20 Reasons for Grievances in Health Insurance and What You Should Do

Health Insurance Grievance ? List of all TPA's in India and their grievance redressal email Ids

When ever you are not satisfied with a claim processing, you as a consumer have a right to escalate it to get redressal. The regulator has put in formal structures to help you do that. Following is a list of grievance email ids for all TPA's in India. 

The typical grievances that we have observed relate to denial of health insurance claim or partial settlement of the claim. 
The processing of the claim is a function of the policy terms and condition. 
The grievance can be filed through any form of communication including phone, email or a letter

List of Grievance Redressal Mechanism for TPA's


Serial NumberTPA NameWebsitePhone NoGrievance
1United Health Care Parekh Insurance TPA Private Limitedhttps://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx1800-209-8884complaints@uhcpindia.com
2Medi Assist Insurance TPA Private Limited www.mediassist.in1800-425-9449grievance@mediassist.in
3MDIndia Health Insurance TPA Private Limitedwww.mdindiaonline.com1800-209-7777https://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx
4Paramount Health Services & Insurance TPA Private Limitedwww.paramounttpa.com1800-226-655https://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx
5Heritage Health Insurance TPA Private Limitedhttps://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx 1800-345-3477https://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx
6Family Health Plan Insurance TPA Limitedwww.fhpl.net1800-425-4033https://www.fhpl.net/Main/Grievance
7Raksha Health Insurance TPA Private Limitedhttps://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx0129-428-9999https://www.rakshatpa.com/WebPortal/Login/Grievance
8Vidal Health Insurance TPA Private Limitedwww.vidalhealthtpa.com1860-425-0251https://www.vidalhealthtpa.com/home/Grievance.html
9East West Assist Insurance TPA Private Limitedhttps://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx011-47222666https://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx
10Medsave Health Insurance TPA Limitedhttps://www.medsave.in/index.aspx011 -71221234https://www.medsave.in/WebGrievanceMail.aspx
11Genins India Insurance TPA Limitedhttp://www.geninsindia.com/0120-4144100
12Alankit Insurance TPA Limitedhttp://www.alankithealthcare.com/index.aspx1800-11-3300https://www.alankit.in/forcomplaints.aspx
13Health India Insurance TPA Services Private Limitedhttps://www.healthindiatpa.com/Home2.aspx022-66131199https://www.healthindiatpa.com/Additional/Web_Complaint.aspx
14Good Health Insurance TPA Limitedhttps://goodhealthtpa.com/1860-425-3242https://goodhealthtpa.com/?page_id=497
15Vipul Medcorp Insurance TPA Private Limitedhttps://www.vipulmedcorp.com/0124 483 3900https://www.vipulmedcorp.com/processing/Grievances/public_Grievence.aspx
16Park Mediclaim Insurance TPA Private Limitedhttps://parkmediclaim.co.in/1800-11-55-33https://parkmediclaim.co.in/Contact
17Safeway Insurance TPA Private Limitedhttp://www.safewaytpa.in/1800 102 5671http://www.safewaytpa.in/grievance.aspx
18Anmol Medicare Insurance TPA Limitedhttp://www.anmolmedicare.in/default.aspx1800-233-1999http://www.anmolmedicare.in/Anmol/CustomerGrievance.aspx
19Grand Insurance TPA Private Limited  
20Rothshield Insurance TPA Limitedhttp://www.rothshield.co.in/1800 228 144 
21Ericson Insurance TPA Private Limitedhttps://www.ericsontpa.com/index.aspx1800-202-2034grievances@ericsontpa.com
22Health Insurance TPA of India Limitedhttps://hitpa.co.in/1800 180 3600https://mdindiaonline.com/StaticPages/ComplaintRegistration.aspx
23Vision Digital Insurance TPA Private Limitedhttps://visiontpa.in/18001029982https://visiontpa.in/Grievance.aspx

Once a grievance has been officially communicated to the third party administrator, it needs to be acknowledged by them including sharing the process that will be followed to address the matter, the person designated to address it and the time line within which it will get addressed.
If the redressal of the grievance is not as per your satisfaction, you can subsequently approach an insurance ombudsman

Reasons for Grievances in Health Insurance

Most the grievances are related to claim not being paid or not being paid fully though there are other reasons as well why you can approach this mechanism. The following is a list of reasons where policyholders may want to approach the grievance cell 
  1. Claim not being filed by the TPA
  2. Claim not being settled in time
  3. Being asked irrelevant documentation to settle a claim
  4. Being harassed by an investigator
  5. Significant difference between the claim assessed / paid versus the claimed amount / bill amount 
  6. Payment confirmed paid by the insurer has not yet been credited
  7. Being asked for a gratification / bribe to settle a claim
  8. Claimed closed despite responding to the queries
  9. Not all queries being raised in a single go
  10. Claim denied on grounds of non cooperation by the policyholder
  11. Claim denied due to delay in submission of the claim documents as per the policy terms despite providing a reason for delay as per IRDAI guidelines
  12. Claim denied due to non intimation by the insured 
  13. Claim denied due to alleged fraud
  14. Claim denied due to main claim not being submitted by a hospital thereby impacting the settlement of pre and post hospitalisation claim 
  15. claim repudiation without any specific reasons
  16. Claim denial or partial settlement on account of specified policy exclusion or term
  17. Refusal to provide cashless facility in an empaneled hospital
  18. Delay in cashless approval
  19. Incorrect details not being rectified in the insurance records of the TPA / Insurer
  20. Alleged misconduct by the TPA staff or investigator
You can also reach us for pro bono advice even if you are not our customer.

Team PlanCover 

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