Raksha Health Insurance TPA Complaints & Reviews

I have a corporate tailor made group Mediclaim with Raksha TPA, my father was hospitalized on 2nd Jan, 24 and released on 11th Jan, 24 and I had submitted all claim forms with original docs on 16th Jan, 24 after that a query arouse for which I submitted all necessary original docs on 29th Jan, 24 itself. From that day till 28th Feb, 24 my claim was 'Under Process, last documents received' and when I contact the responsible person they say its under investigation and on 29th Feb, 24 it is requiring the query documents which I have already submitted a month before. Its like I have been running circles and my valuable time is getting wasted.
Please process my claim at the earliest or I'll have to take stern action.

Member Id: O[protected]SMHQ
Claim Id: [protected]

Receiving photos attached

My wife was admitted to the hospital for maternity reason and daughter was born on[protected] and then daughter was admitted to NICU for 5 days
Two separate claims were raised for Wife and daughter. [protected] for daughter and [protected] for wife
They paid 27601 out of 40672 for wife and claim of 23567 in respect of new born child was rejected as "Claim not payable"
For wife I was given payment voucher where its mentioned that they have deducted for breakup of some charges
While no payment or rejection voucher received for the claim no [protected] for daughter
It was a corporate policy and most payments were done online scnshot of which was already shared
Request to kindly look into this

I submitted a reimbursement claim for my son for his behavioral therapy. However the Raksha TPA team is asking me for the physiotherapy bill to approve the claim. How can I present something for which I am not claiming for? They are simply not understanding and seems they do not want to process this claim citing unlawful reasons. Hence, I am raising this issue here for some help....

I submitted a claim in respect of my wife's cataract surgery of right eye and as per the TPA's website the claim is passed. details of the same are as under:
Member Id : N90BYCJ0089RBIDEBC
Policy No : [protected]
Insured Name : Shri S Joshi
Claim in respect of : Smt Yogini Suresh Joshi
Relation : Wife
Claim Ref No : [protected]
Employee Number : BYCJ0089
Corporate Name : Reserve Bank Of India
Entity Name : The New India Assurance Co. Ltd.

But the amount has not been paid as the TPA has rejected my Bank account particulars as it is a joint account with my wife and she is the first holder in that account. However the requirement that the policyholder has to be the first holder in the bank account details is not mentioned anywhere in the claim form and also was not stressed upon while accepting the claim documents. Funny thing is that the same TPA has paid claim in the same account earlier in 2021 when her left eye cataract surgery was done. Is it a sort of harassment to the policyholder? As a compliance to their requirement I have uploaded fresh bank details online on their website and also enclosed scanned image of the same. I am waiting to see how much more time they take for making payment.

Hi Team,

We have already submitted original documents by courier and they have acknowledged that they received all bills.After somedays they are sending one medical bill original documents missing and sending automated email many times. Please suggest how a person can original documents two times?After receiving courier you are responsible.No customer care picks call.There is a concerned person number he also don't respond properly.
Please help I am a senior citizen.
Thank you
DS Uppal

Dear Sir,
My Claim number is[protected] with policy no[protected] it's status till now showing under process. Inspection process also completed, Plz reimburse payment as earliest as possible.

Regards,
Shashi Kant

I have claimed medical but not cleared due to some kind of your policy. I am just asking that Why didn't your organization inform me through mail, letter, or phone when my form has been rejected? Does your organization provide this type of service? It's been 2 months since I claimed and when I am calling and asking, you are telling that my form has been rejected. I want all my documents in original within one week at my correspondence address.
I have been mailed multiple time Mr. Sandeep Gupta +[protected] he has not been taking seriously and neglected several time.

Dear Sir
I am CHATTAN SINGH working in NGSL korba site Chhattisgarh, my corporate medical TPA is RAKSHA health insurance TPA,
I have been claimed before 2 months ago but there is no any query or update given to me . Why didn't your organization inform me through mail, letter, or phone when my form has been rejected? It's been 2 months since I claimed and when I am calling and asking, manager telling that my form has been rejected.

Policy no. 224302/48/2023/655
Despite sending 3 reminders from hospital, final approval not coming

The patient is senior citizen and resident of Prayagraj

Waiting since yesterday

Wife who is his attendant is also elderly

Pls help

Our Bank has tie up with Raksha TPA for medical reimbursement for employees. Last year on Oct 27, 2022 I had sent my documents for reimbursement. Many queries were asked in batches and I also replied. Last query was asked in December 2022 and I sent the required documents to which Raksha TPA confirmed vide mail dated 03.01.2023 they received the reply of query raised. Now they are saying they have not received the said documents sent on Dec 2022. When I called they are not able to trace my original documents. There is not a single official to whom I can contact over phone. I am unnecessarily harassed. They said now the TPA with Raksha is over. If it is over they should have returned my documents long back, rather they asked queries on different dates.

