Mediclaim — Curtailed Claim From RAKSHA TPA COMPLAINT | |
I had filled a claim for my hospitalisation with RAKSHA TPA, Insured with New India Assurance ltd. Claim had original hospital bill & on query raised even submitted Hospital in house log sheet which was given by hospital (Bhatia Hospital). In house panel of TPA construed that hospital stay was prolonged hence deducted the claim by all most 25% directly, this means standard given by mediclaim policy issuer company ( The New India Assurance Company Limited) has mandated to all TPA's to deduct 25% of all claims received, those coming back on case to case basis, will be approved or further process per merits. I need assistance in filling this legitimate case for full recovery as well mental trauma. Was this information helpful? | |
 2 Comments | |
Comments
Sir, Normally insurance company (TPA) will restrict the approval amount for prolonged stay in the hospital for general illness. They will restrict (duduction) the duration of stay in the hospital. And few policies do have co-sharing option, to cut the cost of medical expences these days
Reply
Respected Sir,
I am covered under Policy No.140802/34/09/87/00000304 & having member I.D.N9030225UNL with The New India Assurance Co.Ltd being in collaboration with Raksha TPA. for Cashless Medical Assistance in Registered Hospitals.
Following mail contents have been sent to gopa.[protected]@newindia.co.in vigilance officer, as well as Raksha TPA but the same have remained unresponded;hence you are kindly requested to act urgently and help me get entitled service of Cashless Access to medical assistance, from your end.
"My Husband has taken a Mediclaim Policy thru UTV News Ltd. wherein Raksha TPA organization is a Third Party Administrator, as above.
Kindly inform if there is any legal provision, that your organization possesses, that the patient is expected to meet the medical expenses first and submit, such expenses, for reimbursement, if so kindly send me an extract of the same.
It is reported by Mr.Xaviere of Raksha TPA (having cell no.[protected], who liases with Campal Clinic at Panaji-Goa for Cashless mediclaim purpose) since few bills submitted by his office, earlier, have not been cleared so far, since last year or so, which has compelled him to introduce the condition that patient's medical expenditure should be first met by the Patient and seek reimbursement later.
Kindly state whether such condition could be introduced if so kindly, state under which authority it is permissible.
I feel such unwarranted unqualified demand amounts to harassment of the patient and breach of good faith due to which above insurance for medicalim has been undersigned.
Kindly consider the above on urgent humanitarian ground and respond asap.Thanks.
SARITA MADHU Ph.No.[protected]:
I am covered under Policy No.140802/34/09/87/00000304 & having member I.D.N9030225UNL with The New India Assurance Co.Ltd being in collaboration with Raksha TPA. for Cashless Medical Assistance in Registered Hospitals.
Following mail contents have been sent to gopa.[protected]@newindia.co.in vigilance officer, as well as Raksha TPA but the same have remained unresponded;hence you are kindly requested to act urgently and help me get entitled service of Cashless Access to medical assistance, from your end.
"My Husband has taken a Mediclaim Policy thru UTV News Ltd. wherein Raksha TPA organization is a Third Party Administrator, as above.
Kindly inform if there is any legal provision, that your organization possesses, that the patient is expected to meet the medical expenses first and submit, such expenses, for reimbursement, if so kindly send me an extract of the same.
It is reported by Mr.Xaviere of Raksha TPA (having cell no.[protected], who liases with Campal Clinic at Panaji-Goa for Cashless mediclaim purpose) since few bills submitted by his office, earlier, have not been cleared so far, since last year or so, which has compelled him to introduce the condition that patient's medical expenditure should be first met by the Patient and seek reimbursement later.
Kindly state whether such condition could be introduced if so kindly, state under which authority it is permissible.
I feel such unwarranted unqualified demand amounts to harassment of the patient and breach of good faith due to which above insurance for medicalim has been undersigned.
Kindly consider the above on urgent humanitarian ground and respond asap.Thanks.
SARITA MADHU Ph.No.[protected]: