Medicare TPA Services Complaints & Reviews

Dear team,

I have submitted a claim for the policy # 4745882 which is held with sbi general insurance.

The claim was submitted and no update yet. It has been more than 45 days. The worst part is if we call the # [protected] or[protected], we are not able to speak to anyone. If that is the case why is the numbers available.

I agree someone calls me once a while after i try to call at least 30 times and the response is claim is in process. To tell this why is some one needed to call.

This is the worst service i have ever experienced. I will surely take serious action on this if the claim is not settled.

Please feel free to call me at [protected].

Thanks and regards
Stephen

I try to avail cashless facility in network hospital. Medicare rejected due to below invalid reason, though i crossed my 2 years waiting period
Cashless can not be accorded, patient is requested to come for reimbursement for further consideration. Pfa for details. I tried to call my insurance (Royalsundaram), they asked to contact tpa help desk.

My uncle bought a medical insurance policy from sbi on 4.2.16 with cashless benefits. My uncle was hospitalised in samaritan clinics pvt ltd on 19.08.17. He is still in icu. At the time of admission tpa said he will get cashless but now saying cashless not permitted. Sbi is also not helping. Now we don't have enough money to pay hospital bills. Help

51379770: this is for my policy number 51379770. My mother is hospitalised and we have submitted the bills and all required documents, initial approval also we have received. But now hospital is submitting the running bills and asking for the approval for more amount but there is no response. Because of this hospitals is asking the money from us again and again. I we have paid all premium on time and also initial approval is given then why there is delay in further approval. This is causing problem please take this matter on priority basis. Thanks

I mr madhusudan h. Thakkar one of your valued customer would like to bring to your notice that the increase in premium amount seems to be a burden to us middle class people. Do see in to the matter and i would be glad if your company see through own point of view. For rs 100000 the company charging rs37000 seems to be a question of thought in regards to continuing the policy my policy no 170700/34/16/25/00000816 and mem no [protected]a

Respected sir,
Sub : reimbursement of bills under hospitalisation scheme
Claim file no. 18rb03nat0273 with tpa vipul mediclaim pvt. Ltd
Policy no. 271005/48/16/[protected]
Insurer – ravindra chunilal kalal

1. I request reference to my claim with your tpa with references as captioned.in this connection i wish to submit as under:

2. Sir, inspite of lapse of two months i have not been sanctioned / paid the amount eligible under the above policy.in between a few queries being raised by them were promptly addressed and replied by me. Shockingly after having complied with all their queries they have, at this late stage told me that i nor the hospital have given prior intimation to them according to the new rules. No intimation in this regard is either received from them or from your office, by me. For your information a couple of claims in the recent past have also been sanctioned and paid by them without this requirement.

3. Upon my countering with them as regards the intimation to be given to me in the event of any rule changes they said that they will have to refer to the insurance company for their clearance.

4. Sir, i am suffering from a terrible illness because of which i am also mentally depressed for which i am taking a separate treatment from a psychiatrist. The treatment meted out to me by the tpa for reasons best known to them always has puts me in a dilemma. My present mental state makes it a very torturous one i am always asked for previous policies without any reason and when countered they delay up the matter before sanctioning in the normal course.

5. I shall be grateful if you make enquiries with the tpa for such unfair and troublesome practices followed by them for unknown reasons.

6. Soliciating your express attention to redress my grievance.

Thanking you.

I am shyamali banerjee. I was admitted in ils, dumdum (1, khudiram
Bose sarani, beside nagerbazar ils flyover, kazipara, kolkata-700080)
On 29/8/2015. My operation has done on 30/8/2015. Submitted the claim
Form along with all documents on 7/9/2015 in 11 prafulla sarkar street
Office

Total expenses=rs. 58799/-
Received amount:
Through cashless package=rs. 37000/-
On 27/10/2015, rs. 4429/-
On 19/11/2015, rs. 12890/-

Remaining amount=rs. 4480/- (Includes misc.=rs. 3520/- and bills 1
Month before admission=rs. 500+360+100=960)

I talked regarding this misc. Bills for claim purpose in ils hospital authority regarding this
Matter. Still i
Didnot get this claim amount already 1year 4 months over. Now mr. Avijit bakshi told "we are unable to pay any further amount against your claim". Why didnot you put the pressure on hospital for this? Why didnot you inform me if you unable to do so?

