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Medical Insurance Claim from Raksha TPA - Details of deductions not given

 
17 Reviews
User
  colinrebello@hotmail.com
Dear Sir,
Before I make an official complaint I need to know my rights with regard to a mediclaim made by me.
Details of this claim are available on the following website:
www.rakshatpa.com
Click on Claim status and on the form that appears fill in

ID Card Number : BN1195327
The claim No is : 12656220708

This claim is made with regard to my son who was recently admitted to Lilavati hospital. The claim amount as per the bills is
Rs: 4,14,860/-
However the insurance company has decided to pay me just Rs:2,20,000 and on the website they have mentioned that this
Amount payable restricted to SI + CB : RS 220000/-

I do not follow what this means and want to ask them to give me details as to why they made these deductions.

Before I take this matter up, legally if necessary, I need to know from you if I am entitled to be given such information by Raksha TPA as to how they have arrived at this low figure in the amount reimbursed.
The company giving me the insurance is:
New India Assurance, Fort, Mumbai

They have mailed me the cheque but with a letter stating that if I encash the cheque then this will be considered as the full and final settlement with no additional liabilities on their part.
Therefore I am NOT encashing the cheque until I find out what are my rights in this matter.

Could you please let me know.
Thanking you
Colin Rebello
Mobile: 9820023193
Phone: 022-66960493
Bandra, Mumbai.
Complaint comments 16 Comments     Updated:
Resolve this Complaint  

Comments

A
User
sppatel  
 
Dear sir

your web net is not working, please pending medicliam ?
Thanku
Sachin Patel
 
id card no 178252 .barcode no 558098 .policy no 4016/0001305/02 ...IL/UP/178252
 
Pl find out what was your sum insured in the policy the liability of sum insured is maximum upto to the sum insured (si) plus some cash benefit if applicable. plus there are some internal restrictions on sum insured depending upon various kind of diseases which are mentioned in the policy document (POLICY WORDING) WHICH COME WITH THE POLICY DOCKET

REGARDS
RAHUL BHADRA
9923103210
RAHUL_BHADRA@REDIFFMAIL.COM
N
User
mdesai  
 
Sir,
Incomplete details
1.Insurer, Type & Name of the `Mediclaim'policy, effective period, ie. cover from 00/00/0000 to 00/00/0000, sum =amount for Insurane, (with Bouns -in % or absolute Rs.sum)if renewed, same details of previous policy
2. As per conditions of policy, some expenses may notbe admissible.
3.Only after details, further action can be thought of
4. You have a RIGHT to know & understand each & every detail of the policy ;same can not be refused
 
i have to get my mother in law operated and want payment by raksha tpa by policy no 52084986 member ID T10016609BCCLDEL how much maximum ammount we can get on this policy no since operation is for knee replacement
 
Dear Sir/Madam,

Sub : Non receipt of claim settlement against my wife Ms Ranjeet Kaur - Membership No. N8587159


I am still awaiting the settlement of my above claim forwarded by M/s New India Insurance Co, Faridabad on 23.9.2008.

Kindly let me the present status.

Best Regards,


G S ARORA
9212558865
House No. 1J-89
NIT FARIDABAD 121 001
Haryana State
 
Dear Sir/Madam,

Kindly let me know the status of my claim:

Policy No.354000/34/07/11/0000/606
Card ID : N8587159
Name of of Insured : G S Arora
Details of Insured Person(in respect of wom claim is made):
Ranjeet Kaur
Date of submission of claim : 23.09.2008

Thanking you,

Yours faithfully


G S Arora
Mobile No. 9250901686
House No. 1J-89
NIT Faridabad 121 001
 
I, kalyanbhai R Gabani request you to plz provide me information about my claim. my claim no is 902891018037. i am requisting you to give me information about my claim. its now 4 months that i have applied for claim.
pleaz do in my favour
policy no110600/34/08/11/00003593
 
I need to see the status of claim submitted in regards with my father who was recently admitted in Anand Rishiji Hospital, Ahmednagar. Can someone please let me know when the Website will start working or let me know the status of the cliam.

Thanks
Suyog Bhanari.
N
User
fazala  
 
I need to see the status of weaver login claim submitted in regards with Can someone please let me know when the Website will start working or let me know the status of the cliam.

