Medi Assist is one of the leading third-party administrators (TPA) providing its services to millions of policyholders of top insurers in the country. Medi Assist is also the TPA for group insurance policyholders from companies such as TCS, IBM etc. In this article, we will explain the reimbursement claim process of Mediassist, including advice on supporting documents required in the claim, how to fill Mediassist claim form and claim submission formalities.
These documents establish the identity of the patient and the main policyholder and bank transfer detail. Typically four documents are required in every claim:
- 1. Aadhaar card copy of the patient
- 2. PAN card copy of the primary or main policyholder/employee. If PAN is not available, substitute with any other govt. ID proof
- 3. Copy of the Medi Assist card or insurance policy certificate (either of patient or primary policyholder)
- 4. An original canceled cheque of the primary policyholder’s bank account.
Hospitalization & Treatment Documents
Documents that you received from hospital – such as discharge summary, hospital bill, payment receipts, bill breakup, package breakup etc. need to be attached in the claim. All documents need to be original, on colored/printed letterhead of the hospital. Check for following points:
- Hospital main bills are generally a summary of expenses. Make sure to ask the hospital to give you a breakup
- If any surgery package has been added in your bill, ask for the package breakup on hospital’s letterhead or it may be on a plain paper with hospital’s seal
- Receipts of all payments made to the hospital must be added in the claim. Total of the amount mentioned in receipts should match the final bill amount (after deduction of discounts, if any)
If yours is a pre-hospitalization and/or post-hospitalization claim only, then you do not need to bother giving hospital bills or bill breakups. Only a photocopy of discharge summary is sufficient.
You will only be having a consultation, pharmacy, physiotherapy and lab bills, so just add them in your claim. Make sure to check your eligibility for the duration of pre and post hospitalization. All bills in pre and post hospitalization claim need to be in the original.
Remember to add doctor prescriptions (in original) as supporting evidence for all pre and post hospitalization bills you are submitting. In the absence of the same, Medi Assist will not pay for those expenses.
Carefully examine all the lab investigations and scans billed by the hospital and reconcile with the reports you have with you. You need to gather all reports in the original. Original means they need to be on the colored/printed letterhead of hospital or lab. Print on plain paper with hospital/lab seal won’t be accepted by Medi Assist.
If you miss out on any report, Medi Assist may deduct the amount billed for those investigations or it may even raise the query in the claim asking you to furnish those reports. Best thing to do when any report is not available with you is to add a cover-note in your claim and mention the date-wise list of reports which you will not be able to submit as you don’t have them.
If you are filing a pre and post hospitalization claim, make sure you add reports of all investigations for which you are submitting the bills. These also need to be backed by doctor prescription on their letterhead or a lab requisition slip. Most claimants make mistake in this step and lose a lot of money in their claim.
Accident Details, if Applicable
In claims pertaining to accidents, there are additional documentary evidence required such as Medico-legal Certificate (MLC) from the hospital where treatment was taken and Police FIR copy if the accident/dispute was reported to police.
If the accident pertains to self-injury, make sure to add a letter signed by the patient giving elaborate details on how the patient injured himself/herself. It could be a case of self-fall or being hit while playing.