Sir

with reference to the above i would like to say that i have submitted the medical claim form for my cataract surgery. it is since 2 months the documents has been submitted but nothing has been done.
some days back i got a call from kolkata office stating that the document is not original and they are not initiating the claim. they said that they have kept it pending.

kindly help us to get the claim as soon as possible since we have sent all the documents.
policy number 03I01354006B

regards

amrendra kumar
[protected]

Dear Ms.Bhawnaben Vyas,

Ref your trailing mail, it is really surprising that you quote the letters - two of 28.08.2015 for Cataract operations of Bhupendra Patel and third one dated 31.08.2010 for Lt. Knee Joint operation of Mrs. Urmila Patel, which have never been written to me by TPA - Raksha.

On the contrary, three vouchers / letters have been taken by me from Raksha's Site and have submitted to all concerned in the past and last to you on 15.12.2015 when I met you in your Office and explained in person the details show approval of amount in each case. These three
documents have been collected by you from me for further transmission.

These are definitely not the repudiation letters, they are letters indicating sanction of the amount in each case.

No one has officially sent these letters.

In order to prove my point, I have just copied the three letters referred to by you to explain you what is the fact and what is written on each of them by TPA- I have quoted in CAPITALS what is written in each one.

1.
28/8/2010 RT.EYE CATARACT[protected]
"CLAIM AMOUNT 39306.00.
AS PER POLICY TERMS AMOUNT PAYABLE RESTRICTED TO RS.25000/ FOR THE TREATMENT OF CATARACT HENCE
EXCESS AMOUNT OF RS.14306.00 (Rs fourteen thousand three hundred six only) DEDUCTED.
CHEQUE NO/AMOUNT 065660/RS.25000". Even cheques number is also given.

2.
28/8/2010 LT.EYE CATARACT[protected]
"CLAIM AMOUNT 39810.00.
AS PER POLICY TERMS AMOUNT PAYABLE RESTRICTED TO RS.25000/ FOR THE TREATMENT OF CATARACT HENCE
EXCESS AMOUNT OF RS.14810.00 (Rs fourteen thousand eight hundred ten only) DEDUCTED.
CHEQUE NO./AMOUNT 065557/25000". Even cheques number is also given.

3.
31/8/2010 LT.KNEE JOINT REP. [protected]
"AS PER (FOR PRE-POST)AMOUNT...AS RS.161250.00 ALREADY PAID IN CASHLESS CLAIM
NO.[protected], HENCE REMAINING AMOUNT OF RS.15928.00 (ruspees fifteen thousand nine hundred
twenty eight only) STANDS PAYABLE." CHEQUE NO.065364/15928.By mistake Raksha has written
Rs.18178/.

I hope you had sent these three letters to your other Officials I suggest you to kindly once
again see these letters minutely and objectively without depending solely on what TPA says.

Thanks.

Bhupendra Patel
Ahmedabad.
M-[protected].

They are t.P.A. O[censored]nited india insurance, chennai for eastern region. I am a policy holder of their arogya raksha health insurance scheme (indian bank).
As interaction with the t.P.A. Is very important for the insured, medicare t.P.A. Are unreachable. Their website never opens. They have had a very poor reputation in the past.
United india insurance should give an option of more than one t.P.A. For a region.

I subhasish Banerjee vill;Ballavebati.po; munshirhat dist;Howrah, policy no;H043/[protected]/01, have admited west bank health and wellness institute, 120/1, andul road, Howrah711103 dated on 25/09/2014. I also have submitted claim form at LIC'S Domjur, howrah branch dated on 16/10/2014.But Ihave not received any information till now.It is injustice to me.If you kindly take the matter, I shall be highly obliged.

Ref: T[protected]/ Tarun Kumar Roy.

Sub: Complaint against partial refund of claim.

Dear Sir,
I am a policy holder of LICI Health Plus. I was admitted to the Appolo Hospitals,Greams Road , Chennai 600006, on 05/04/2012 & was discharged on 08/04/2012. I submitted all the documents on your office on 04/05/2012 for reimbursement of medical expenses.