Thanks
fazala
Mubarakpur
 
Already send the mail to you but yet to recevied replay, you are told send the cheque but i am not recevied kindly conform whom recevied the cheque ?

Regards

Khan
9844813469
 
I have taken "The Origiental Insurance Co.Ltd. Mediclaim Policy" from our Thane Janata Co-op
Bank, AIROLI, Navi Mumbai & got issued the ID Card for my wife Mrs. Meenakshi S. Dalvi.
But the name appears wrong, instead of my surname Dalvi it appeared Dalvirat. I don't know how this
rat appeared after Dalvi. Details are as under :

1. Name : Mrs. MEENAKSHI SURYAKANT DALVI
2. Policy No. : 123195 / 48 / 10 / 3
3. Member ID : 0 5 5 6 9 9 3 5 9 1 1

You are requested to make the necessary changes in ID Card and the correct name should be
MRS. MEENAKSHI SURYAKANT DALVI.
Regds Dalvi
 
We are health care provider in the name and style of Agile Hospitals Pvt Ltd, Guwahati, Assam.We are providing cashless treatment to patients insured by ICICI Lombard under various schemes like Artisan, Handicrafts, weavers policy etc of Govt of India.The treatment was provided after getting due authorisation from Raksha TPA.The accumulated payment receivable by us amonts to Rs 88, 43, 832/(Eighty eight lacs forty three thousand eight hundred thirty two only) against the bills submitted upto 31.03.09.The amount agaist bills submitted after 31.03.09 is not included here.But inspite of our repeated reminders the payment is not released till today without any reason.We have also came to know that The ICICI Lombard had released the amount about one month back.The TPA has put us in a state of financial collapse now.What is the remedy now?
 
dearsir, i am running my opd & providing cashless treatment to pts. insured by icici lombard under artisans, weavers .ihad arranged two health camps on dated 23july @15 august 2009 but till now i have not the amount .what should i do now iam in financial crisis.
N Dec 15, 2011 by
User
SHRI MOHAN LAL JAIN  
 
DEAR SIR,
I SUBMEET APPLICATION IN YOUR OFFICE TODAY DT.24/11/2011 AT 11:50 AM TO SHRI CHANDAN JI FOR PAYMENT SHORT RS.4873.05 AND I MAIL TO YOU OUR PENDING OUTDOOR EXP.BILL WITH ORIGINAL FILE PAGE NO. AND ORIGINAL FILE WITH PAGE NUMBER IN YOUR OFFICE ALREADY. MY CLAIM TOTAL RS.25997.05 BUT TPA PASSED RS.TOTAL RS.21124/-( HITAISHI HOSPITAL BILL RS.21124 WITH YOUR DEDUCTION CHARGE) SIR PLEASE CHECK MY FILE AND SEND THE ABOVE CLAIM CHEQUE. I SHALL BE THANKFUL TO YOU FOR THIS ACT OF KINDNESS.THANKING YOU
MOHAN LAL JAIN
C/O DEEPAK KUMAR SUYASH KUMAR
4059, NAYA BAZAR DELHI-6
R/O, G-22/367, SECTOR-7, ROHINI, DELHI-85
MOBILE NO.; 9999659003
CLAIM NO.55622111296235
ID : O8564224
POLICY NO.: 212700/48/2011/2947
M/S RAKSHA TPA PRIVATE LIMITED.
CLAIM NO. 55622111296235
TOTAL EXPENCES DETAIL
NAME OF INSURED : MOHAN LAL JAIN
DETAILS OF THE INSRUED PERSON : MANISHA JAIN Age / Sex: 18 yrs./ F
D.O.A. : 30/09/2011 AT 10:00 PM D.O.D. : 06/10/2011 AT 1:00 PM
NAME & RELATIONSHIP WITH INSURED : DAUGHTER
PRESENT COMPLETED AGE : 18 YRS.
OCCUPATION : STUDENT
RESIDENTIAL ADDRESS :G22/367.SECTOR-7 ROHINI, DELHI-85
POLICY NO. : 212700/48/2011/2947 Member ID : O8564224
NATURE OF ILLNESS : DENGUE & ENTERIC FEVER

