Never provide expected claim reimbursement. Review on Medi Assist India

Medi Assist India TPA Pvt. Ltd.(uses portal Medibuddy.in) is one of the largest TPAs in India so it is unavoidable to find insurance policies where Medi Assist is not selected as TPA. I have submitted more than 7 reimbursement claims to Medi Assist TPA in AT 2019 so here is the first hand feedback on my experience.

1. Medi assist has some predefined SLAs to service the claim(7 days response time) so they provide regular updates on claim processing.

   
   




2. When they receive the claim documents via courier, some ill-trained person(probably a peon) segregates the documents in bills, payment receipts, claim form and ids, investigation reports etc and scans them to upload to a medibuddy portal. 100% of the time segregation done is wrong.

   
   




3. Claim processing team verifies the documents as per segregation and as a result 50% of the queries on my claims were due to wrong segregation. It tells me the expertise level of claim processing team as well. I had to always call them to say that I have already submitted the document and it is located somewhere on medibuddy portal. Personally, I feel it is a matter of shame for Medi Assist that I have to do their job.

   
   




4. Call center wait time is on average 15 mins and their call center team has no medical knowledge. They seemed to be 12th failed and they never allow to directly talk to claim processing team. It feels like talking to a peon to pass on the message to the backend team.

   
   




5. Emails sent to info@mediassistindia.com, retailsupport@mediassistindia.com and delhigrievance@mediassistindia.com are never answered. Only an automated ticket number to get response in 48 hrs is assigned and then forgotten. I have tickets(#5721442, #5721439, #6990874, #7477275) open for more than six months till date.

   
   




6. Medi assist earning and commission are driven by how much less they approved from the claimed amount. So, they will do their best to make deductions. I have experienced deductions such as hospital discount on reimbursement claim(discount to medi assist which I paid to hospital lost Rs 3000), security deposit included in the final payment receipt but without proof(lost Rs 10000 on payment to Apollo hospitals), certain non-medical expenses not mentioned in the IRDA non-medical list(take advantage on customer who lacks knowledge).

   
   




7. Deductions are made only in the final settlement letter and they settled the claim immediately. They do not entertain any feedback or additional documents from customer. So, the claim decision is one way traffic and no customer can challenge it. Only way to challenge is to go directly to the insurance company or log in complaint to IRDA portal which are never entertained.

   
   

It is very unfortunate that IRDA has allowed formation of such TPA companies whose sole purpose is to benefit insurance company. They are of insurance companies, for insurance companies and by insurance companies. Retail Customer/Patient voice is not heard anywhere and IRDA is not bothered about it.

I would not be surprised if I hear that Medi assist works hand in hand with some insurance company executives, pays them regular bribes to maintain TPA status and benefits them by keeping reimbursement amount low but meet claim settlement ratio. Anyways, we live in corrupt India.

My tip is to NOT select a retail insurance policy where medi assist is a TPA rather ask your insurance agent to provide an alternative policy.

If it is an offering from the corporate/employer then there is still some chance to put pressure on Medi Assist via company HR as it is a large business contract.