I regret to inform you that I received a cheque of Rs 575/- ( Five hundred seventy five only) against the policy of Rs 100000/- from the Medicare TPA Services (I) Pvt. Ltd
Sir, I am really very unhappy. I cannot understand why only Rs 575/- have been fixed up infavour of my claim for Rs 227632/- although I have to right to get Rs 100000/-.

I shall be obliged to you if you kindly make a through enquiry regarding this and help me to get the actual benefit. Also please inform the details of your policy.

I look forward to hearing from you.

Thanking you.

Yours faithfully,

Tarun Kumar Roy
e-mail: [protected]@gmail.com

Kolkata, West Bengal.

Dear Sir,

The New Indian Insurance Company and its T.P.A. “Medicare “ T.P.A. service Ltd at Flat No. 10, Paul Mansions, 6B, Bishop Lefroy Road, Kolkata-70020 is harassing the customers. Its agents convince with many a ‘facilities’ of several kinds, particularly for the Old-aged people, who need it best. The papers and documents of huge nature or produced for obtaining signature of the insured. There are hidden conditions in favour of the company itself and that also not explained the details, excepting the preferences and insured. My membership No. is [protected]A and twice I am being harassed and both the time I was admitted in CMCH, Vellore, where the hospital is best know to be run for ‘Mission’ and not for business.

The questionnaire sent by T.P.A. Service Ltd from Bishop Lefroy Road, (Address shown herein above) do insult the Prof. Physicians of the Hospital and as such they feel uncomfortable to reply. As such I am not to go for any help from Medicare instead I shall beg for finance to meet my expenses, provided I get well and return home.

Manju Sarkhel, Bharat Residency. M.G.Road, Vellore-4.

Permanent Address
357/1, Po & P.S. Ashoknagar, (N) 24-Parganas,
West Bengal, Pin: 743222
Present Address
Santi Appt. Flat No-3A, 18,B.C.Pathagar Road. DumDum,Kolkata-30
E-mail ID- aurindam.[protected]@gmail.com
Mob- [protected]/ [protected]

I give below the abstract of correspondence with Sr. Manager of MEDICARE TPA SERVICES (I) PVT. LTD. CALCUTTA,which is self explanatory:


Re: denial letter of M Jasani‏
From: abhishek aditya (abhishek.[protected]@medicaretpa.co.in)
Sent: 17 February 2010 14:10PM
To: Mahendra Jasani ([protected]@hotmail.com); the new india assurance co.ltd. mumbai (bijay.[protected]@newindia.co.in); helpline medicate ([protected]@medicaretpa.co.in)
Cc: debjani.ray customer care ho (debjani.[protected]@medicaretpa.co.in)

Dear Sir



The policy is in force from 2008 & in 2007 (prior to policy inception) you have undergone Cataract Surgery of the right eye. The present ailment, Right Eye Posterior Capsular Opacification, is complication of the cataract surgery in 2007. Thus the present ailment is a complication of pre-existing disease.



The policy does not cover pre-existing diseases or their complication & hence the present claim is outside the scope of policy coverage.



We regret our inability to accord cashless. Please feel free to contact us for any further clarification



Thanks & Warm Regards

Abhishek Aditya

Sr. Manager – Claims






----- Original Message -----

From: Mahendra Jasani
To: Sr. Manager, Medicare HO Kolkatta ; the new india assurance co.ltd. mumbai ; helpline medicate
Cc: debjani.ray customer care ho
Sent: Wednesday, February 17, 2010 1:59 PM
Subject: RE: denial letter of M Jasani

My first Policy is in force from 3rd January, 2008
and My Certificate No. 130100/48/538337/531685/140772, dagted 03/01/08
and policy period: 03/01/08 to 01.01.09

I have no policy in 2007 so the previous claim (in 2007) was NOT settled by the Insurance Co., (which I have already cleared in my previous email). This is for your information.

I submit all 3 policy to your Mumbai Office.

Thanx

Yours faithfully,


Jasani Mahendrakumar

From: abhishek.[protected]@medicaretpa.co.in
To: [protected]@hotmail.com; bijay.[protected]@newindia.co.in; [protected]@medicaretpa.co.in
CC: debjani.[protected]@medicaretpa.co.in
Subject: Re: denial letter of M Jasani
Date: Wed, 17 Feb 2010 13:01:08 +0530

Dear Sir

Can you please confirm since when the policy is in force & whether the previous claim (in 2007) was settled by the Insurance Co.

