Subject: Claim ID 15404224 – Wrong Amount Deducted
My Name: Rikinbhai Shah
My City: AHMEDABAD
My State: GUJARAT
My Complaint Against: Medi Assist TPA India Pvt Ltd
Complaint Category: Insurance Companies
Claim Amount (Approx.): 3750
My Complaint Description:
I had taken insurance policy from Punjab National Bank & my TPA is Medi Assist TPA Pvt Ltd.
I had given Post Claim as on 29.09.2017 of Rs 5042.00 vide claim no. 15404224 for my wife name as Jyoti which includes Report Charges, Consultation Charges & Medicines Charges.
As per report Haemoglobin of my wife is 8 gram only so Doctor suggested 3 months medicines to be continues & he written the same as on 22.09.2017 & the same I had been purchased as on 23.09.2017.
Now TPA approve only Rs. 1292 (150 Lab Charges, 600 Consultation Charges & 542 against medicines) While I had putted medicines bills of Rs. 4292.00 for all the months as per prescription dated 22.09.2017 (which is in 60 days period) Also they denied the same medicines which has been already paid in main claim & now they said its of protein medicines so not to be paid. But as per doctor the same is required for the patient for the recover the normal stage. How TPA can denied the same medicines which they had already paid in main claim?
Now TPA rejected Rs. 3750.00 as query complaint 60 days & approved only Rs 542.00 which is wrong amount. (They had already recalculated yesterday by their doctor panel the same & accepted this had their mistake only)
When I visited TPA office the manager named Mr Prashant gone away in office hours & also not picked my call tried more than 3 times. And staff is behaving like nonsense with me & refused the process my excess amount which has also accepted by them that is their mistake.
So, request you to see in matter & help me for cleared excess amount form the TPA so that insurance company can pay me. I had attached Claim Settlement Advice for your ready reference.
TPA contact details are as under,
Medi Assist Insurance TPA Private Limited.
401, 4th Floor, Rembrant Building,
Opp.Associate Petrol Pump,
C. G. Road, Ahmedabad – 380006.
Customer Care Department
Email: [email protected] , [email protected]
Request you to clear my pending excess payable amount ASAP & take some action against TPA for the mistakes they had done.