Hello, my name is Gokul, employee of KIAL ltd my Member ID is N9071KIALTD, My Reimbursement pending for long, even after given all related documents. And same has been received by concerned office. Call frequently to customer care number for my status of applications. Everytime customer representative said my claim under process kindly wait, days passed and also we are not getting any updation from ur side where is my reimbursement.

Hello sir, my name is Bhupender, PNB employee posted at kahargpur circle, permanent resident Haryana Rohtak, my Member ID is M58343910PNBA, My Reimbursement pending for long, even after given all related documents. And same has been received by concerned office. Call frequently to number [protected], to my status of applications. Everytime customer representative said call me after 10min/15min/15 days, and also we are not getting your details...

Claim of nivesh kumar[protected] not received yet claim passed in the month April 2022 but claim amount still not credited in the account.i have contacted multiple times with raksha TPA team but not received proper response from the team .not guided properly . kindly resolve my issue as claim of Rs 22153 is very long pending.pl resolve

I have submitted all documents regarding my claim. Then also my claim status is in query. Whatever they have asked to submit I have done the same. Then also my claim is in query. Already 2months are over. How much time do you take to settle a claim??

2023 NOT Recommend RAKSHA TPA.

I am an official working at Times of India and this is our health insurance provider. In my complete experience, I never met any such fraud company. All documents are provided to them already and they are playing by sating this is not original, that is not original. Save your money and never go to such looters....

MEMBER ID-M[protected]PNBA

It is inform to you that i had sent two nos. Original Maternity bills in the name of Gurpreet Kaur and two original bills of baby in the name of baby of Gurpreet Kaur i.e. Sant Child Care Hospital and Columbia Asia Hospital via Reg post no RP[protected]IN dt 20.10.2021 (to Chandigarh office), bills related to Columbia Asia Hospital are settled, but bills related to Sant Child Care Hospital of Rs 26, 268/- (admission date 15.09.2021) are still pending, even not registered on the portal. I have contacted telephonically and through email many times but every time they say that will be done in a few days, but still pending.

Member ID-M[protected]PNBA

It is inform to you that had sent two nos. Original Maternity bills to Chandigarh office in the name of Gurpreet Kaur and two original bills of baby in the name of baby of Gurpreet Kaur (now baby name is Aviraj Singh Kainth) i.e. Sant Child Care Hospital and Columbia Asia Hospital via Reg post no RP[protected]IN dt 20.10.2021, bills related to Columbia Asia Hospital are settled, but bills related to Sant Child Care Hospital of Rs 26, 268/- (admission date 15.09.2021) are still pending, even not registered on the portal. I have contacted telephonically and sent various emails but every time they say that will be done in a few days, but still pending.

Submitted claim on 2 Aug 2022 for Cataract operation. Received email on 30 Aug 2022 for remittance of Rs 40, 000. NEFT got returned by my bank due to some technical glitch of my account being NRO. No intimation by email or call by Raksha TPA, came to know by September first week only after checking it on the website. Have written several emails, made several calls, arranged several physical visits of my family members to Raksha Lucknow office. No reply received at all of any of my emails. No one attending phone. Have no idea what's wrong now.

Claim Ref No:[protected]

Respected sir/madam
I am an employee of Punjab National Bank and got opportunity to become father on dated 19th August 2022, but due medical conditions my baby admitted to hospital from 19th August to 30th August 2022 for same intimate to company but now company deny to settle my claim there is tool to contact is toll free no and mail, no is not working and I have mail about claim many time but not found satisfactory response and after that he denied to settle case kindly help I have expenses huge amount for treatment of my baby kindly help sir

Please refer the Cashless Authorisation Letter (As Attached) from Raksha TPA (Claim No.[protected]. As per the letter, a total amount of Rs.5500/- was to be paid by the insured as the amount of Rs.5751/- was not to be collected from the patient. However, the Hospital authorities made us to pay a total of Rs.11251/- before the discharge.
We request your clarification from the letter as only 5500/- was to be paid by the patient. Please advice at the earliest so that we may intimate the Hospital for refund