Thanks & Regards
Abhishek

----- Original Message -----
From: Mahendra Jasani
To: Sr. Manager, Medicare HO Kolkatta ; the new india assurance co.ltd. mumbai ; helpline medicate
Cc: debjani.[protected]@medicaretpa.co.in
Sent: Wednesday, February 17, 2010 12:59 PM
Subject: RE: denial letter of M Jasani

Dear Sir:

I have no any policy before 2008 and I operated for cataract with my own expenses, and I submit the Receipt and Doctors paper to Ms. Sharmeela and she forward the papers to you for your ready reference. I think it is sufficient for you and consider my cashless accord.

Thanking you,

Yours faithfully,

Jasani Mahendrakumar

From: abhishek.[protected]@medicaretpa.co.in
To: [protected]@hotmail.com; bijay.[protected]@newindia.co.in; [protected]@medicaretpa.co.in
CC: debjani.[protected]@medicaretpa.co.in
Subject: Re: denial letter of M Jasani
Date: Wed, 17 Feb 2010 12:45:36 +0530

Dear Sir



As per the date provided to us with regards to your policy, the same is effective from 2008. Since the primary cataract surgery was in 2007, which is prior to the effective policy paper we were unable to accord cashless. The settlement details provided by you do not indicate the policy number nor does it specify that the claim was settled in respect of the Union Bank Policy.



In case your have the policy papers prior to 2008, kindly provide the same to enable us to proceed further with your cashless.



Thanks & Regards

Abhishek Aditya
Sr. Manager - Claims

----- Original Message -----
From: Mahendra Jasani
To: abhishek.[protected]@medicaretpa.co.in ; the new india assurance co.ltd. mumbai ; helpline medicate
Sent: Wednesday, February 17, 2010 12:36 PM
Subject: RE: denial letter of M Jasani

From: [protected]@hotmail.com
To: abhishek.[protected]@medicaretpa.co.in
Date: Wed, 17 Feb 2010 12.33

Dear Sir:

With reference to your email, my Membership Id: 02I00837013B and My Certificate No. 131200/34/09/81/00000001, dated 22.12.09. I have already talked to Ms. Debjani Ray and given her my Membership no.

Thanx and with regards,

Jasani Mahendrakumar
From: abhishek.[protected]@medicaretpa.co.in
To: [protected]@hotmail.com
Subject: FW: denial letter of M Jasani
Date: Wed, 17 Feb 2010 12:03:26 +0530

Dear Sir

Kindly provide your policy / membership no to enable us to trace the claim details.

Thanks & Regards
Abhishek Aditya
Sr. Manager - Claims



[protected] Forwarded message[protected]
From: Mahendra Jasani <[protected]@hotmail.com>
Date: Feb 17, 2010 7:30 AM
Subject: FW: denial letter of M Jasani
To: medicareho calcutta <[protected]@medicaretpa.co.in>

just a REMINDER I .....

PLEASE REPLY

From: [protected]@hotmail.com
To: [protected]@medicaretpa.co.in
Subject: FW: denial letter of M Jasani
Date: Tue, 16 Feb 2010 09:55:42 +0530


FOR KIND ATTEN: DR. UTPAL RAY, MS. PRIYANKA KAPOOR, MS. DEBJANI RAY

for your kind information and necessary action. AS THE POLICY DETAILS PRIOR TO FEB 2008 ARE NOT KNOWN , THIS CASHLESS REQUEST CANNOT BE ACCORDED.

I have already submitted my receipt of cataract operation and operation details to Ms. Sharmila of your Mumbai Office but I get the same reply. It is not my fault. Your people Mr. Sanjay of Mumbai as well as Mr. Rajesh Kunthe adviced me to your first pay to the hospital and claim afterwards. Please reply me immediately.

I have tried to contact your help line as well as [protected] but not succeed.

My phone no. is [protected].

If i dont get reply I have no alternative to go to COURT OF LAW or CONSUMER COURT.