Sr. No. Name of the Test / Item Detail Date Bill No. Amount
Rs. p.
1 Lab Test Desgupta Pathology 28.09.11 1611 80
2 Lab Test Desgupta Pathology 29.09.11 1631 50
3 Lab Test Desgupta Pathology 30.09.11 1637 250
4 Consultation Fee On 27.09.11 & 30.09.11 Dr.Mahesh Garg 30.09.11 41985 500
5 Chemist Bill Avon Medicos 30.09.11 3855 1111 55
6 Chemist Bill Hitaishi Medicos 30.09.11 11019 350
7 Chemist Bill Hitaishi Medicos 01.10.11 11026 76
8 Chemist Bill Hitaishi Medicos 01.10.11 11043 260
9 Chemist Bill Hitaishi Medicos 01.10.11 3863 412 50
10 Chemist Bill Avon Medicos 02.10.11 11078 168
11 Chemist Bill Hitaishi Medicos 03.10.11 11102 18
12 Chemist Bill Hitaishi Medicos 03.10.11 11144 336
13 Chemist Bill Hitaishi Medicos 04.10.11 11213 260
14 Lab Test (TPC) Saral Diagnostic 05.10.11 S-228 120
15 TPC RGCI 03.10.11 R/11-12/136031 160
16 TPC RGCI 04.10.11 R/11-12/136031 160
17 TPC RGCI 04.10.11 R/11-12/136031 160
18 TPC RGCI 05.10.11 R/11-12/136031 160
19 TPC RGCI 05.10.11 R/11-12/136031 160
20 Medical Bill Hitaishi Hospital 06.10.11 3029 21124
21 Chemist Bill Hitaishi Medicos 06.10.11 11302 81
G.Total 25997 05

LESS CLAIM PASSED 21124


BALANCE CLAIM 4873 0.05




PENDING OUTDOOR EXP. BILL

Sr. No. Name of the Test / Item Detail Date Bill No. Amount ORIGINAL FILE PAGE NO.
Rs. p.
1 Lab Test Desgupta Pathology 28.09.11 1611 80 56
2 Lab Test Desgupta Pathology 29.09.11 1631 50 54
3 Lab Test Desgupta Pathology 30.09.11 1637 250 58
4 Consultation Fee On 27.09.11 & 30.09.11 Dr.Mahesh Garg 30.09.11 41985 500 51
5 Chemist Bill Avon Medicos 30.09.11 3855 1111 55 60
6 Chemist Bill Hitaishi Medicos 30.09.11 11019 350 62
7 Chemist Bill Hitaishi Medicos 01.10.11 11026 76 65
8 Chemist Bill Hitaishi Medicos 01.10.11 11043 260 66
9 Chemist Bill Hitaishi Medicos 01.10.11 3863 412 50 69
10 Chemist Bill Avon Medicos 02.10.11 11078 168 71
11 Chemist Bill Hitaishi Medicos 03.10.11 11102 18 72
12 Chemist Bill Hitaishi Medicos 03.10.11 11144 336 73
13 Chemist Bill Hitaishi Medicos 04.10.11 11213 260 75
14 Lab Test (TPC) Saral Diagnostic 05.10.11 S-228 120 33
15 TPC RGCI 03.10.11 R/11-12/136031 160 35
16 TPC RGCI 04.10.11 R/11-12/136031 160 38
17 TPC RGCI 04.10.11 R/11-12/136031 160 42
18 TPC RGCI 05.10.11 R/11-12/136031 160 45
19 TPC RGCI 05.10.11 R/11-12/136031 160 48
20 Chemist Bill Hitaishi Medicos 06.10.11 11302 81 29
G.Total 4873 05
A Oct 30, 2012 by
User
SHRI MOHAN LAL JAIN  
 
DEAR SIR, mera sara claim mil gaya hai
THANKING YOU
MOHAN LAL JAIN
C/O DEEPAK KUMAR SUYASH KUMAR
4059, NAYA BAZAR DELHI-6
R/O, G-22/367, SECTOR-7, ROHINI, DELHI-85
MOBILE NO.; 9999659003
CLAIM NO.55622111296235
ID : O8564224
POLICY NO.: 212700/48/2011/2947
M/S RAKSHA TPA PRIVATE LIMITED.
CLAIM NO. 55622111296235
TOTAL EXPENCES DETAIL
NAME OF INSURED : MOHAN LAL JAIN

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    Medical Insurance Claim from Raksha TPA - Details of deductions not given

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