
 
Jun 5, 2016

Disrty Service

We requested a cashless hospitalization request they will denied the request without seeing the mode of treatment

maternity capping is a fixed amount 50 k which is very bad in case of pre hospitalization for any minor complications.
it starts from the day of conceive..

very dirty services. company should not sign the contract again.

reimbursement is very difficult.

never go for such kind of services.
chetansuda
 
Jun 5, 2016

Legal action against Mediassist

HI,

Can some one tell if we can raise a legal complaints againt Medi assist. not sure how govt can give authorization to run these kind of firms.
1) Call center number is not valid
2) Head office numbers as per website is not operating
3) They dont have any information about policy
4) Corporate employees are just suffering since their organization i tied up with that and reimbursement is very difficult.
5) No escalation contacts provided any where
frustrated by medi assist
 
Jun 2, 2016

Delay in Claim Settlement non legitimate deductions

Medi assist is THE MOST PATHETIC TPA i've ever seen !!!

My mother got hospitalized in Sep 2015 we submitted all the docs for reimbursement in Oct 2015 ; we received partial claim only in Apr 2016 that too after running from pillar to post !!

They've deducted amount of claim saying original reports not submitted whereas i have an acknowledgment stamped by their Noida office confirming all originals are with them

This stupid call center number never works ; it always says MAID you entered is incorrect

I wish IRDA takes an action against this pathetic TPA ; a person is already so disturbed when family member is admitted to the hospital these TPAs add on to the stress NOT AT ALL HELPFUL rather they humiliate and irritate you to the core
goodyear
 
May 23, 2016

Mediclaim not received

Hi,
I raised a medical claim in mediassit with claim number 12507737.It got approved by 08-04-2016 itself. But still the amount is not reimbursed to my account. When I contact the mediassist help desk they are giving false statements and promises .I am surprised every time the customer care SPOC’s are giving different answers and dead line .I am literally fed up with the approach by mediassist because of the delay . Is this the approach given to every clients of mediassist? As it is already late , kindly help me to get the amount reimbursed ASAP.

Regards
Sachin
linsa
 
Mar 17, 2016

reinbursement of cash for the hospital bill

SIR,
Actually i admitted the hospital for the cyst in PDOC. Not for the treatment of infertility.why should you deny the claim.
policy no:760405/34/15/28/00000139
linsa
 
Mar 17, 2016

reinbursement of cash for the hospital bill

SIR,
Actually i admitted the hospital for the cyst in PDOC. Not for the treatment of infertility.why should you deny the claim
nikhilvohra
 
Mar 5, 2016

Extremely Poor Service

Poilicy No. 231290/48/2016/544-2 - 111738‏

I wrote the below given mail on 9th Jan . Not its close to 2 Months this is still under process. I have given multiple reminders but the revert is its with the specified team. If that is how an insurance company works i think its necessary to take them to the regulator that is IRDA.

Extremly poor service i will wait for another week and the i will write to IRDA for this problem.



This is in ref to the Policy issued above in favor of HBL Vohra (Hari Bhajan Lal Vohra).

Wanted to inform you that HBL Vohra Expired on 19-Dec-2015. So please arrange for refund of prorate premium.

Also wanted to check that HBL Vohra was in alchemist Hospital from 16th Dec 2015 to 19 Dec 2015 and was covered under by a mediclaim policy of my office there is a co payment and non medical charges of Rs 15000/- paid. Pleaase suggest how will i get hat amount fom your end.

Regards
Rajesh bansal22
 
Mar 5, 2016

Claim not paid

Mediassist is fraud
praveenkumar-sri
 
Mar 3, 2016

Delay in reimbursement

Hi,
I raised a medical claim in mediassit with claim number 12271516.It got approved by 12-02-2016 itself. But still the amount is not reimbursed to my account. When I contact the mediassist help desk they are giving false statements and promises .I am surprised every time the customer care SPOC’s are giving different answers and dead line .I am literally fed up with the approach by mediassist because of the delay . Is this the approach given to every clients of mediassist? As it is already late , kindly help me to get the amount reimbursed ASAP.

Regards
Praveen
mchowdappa
 
Feb 26, 2016

Worst service

Trying claim Rs 4,324/-

I have submitted below docs on 14-12-2015 to claim H141220151243370050.

1.Discharge summary
2. Cash Receipt (No: 52413).
3. Reports
4. Claim form.

