Raksha Tpa — Reimbursement of Balance amount of Medical expenditure

Address:	Faridabad, Haryana, 201012
Website:	raksha tpa

Member ID: O[protected]BCCLODEL Policy no: 211200/48/2016/652 Name :Kalapana sharma W/O Yashpal sharma TPA : Raksha TPA PVT LTD. C/O Escort Corporate centre. 15/5 mathura road faridabad 121003. [protected] Fax no- [protected] My wife Mrs. Kalpana Sharma was admitted to Pushpanjali Hospital Vaishali on 14/09/2015, when she was experiencing an acute pain in abdominal area. In the preliminary diagnose it was found that she is having a stone in her right kidney, on later further deep diagnose it was found that the kidney was infected and was full of pus and the stone was not normal instead it was a stone of pus, due to which patient had to be admitted for 4 days and had to undergo a major surgery in which a stunt was also temporarily fixed in the body and after the treatment the paitent was discharged on 18/09/2015. The total cost of treatment came out to Rs. 78404.26 /- . As per our Medical Insurance norms the amount being reimburse for the treatment of the kidney stone is capped for Rs 40000 /-, but since this case was different and was also explained to the TPA personnel . Even the DR. Salesh chandra shay which done the operation make a special discharge report and sent to Raksha TPA again, mention in it the complete detail of treatment i.e. not only the caes of Stone but major infection inside the kidney and all kidney full of PUS. but they ingore it completely. Even they did not read it. but then also only the capped amount i.e. Rs. 40000 /- was sanctioned. I therefore request you to please consider the case as per different scenario and and kindly reimburse the balance amount Rs. 38404.26 /- to the employee at the earliest which was not reimbursed at the time of discharge. The discharge papers, bills and total treatment history is attached with this letter. RGDS Yashpal sharma manager THe times of india press M[protected] yashpal.[protected]@tiemsgroup.com