Hi All,

I had a bad experience with TPA MediAssist. I went for Pre-approval for Cataract Surgery which is quoted by hospital as Rs. 34,500/-. They approved only Rs 20,000/-. I asked the reason for not approving the entire amount of Surgery. The hospital and TPA replied back we can get the entire amount of surgery by requesting enhancement and asked us to admit for the surgery as the process of enhancing will take some time. They did collected the cheque for the remaining amt. As soon as the surgery is over MEDIASSIST informed that remaining amount cannot be approved. The question here is:

Why they are not giving proper explanation for the amount approved and amount not approved?

What are the procedures for doing enhancement ? And they why it is informed after the patient got admitted to hospital and remaining amt is paid(meaning of cashless hospitalization is invalid).

So Beware whenever Hospital or TPA is talking about enhancement and they are cheating in form of having that option.

Thanks

CLAIM NOT SETTLE BY MEDI ASSIST
Hi

My name is Vijay Kumar and my Medi Assist ID no Is- ID NO-282510310452 and policy no- 1306/282510310452, i have submitted all the documents in Delhi head office(Sant Nagar , East of Kailash) on 8/9/09, but till i dont get any response regarding my claim , so please tell me when will i get the my claim money?

i m not getting any reply from medi assist.

I have submitted all the documents more then 4-5 times in MEDI ASSIST Office

have submitted again all the documents as per your MEdi ASSIST REQUIREMENT submitted in DELHI (East of KAilash Branch) on 27/10/09 by Hand to Ms.Priyanka.

I m Submitting this my docs at 3rd time please process urgently, and one thing is more when i called to ur branch Delhi office east of kailash there is some person Mr AMIT he is not giving any proper answer and also missbehave on phone.


Thanks

Vijay Kumar

PH NO-9718008500, 9211094436,9250520518

[QUOTE=Unregistered;10526]Hi All,

I had a bad experience with TPA MediAssist. I went for Pre-approval for Cataract Surgery which is quoted by hospital as Rs. 34,500/-. They approved only Rs 20,000/-. I asked the reason for not approving the entire amount of Surgery. The hospital and TPA replied back we can get the entire amount of surgery by requesting enhancement and asked us to admit for the surgery as the process of enhancing will take some time. They did collected the cheque for the remaining amt. As soon as the surgery is over MEDIASSIST informed that remaining amount cannot be approved. The question here is:

Why they are not giving proper explanation for the amount approved and amount not approved?

What are the procedures for doing enhancement ? And they why it is informed after the patient got admitted to hospital and remaining amt is paid(meaning of cashless hospitalization is invalid).

So Beware whenever Hospital or TPA is talking about enhancement and they are cheating in form of having that option.

Thanks[/QUOTE

Hi,

Its not that Mediassist has cheated you.

Please read below how a cashless works

If a person gets admitted to a hospital the concerned doctor/hospital has to fill pre authorisation request form and send the same to the concerned TPA.The TPA will approve/disapprove(as per terms & conditions) a nominal amount and send in the reply it to the hospital.
At the time of discharge the Doctor/Hospital has to send all the details like Final bill,discharge summary, investigation reports,etc to the TPA,then the TPA will procees the claim & approve/disapprove based on the terms & condition of your policy.

It is most important for anybody to read the terms & conditions before one takes a policy.
They don't cheat just like that.

If you have paid on your own go to Mediassist & get expenses reimbursed by filling a claim form & submit all the original documents you have with you

Yes, you are right . Media Assist TPA is completely fraud..........................

We went for cashless facility. Customer care person clearly declined , but give complaint number so to claim latter on.

Policy holder is having Mediclaim policy Gold Plan of Reliance General Insurance company .Person affected intimated to TPA on 31st Aug who alloted intimation reference no 6213 & accordingly related required documents submitted

Claim against Policy # 282510350754 was requested around 3 months back .

Still there is no status update on the matter .

This is happening with the insured person who is alive. What will be their response when something happens to insured person & their family went around for whole process.

Can we all start common campaign against this TPA.


Naveen Soni
Policy No- 282510350754
Reliance Mediclaim Policy - Gold Plan
Cell No- 93130-71561

Hi all

i am putting forward my experience with medicare tpa regarding empanelment of our hospital. Our hospital is established in 1977 with a very good reputition. I applied for empanelment of our hospital with medicare tpa. This is the response you get if you apply for empanelment with medicare.

how old is your nursing home ?

my reply - 32 yrs

sorry not audible comes the reply, i repeat 32 yrs

How many bedded - 52 beds

sorry not audible again

i repeat 52 beds

i inform the incharge that our hospital is a well recognised centre and that we are recognised by 10 other tpas

there are 40 tpas in india do u know that comes the reply

BEWARE DOCTOR Colleagues if you are planning to apply for empanelment with medicare tpa, get ready for humiliation

be prepared to face the arrogance of the empanelment incharge

if the incharge replies this way to a senior doctor imagine the plight of the insurance card holder or any common man who would apply for insurance with medicare tpa

i warn you again beware, beware

GOD BLESS MEDICARE

Medi assist has given approval of 50,000 against estimated cost of treatment 90,000/- of a reputed Nursing Home. The Hospital authority asked for deposition of balance amount. Could one can help me out how to get the balance amount. If there is any forum to get redress for such unethical job. Kindly let me know. What is the meaning of so called cashless benefit. The helpline as provided by them is asking for the extension number otherwise IVRS system replied 'Dial next day" and on the very next day the message repeats. How they are cheating you can realise. Sujoy mondal.

hello, the new india insurance co. maid group mediclaim policy, and term & condition is pri disis are after 30 day and same day cover. they made two diffarant tipe policy. but the time of claim insurance com told claim rasiyo is very high. so they are all claim is reject. i have my complen submit the new india R.O. but ther are no answer this problem. so pls . pls ... pls i request

Branch Manager Dr. Faisal involved in fraud claims.

