[Resolved]  Raksha Health Insurance TPA — Claim put on hold due to requirement of documents

Address:

Faridabad, Haryana

Claim no: [protected]
My mother, Savita Chopra, MemberID: SBIG[protected]SBIDEL
Policy No:[protected]-01, was admitted to Fortis Hospital Shalimar bagh on 28th May - 30th May and had to get angioplasty done.

This was supposed to be a cashless experience but Fortis informed us that the contract with raksha TPA has expired and the amount needs to be paid entirely by us. We had no intimation from Raksha TPA about this. Due to this, we paid the entire amount and filed the claim.

The claim has now been put on hold as certain documents are needed:
1 Kindly provide Break up of Rs 254700 /- charged on account of PACKAGE dated 28/05/2021
We have checked with Fortis and they have mentioned that they do not provide a package breakup. The same is mentioned on their estimate form. This was ideally supposed to be a cashless hospitalization but Fortis informed us on the 28th May that their contract with Raksha TPA has been revised and they cannot allow a cashless hospitalization. Due to this, we were forced to pay the money from our own pocket. There is no way to arrange for the breakup. Fortis is on the panel of Raksha TPA, then they must know this already.

2 Kindly Provide Sticker for Stent used in the surgery.
All the surgery related physical boxes (stents and others) have already been sent.

3 Kindly provide Self Attested Xerox copy of Photo Identity Proof for the Patient : (Aadhar Card /Passport/ PAN card/ Voter Identity Card/ Driving License/Letter from Recognized Public Authority duly affixed with photo).
We will send the same. The requirement for this was nowhere mentioned on the downloaded Raksha TPA claim form.

4 Kindly provide Original Pre-numbered, Preprinted duly signed and stamped Receipt against the Final Hospital Bill
We have checked with Fortis. The inpatient summary bill of Fortis clearly mentions the amount paid by the patient Rs 3, 35, 346. Fortis does not provide any other receipt than this. Then why is a separate receipt needed.

We have been told that without the receipt and package breakup the claim cannot be processed further as Raksha does not work according to Fortis. At first, it is an issue with Raksha TPA that their contract with fortis was terminated. It is due to this a cashless experience turned into a claim settlement. How is it the fault of the patient?

Is this a way to cheat senior citizens of their hard earned money.

Please look into this matter and process this claim forward without the need of any additional receipt and package breakups. Reach out to me on [protected]. I am Rajiv Chopra, the son of Mrs. Savita Chopra.