To

Medi-Assist insurance TPA pvt ltd

Sub -
1. Valid reason for delay intimation or no intimation of claim.
2. Valid reason for delay in submission of claim.

Ref -
1. Email correspondences from vshambhar83@gmail.com to msebmediclaim@mediasssist.in
with generated ticket nos as-6463666431, 6464091203, 6492525486, 6512267292.
2. Telephonic calls to MSEB mediclaim helpline no-04068172727 on dtd. 04.03.2022,
06.03.2022 and 29.04.2022 from my telephone no. 7620915912.

R/Sir, mam,

This is in reference with above mentioned subject, my daughter Miss. Ojasvi vivek Shambharkar
is born on dtd. 21.01.2022. Due to certain serious health issue problem, she was admitted to
Trinity children's hospital Chandrapur on dtd. 03.03.2022.

I informed her Hospitalization to Medi Assist on email id msebmediclaim@mediasssist.in on dtd.

04.03.2022 and asked about guidelines regarding reimbursement of Hospitalization Claim as
she was the new member of our family. Generated Ticket no was- 6463666431.

Again on same dt. i. e. 04.03.2022, I emailed to msebmediclaim@mediasssist.in regarding

enrollment of my daughter Miss. Ojasvi vivek Shambharkar and onward acknowledgement for
mediclaim reimbursement. Generated Ticket no was- 6464091203.

After several correspondences, on dtd. 15.04.2023, I confirmed the enrollment of my daughter

on email. Generated Ticket no was- 6492525486.

So I think I intimated the said Hospitalization reimbursement claim via email on

msebmediclaim@mediasssist.in on dtd. 04.03.2022 itself.

Meanwhile after first Hospitalization from dtd. 03.03.2022 to 06.03.2022, my daughter Miss.
Ojasvi vivek Shambharkar again hospitalised in the same hospital i. e. Trinity children's hospital
Chandrapur on dtd. 17.03.2022 to 21.03.2022.
I was very very busy in caring and looking after the medical treatment of my daughter after
discharge from hospital on dtd. 21.03.2022.

After enrollment confirmation on email on dtd. 15.04.2022 (Ticket No. 6492525486), I raised my
issue/query about the Hospitalization claims for both the Hospitalization i. e. From 03.03.2022 to
06.03.2022 and 17.03.2022 to 21.03.2022, on dtd. 29.04.2022. The Generated Ticket no was-
6512267292.

On dtd. 01.05.2022, I was trying to submit the online claims through portal for both
Hospitalization period. But I was unable to select the date 03.03.2022 as a date of admission to
hospital. The screenshot of the same was emailed to you on dtd. 02.05.2022 (Ticket No.
6512267292)
Online claim for Hospitalization period from 17.03.2022 to 21.03.2022 was successful without
any error on dtd. 01.05.2022 (claim no. 28271689)
On dtd. 07.05.2022, I received email regarding missing documents/information w. r. t. Claim no.
28271689.
I was doing rounds of hospital in getting/receiving these documents from hospital in my busy
schedule of day to day office work.
I received very late, all the related documents from the hospital and I submitted all the physical
documents by courier on dtd. 27.05.2022.
These documents are acknowledged by pune office on dtd. 30.05.2022, having PUN NOs as
PUN01274628 and PUN01274627.

Respected sir, mam

I have done several correspondences with Medi Assist on telephone and email regarding
enrollment, claim intimation/information, online/offline claim submission starting from dtd.
04.03.2022 after Hospitalization on dtd. 03.03.2022.
I have mentioned various references for this. You can verify the same from your record.

Note= if the information provided by me in this letter is false then you can do whatever you want
to do with my claim. But I kindly request you to consider my case faithfully and do the needful
regarding mediclaim reimbursement of my daughter Miss. Ojasvi vivek Shambharkar.

Thanking you.

Regards
Er. Vivek Balaji Shambharkar
Deputy executive engineer
CPF NO-2413663
MSETCL.