Raksha Health Insurance TPA — Payment not received

Address:

Vinay nagar sec 03 Gwalior

Dear Sir,
My name is Sachin Gupta, I am a Senior Manager at Bank of India Jiwaji Chowk Branch Gwalior (M.P.). -[protected]

My insurance policy was from your TPA, whose policy number is UIC[protected]BOI.

There are currently 4 claims pending in your TPA more than 7 months, for which I have mailed to your department several times and have spoken to Swati ji and Jagat Pal, farooq mohammad several times over the phone and mail dated-19.11.2020, 21.11.2020, 26.11.2020, 01, 07, 08, 10, 11, 14, 19, 21, 31 Dec 2020, 01.02.2021, 12.02.2021, 15.02.2021 but till date I have the following claims pending.

1. [protected]- Total claim Rs-10240 but pay only Rs. 2740 (एम्बुलेंस का भुगतान मुझे नहीं किया गया )

मेरे द्वारा आपके Raksha TPA में क्लेम भेजा गया था जिसका क्लेम नंबर [protected] है मेरा क्लेम कुल रूपया 10240/- का था जिसमे से मुझे मात्र 2740 रूपया स्वीकृत किया गया है मेरे द्वारा भेजे गए bill में एम्बुलेंस का भुगतान मुझे नहीं किया गया है
कृपया पुन मेरे क्लेम को चेक कर मुझे एम्बुलेंस का भुगतान किया गए

2. [protected]- Rs. 30444/- Claim pending

3. [protected]- Rs. 3248/- Claim Pending

4. [protected]- Rs. 36392/- but pay only 2500/- (Ambulance difference and hiring a nurse Charge not paid)
Regarding this claim I gave the following Representation in your TPA-
the policy's point number According to 3.13 -“Taxes and other charges: all Taxes, Surcharges, Service charge, Registration charges, Admission Charges, nursing, and Administration charges to be payable. Charges for diapers and sanitary Pads are payable if necessary as part of the treatment charges for hiring a nurse/ attendant during hospitalization will be payable only in case of recommendation from the treating doctor in case ICU/CCU, neo natal nursing care or any other case where the patient is critical and requiring special care.” the above amount is covered in TPA Dr.'s recommendation has been attached by me with the said claim. (Recommendation and policy Para 3.13 copies attached)

Please do need ful.

Sachin Gupta
[protected]