Hi all, my MAID is 5003447649,
we applied for Pre-auth letter from KIMS, Hyd on 04 Oct 10 for admitting on 07 Oct 10, so these medi asst people are sleeping till 07 Oct 10 by not takin any proper action on it and awaited till 07 Oct and came to the hospital in search of the patient, what is cashless, if one have to admit in the hospital by paying advance to the hospital why do we need these cashless facility. so as we didnt get any confirmation, we postpone the surgery for the other date given by the doctor. meanwhile these medi asst guys namely, Mr Santosh, who put the remarks on the pre-auth is stating, patient not admitted on the hospital, his intention we came to know when we approach him directly that, if they prcess the cashless they wont get any benfits, so they encourage re-imbursement so we go them directly and ask them for request so they can seek the percentage on the entire amount. so this is what happend with me in the hyderabad branch here. and moreover Ms Gurpreet kaur is also involved in this with him. so evrything plannedly they are doing., such people shouldnt get encouraged.

[QUOTE=Unregistered;25984]CLAIM NOT SETTLE BY MEDI ASSIST
Hi

My name is Prakash Kanade and my Medi Assist ID no Is- ID NO-282510144538 and i have submitted all the documents in Mumbai, Andheri Office , but till i dont get any response regarding my claim , so please tell me when will i get the my claim money?

i m not getting any reply from medi assist.

I have submitted all the documents more then 4-5 times in MEDI ASSIST Office


I m Submitting this my docs at 3rd time please process urgently, and one thing is more when i called to ur branch Mumbai, Andheri office noone gives any proper answer and also missbehave on phone. Their line is always busy.


Thanks

Prakash Kanade

PH NO-9869008667 / 9821448587

Yes, i do agree, i have submitted all the necessary documents of my claim, but they are still asking for N number of documents... and not replying back to mails.. i will for sure lodge a complaint n consumer court if my claim is not approved.. Guys please dont be victims ..rise against them.. you can make a difference

Hi


My name is Jayanta Chakraborty and my TPA Medi Assist reference no Is- CCN #5819554 and policy no(Which has been taken from Relience General Insurance )- 1503/702825000379, I was admitted in Care and cure (barasat,24 PGS north,W.B) hospital from 27/03/2011 to 29/03/2011 for my gall stone surgery and this hospital is in listed hospital for cash less facility. And hospital management was submitted all the document as per requirement of Medi assist for cash less facility.In 29th of March'2011 one letter was received by hospital from medi Assist and medi assist denied this cash less facility and asking possibility of reimbursement of this expenses. Accordingly ,I have submitted all the original document for this claim as desired by Medi Assit on 19/04/2011.After passing long time now(03/05/2011) Medi assist raised some issue regarding documentation of this policy. Further ,Medi Assist wants following documents,
i)The advice for admission.
ii)The duration of presenting complain.
iii)The Continuation from Insurance company as there is 10 days break in the policy.
In view of above ,I want to point out that the intension of medi assist not been cleared to me. And this is for your kind information that ,my policy has been 3 years old and question of continuation of policy does not arise because I am suffering acute abdominal pain and fever from 05/03/2011 and my policy premium paying date was 09/03/2011 and I already paid it on 20th of March and laproscopic surgery was done on 27th March'2011 and the reason for this late submission of premium is due to my bad health condition.
Secondly, advice for admission does not arise because with out advice of doctor no body can admit in hospital.
last but not the least ,I can't understand the meaning of the duration of presenting complain.
This type of attitude of Medi assist is increase my distress level.
I think medi assist try to forfeit my claim .So, please suggest me and take proper action to that.

Thanks And regards,

Jayanta Chakraborty
(9163275587)
chakrabortydotcom@yahoo.co.in

Hi

My claim no is 5519876 this claim took almost 8 months to say that the claim is rejected and could not be settled as because of "new policy" and for this I had to visit medi assists office several times as their phones are always engaged. To check whether the policy is new or old and whether the policy will be claimed or not takes 8 months ??? and even after when the policy got rejected I asked to get back my file I haven't got any response yet I also gave the required forms but still no reply....Its almost +2months I am fighting to get my file back after claim rejected. Its really pathetic service from medi assists. I still don't know why are they not giving my file back if the claim could not be settled.

Please help me with this .....

Regards

Sachin Murudkar

Hi,
I had paid the premium for me and my parents(father and mother) for the period May 2011 to May 2012 ,but due to some personal problems i have resigned the job on 16th NOV 2011. I have claimed some claims on 31 OCT 2011 and till now no update on those claims . Don't i have access to mediassist if i resign from the company , as of now i'm unable to login to the portal . If not is it the correct way, i had paid the entire premium for a specific period and why i am not applicable atleast to that period??...





Thanks & Regards,
Chandrasekhar Gupta Yelchuri,
chandu_gupta143@yahoo.co.in