Still Mediassist team says that I have submitted bills but not cash receipts (I am confusing here how cash bills having cash receipts number and other details) and keeping my claim on hold for more than 2 months now. Response is not good.
sheetal r raut
 
Feb 17, 2016

CLIAM AMOUNT NOT RECEIVED

MY CLAIM REFERANCE NO.11938103 .MY CLAIM WAS APROOVED BY YOU ON 16TH DEC.2015 AMOUNT OF RS.30175/-
BUT TILL TODAY I HAVE NOT REVEIVED CLAIM AMOUNT .AS PER YOUR RULE WITH IN 7 DAYS FROM CLAIM APPROVAL DATE YOUR CREDIT IS GIVEN.PLEASE LET ME KNOW THE PROPER REASON FOR DELAY OF CLAIM AMOUNT,AS I HAVE RECEIVED VARRIES RESONS FROM YOUR SIDE FOR DELAY OF CLAIM AMOUNT. PLEASE LOOK INTO THE MATTER AS EARLY AS POSSIBLE .
trishalajaiswal
 
Feb 5, 2016

Denial of medical claim

Hi Team,

As understand that the OPD treatment is not covered under the same, but i was admitted in hospital last year (for 2 days ) and i have raised the claim and submitted the document for the same and have been reiumbursed the amount.
You may check your record.(it will have all the hospital bills, my MRI scans , my reports etc)

After i was admitted to hospital, i have to go for my continuous check every 4 months and every time my doctor is suggesting huge amount of medicine to take in.
My treatment is a long term treatment, it is going to acquire 4-5 year.

So i need to know what is the option i am left with, i am paying my health insurance per year, but i am not benefited with it.
Let me know the higher contact person, where i can contact with.
I want to escalate the issue as my treatment is very costly and i am facing difficulty in affording it.

Claim No :91837959
Policy : 920000/34/15/04/00000001
Policy Period:01-04-2015 to31-03-2016
Patient Name : Trishala
Policy Holder Name : Tata Consultancy Services Ltd
Claimed Amount : 6628
Final Diagnosis : Convulsions, not elsewhere classified
MAID : 4014366095
Hospital Name/City : MAX HEALTHCARE SUPER SPECIALITY HOSPITAL
DOA : 07 Nov 2015
DOD : 09 Nov 2015


Subject: Denial of claim 91837959 under 920000/34/15/04/00000001

Thanks,
Trishala
trishalajaiswal
 
Feb 5, 2016

Denial of medical claim

Hi Team,

As understand that the OPD treatment is not covered under the same, but i was admitted in hospital last year (for 2 days ) and i have raised the claim and submitted the document for the same and have been reiumbursed the amount.
You may check your record.(it will have all the hospital bills, my MRI scans , my reports etc)

After i was admitted to hospital, i have to go for my continuous check every 4 months and every time my doctor is suggesting huge amount of medicine to take in.
My treatment is a long term treatment, it is going to acquire 4-5 year.

So i need to know what is the option i am left with, i am paying my health insurance per year, but i am not benefited with it.
Let me know the higher contact person, where i can contact with.
I want to escalate the issue as my treatment is very costly and i am facing difficulty in affording it.

Thanks,
Trishala
coolfairy
 
Dec 25, 2015

very poor cashless facility

Patient have applied for cashless since yesterday but till next day evening, there was no revert back. patient was admitted for bipass surgery. The med id is 5010261877.

pl look into the matter urgently
PemaChoden
 
Dec 23, 2015

domiciliaty claim

I'm an employee of TCS and I've been trying to claim the amount for more than a month. At first they denied the claim just because I didn't give original copy of X-ray. I have routine check-up and can't give my routine check-up original reports. Even if I didn't the original report, I wonder what would mediclaim do with my medical report. Before I gave my documents I asked Mediclaim (through TCS admi) that what if I don't give my x-ray and can't give the photo copy because x-ray comes all in black print. They said it's fine. After few days, my claim has been denied and asked to send all the origianl scanned reports, which I did. After that I've not heard anything of them. I've been told that there's only extension number- 69155 and no e-mail address or alternate contact number. No matter when I call and how many times I call, no one answers the call. I've e-mailed few times to kolkata.his@tcs.com but of no response. Even domestic call centre is not so ignorant like Mediclaim. This is really disappointing!!

MediAssist Claim No.- 91507694,
IWP ClaimRegistrationNo.- D1610151031097A002.
It was raised on 16-10-2015.
Claim denied on 27-Oct-2015.
Re-sent the scanned copies around first week of Nov.
swadesh kumar roy.
 
Nov 15, 2015

co. do not provide 100% cashless

sir, we would like to inform you that,my brother sanjoy roy ma-id no- 5006497287 and cashless claim no- 11859897 still now medi assist administrator do not 100% cashless provide the patient. my brother admitted in mission hospital,durgapur,west-bengal from 18/10/2015 to still now and BILL AMOUNT 9,50,000/-(nine lakh fifty thousand) approx before 2 day's ago.
we are requested to take care that matter and provide the 100% means 3,00,000/-(three lakh)cashless facility to your customer.

swadesh kr. roy.
brother of sanjoy kr. roy.
ma-id no- 5006497287.
claim no- 11792401.
policy no- 150403/48/14/8500003014.
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.

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