Thanx

Yours faithfully,

JASANI MAHENDRAKUMAR


From: [protected]@hotmail.com
To: [protected]@medicaretpa.co.in; [protected]@medicaretpa.co.in; [protected]@hotmail.com
Subject: FW: denial letter of M Jasani
Date: Fri, 12 Feb 2010 09:07:18 +0530



From: [protected]@hotmail.com
To: [protected]@medicaretpa.co.in; [protected]@hotmail.com
Subject: RE: denial letter of M Jasani
Date: Fri, 12 Feb 2010 06:26:42 +0530

I submit herewith following in support of my CASHLESS claim for your ready reference. I have also submitted (in person) to Ms. Sharmila Mam and she forward the same. How you say the previous cataract claim details are not known, hence this cashless request cannot be accorded. I, therefore request you again to consider my case favourable and sanction cashless request and oblige.

Thanking you,

Yours faithfully,

Mahendra Jasani



Cataract Surgery Complications
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By Chris A. Knobbe, MD

On this page
Posterior capsule opacity (PCO)
Treating PCO
YAG laser capsulotomy risks
Dislocated intraocular lenses
Other cataract surgery complications
Vision after cataract surgery

Cataract surgery complications are few, but one of the most common is posterior capsule opacity (PCO), which you may have if your vision is cloudy or blurry after cataract surgery. A PCO is a hazy membrane (capsule) just behind the artificial intraocular lens (IOL) that was implanted during your cataract surgery to replace your eye's natural lens.
Although some people call this condition a "secondary cataract," it is not really a cataract. Once a cataract is removed, it does not come back.
Other cataract surgery complications can include eye inflammation, infections or a dislocated intraocular lens.

Why Is Posterior Capsule Opacity a Common Cataract Surgery Complication?
During cataract surgery, your surgeon will remove the cloudy natural lens of your eye (cataract), replacing it with an intraocular lens implant.
When the cataract is removed, your surgeon makes every attempt to maintain the integrity of the capsule that contained the natural lens so the new lens can be placed within it. Normally your vision after cataract surgery should be very clear.
However, about 20 percent of patients with intact posterior capsules have haziness of the capsule, so vision is blurry.
This occurs because lens epithelial cells remaining after cataract surgery have grown on the capsule. In some cases, if the condition progresses significantly, your vision may be worse than it was before cataract surgery.



From: [protected]@medicaretpa.co.in
To: [protected]@hotmail.com
Subject: denial letter of M Jasani
Date: Thu, 11 Feb 2010 10:11:26 +0530

Dear Sir ,

Plz find attached denial letter of Mahendra Jasani.

Thanks ,
Sharmila

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I attached below the letter from medicare, which is self explanatory.


Medicare tpa services (I) pvt. Ltd.



6, bishop lefroy road, kolkata 700 020

Ph: 40079999, [protected], [protected]

Fax:[protected],[protected]

E - mail: [protected]@medicaretpa.Co.In

Website:medicaretpa.com

 


Dated 15.2.2010

Maa nursing home & netrajyoti eye care centre
Himachal bldg, s v road, opp. Sunder nagar, malad,
Goregaon (W), mumbai,
Mumbai
Denial of cashless access


Hospitalisation of mahendra kumar jasani
Membership no. 02i00837013b (New india assurance company ltd.)  
 

 




Dear sir/madam,

It is unfortunate, but we regret to inform that your request for cashless payment, for your ailment has been refused.

The member is enrolled under the policy from 1/2/2008. The member is suffering from right eye posterior capsular cataract which is a complication of cataract surgery of rt eye, done in 2007. As the policy details prior to feb 2008 are not known, this cashless request cannot be accorded.

Please note that the above-mentioned  reasons for declining your  request for availing of cashless facility have been
Mentioned and adjudicated based on certain preliminary treatment documents. However the denial of   authorization
For ‘cashless’ access does not imply denial of  treatment   and does not in any way prevent you   from seeking
Necessary medical attention or hospitalization.



Thanking you

Yours truly
For medicare tpa services (I) pvt. Ltd.


Authorised signatory
Copy to : member :mahendra kumar jasani

I have no policy at the time of cataract operation. I send receipt which i have paid for cataract operation and details of operation. Please guide me to whome should i contact for my right.