Medicare Tpa Services — Non-payment of our medical reimbursement claims.

Bhupendra K.Patel

from Surat, Gujarat

Address:

Ahmedabad, Gujarat, 380054.

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].

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Medicare TPA Services customer support has been notified about the posted complaint.

Sep 01, 2016

Updated by Bhupendra K.Patel After the above complaint, I have written to New India Insurance Co, Mumbai, many Secretaries in Central Govt, but of no avail. I have approached you as a last resort and with a hope that the amounts sanctioned by TPA shall be paid to me. The claimants, Bhupendra Patel (me) is 71 and Urmila Patel, my wife is 66. We can not opt for litigation as by the time case proceeds or judgement is delivered we may not be alive. Therefore I am trying thru different forums and NOW through you.

I can send scan copy of the Vouchers having sanction from TPA Raksha if required.

Looking forward for a positive outcome.

Thanks.

Bhupendra Patel
M-[protected].

Sep 09, 2016

Updated by Bhupendra K.Patel Dear Sir,

Further to my this complaint of non-payment of Mediclaim amounts despite passage by TPA Raksha and New India Insurance Company, I have to inform you that today one Mr. Vikram Patel from Mumbai called me up today (09.09.2016) and informed that he is speaking from Medicare TPA Services (I) Pvt. Ltd. and that against my payments due, the TPA has sanctioned Rs.90420.00 and that against my immediate deposition of Rs.5500/ as service tax on this payment in Axix Bank, the above amount of Rs.90420/ shall be deposited in my Account in SBI, Drive in Road, Ahmedabad in 15 minutes. He took Bank account number from me.

He has sent me a SMS to this effect. When I asked him to deduct the Service tax amount from the above payment, he said he can not do it and when I said I am not going to deposit service tax in his Bank, he said he shall cancel the payment.

I am really surprised to receive such message. His Mobile Number is [protected].

May I request you to find out bona fide of this caller and inform me the fact.

Thanks.

Bhupendra Patel
M-[protected].
Ahmedabad.

Nov 06, 2016

Updated by Bhupendra K.Patel Nothing is heard so far. Kindly look into the matter.

Thanks.

Bhupendra Patel
M-[protected].
Ahmedabad.
06.11.2016.

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Comments

Bhupendra K.Patel

from Surat, Gujarat

I very humbly request you NOT to go by the versions of TPA Raksha and New India Insurance Company. I shall send you the Vouchers carrying approval of TPA Raksh showing claim amount payable to me. They backed out thereafter.

Kindly take note of this request.

Bhupendra Patel
M-[protected].
Ahmedabad.
Gujarat.
01.09.2016.