Name of Complainant	Ankit garg
Date of Complaint	May 4, 2019
Name(s) of companies complained against	Medi assist tpa india pvt ltd and oriental insurance
Category of complaint	Insurance
Permanent link of complaint	Right click to copy link
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“My name is Ankit Garg. I have a group Medi claim policy from The oriental Insurance co. Ltd TPA by Medi assist Insurance TPA private limited through Axis bank employee No. 29428 Policy No. 124500/48/2018/3711_P Medi assist ID 5007946709 Policy period was from 01/10/2017 to 30/09/2018. The dependent in this policy was my wife who’s insurance was free and My parents who’s premium was born by me as per company policy.

My mother Smt Neeru Garg Medi Assist ID 5007946711 insured in the same policy was admitted in hospital Rameshwar Dass Memorial hospital Jagadhri doctor Parveen Garg on 15 August 2018 which was not on panel of Medi assist. She was suffering with Pneumonitis Right side. As per the medi assist policy for the claim I have intimated to them regarding her admission on the same day under intimation no. 10655216. My mother was diagnose by the doctor for 10 days and was discharged from hospital on 24 August 2018.

At the time of discharge we have taken all the necessary documents regarding her admission, Diagnoses, Reports, Bills, Case summary, discharge sheet, Payment receipts etc to submit to medi assist. All the required original documents with X- Ray reports was Dispatched to medi assist for amount 52007/- and received by them on 15th September 2018 as per one-month policy after discharge Tracking ref No was MUM00318498.

The same duly acknowledged. The claim status was showing as in progress. Although in one shot we have completed all the documents. Even then Medi assist demand an addition requirement from hospital on 18th September 2018 against which we have taken the same from Doctor and courier them on 20th sep 2018 which was received by them on 22 september 2018 Under POD no. 79949782 Skyline courier.

After Receipt of the letter the claim status was showing as In progress till 09 January 2019. In this period I have contacted to them several times through toll free no., E-Mails, and was tracking on Medi App and on link provided by them. I was given the information that your claim was under investigation in the month of October, November. In December I come to know that the positive investigation report is submitted by the investigator as he visit in the hospital and cross check all the bills, reports, discharge summery, Diagnose, ID proofs of my mother etc and found ok.

Again I started tracking my claim. Many- Many times it happens that the call centre people make my call on hold for a very long time and then disconnected without giving any status. I Have send many trail mails on mediclaim@mediassistindia.com but except two three times I did not get any response. Now on 28th December 2018 they again request a letter from the hospital stating the recommendation of 10 days hospitalisation from the doctor which we have send to them on 31/12/2018 under pod no. 83786448 received to them on 03/01/2019.

Now on 11th January I come to know that my claim is being denied by Medi assist due to the clause 5.5 Claim Documents not submitted within three months and on maximum 3 reminders. I just want to know my fault where I am lacking. Every time when they demanded a document from us, I provided the same within 10 days. Investigation process takes approx. 2 months then where is my fault that I have not completed all documents within 3 months. Even when they demanded letter from hospital on 28th December 2018(Which was not required) and if required why not asked earlier in last three months, I have provided them within 10 days.

Again I called them up to recheck the same on 11th Jan 2019 and register a complaint on their toll free number against complaint no. 5966013. On which they ask me to wait for 3 working days and the claim will get approved. Still the same is showing as denied. Now whenever I am trying to contact them on their toll free number they are just putting my call on hold. On mail No response is given. Even Medi assist customer care escalations is not picking my phone. Is this the way to treat a customer query? I did not create a forged admission of my mother.

You can check it at any time. Then why my claim is denied. My claim is denied intentionally by Medi assist and just to pass three months to apply clause no 5.5 they took 2 months of Investigation. And still demanding more documents. My request to all of you to please look into the matter and resolve as soon as earliest possible.
Dear Team In continuation of the above complaint even after your intervention The Medi assist and OIC in not processing my claim. After your intervention They ask me to submit some more documents from the hospital which i have couriered them and received by them on 4 March. Even once again they raise a query to submit clinical noted from the doctor which was again taken from the doctor and submitted to medi assist and received by them on 20 March. After that i have send many mails to them to confirm me the status.

Also talk on their helpline number but sorry to say that they are not even responding on my mails nor giving status on phone. One of their executive said that the claim is in process and you will get a new claim number in a day or two But i am still waiting. I need help from your side please. Request you to please take a serious note on this that why they are not passing my claim while i have submitted all the document again and again when ever they required.

Even i also ask him in case you need to investigate the same they can arrange another investigation in the hospital and meet doctor to get the every thing cleared.

I am very much surprised that the kind of services Medi assist and OIC is providing. Please help me passing my claim on urgent Pleaseeeee. ”

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