Raksha Health Insurance TPA Complaints & Reviews

Member id :[protected]
Patient name : shashi jain
Claim no. [protected]
Date of admission : 4 august, 17
Date of discharge : 29 august, 17
Claim amount :26074
Firstly applied for cashless they had taken too much time due to which i have to take discharge. Now, i had sent the file for claim settlement to the faridabad office but still it’s showing under process

I was admitted to care hospital, surat, doa - 27/9/2017, 10.18 am to dod - 28/9/2016, amt - rs 15128.00, i had submitted all the docments in orginal to raksha tpa mumbai office as well as in mail too, inspite of all documents provided to them, but still they are not relieving my payments.
Details mention below
Memberid *:* uic[protected]
policy no *:* [protected]p[protected]
policy period *:* 01/03/2016 to 28/02/2017
insured name *:* munish kumar yadav
claim in respect of *:munish kumar yadav
relation *:* self
claim ref no *:* [protected]
dev officer/agent code *:* agi0046321/22784
hospital :- care hospital & heart institute.
claim amount*:* rs.15128

Sub: complaint against raksha tpa pvt. Ltd.
Ref: policy no: [protected]p[protected]
Member id: uic[protected]
Claim ref no.: [protected] (United india insurance co. Ltd.)

Greetings for the day,
My self mr. Mayur m. Darbar holding a family mediclaim insurance policy with united india insurance co. Ltd. Since 29/09/2000 to my 1st policy no.: 020100/48/037/010818/2000.

I was admitted to aditi hospital on 29/06/2017 at 6.35pm. The very same day at 7.30pm i informed raksha tpa pvt. Ltd. For cashless claim. Next day i. E. 30/06/2017 raksha tpa pvt. Ltd. Initially approved a claim amount of rs.18000/- to aditi hospital and told them to submit all the bills. But till 8.00pm they did not gave any confirmation to the hospital about the same even after submitting all the bills. Hospital advised me to pay my bill or i will be needing to stay for a night till raksha tpa pvt. Ltd. Clears the bills. So i cleared all the bills and after discharge with all the bills and with dr. Certificate i submitted the claim on 10/07/2017.

After 50 days of my claim submission they have raised a query regarding the document submission. Documents were already been given at the time of claim and even the hospital had mailed them during the cashless claim.

Please look into the matter and do the needful.

Member id :[protected]
Policy no. 121800/48/2017/9900
Policy period : 15/12/2016 to 14/12/2017
Inssured name : dattatrya ghosalkar
Cliam in respect of : poorvank ghosalkar
Claim ref. No, [protected]
Claim amount 17, 132/-

Query of non settlement claim.
Hospital provide the printed bill with final settlement receipt but the detail of medicine was mention manually on supporting docs which is not acceptable by the raksha tpa company.

My question is bill and receipt from the hospital is provided to insurance company and proof of payment from inssured person is provided however still why such delayed?

I am policy holder of new india assurance
Policy number:[protected]
Claimno: [protected]
Email address: [protected]@systra.com

Raksha tpa not clear my madicliam saying your surgery is unproven

But i had noticed that other tpa of new india assurance passed same type of surgery
So, question is why raksha tps denial for my claim
Pl see the attached documents as a proof.

I am medically insured by raksha tpa pvt ltd.
Recently i got admitted in chhabra hospital panipat for 2 days for which i paid the total amount of rs. 18500.
When i filed for reimbursement, as thats is my right to claim the amount, the company is following the dealying tactics as they are continuously delaying the claim by asking one or the another document despite the fact that i myself submitted all the documents in original they asked for at their head office in faridabad by hand..
Kindly help me..

Non settlement of claim for the oriental insurance policy no - 222205/48/2017/3026 and claim no-[protected] for rs.40397 for claim type reimbursement
I have made regular correspondence through email and had submitted the bill on time but the company is not settling my claims
I visited many times at raksha tpa office at lucknow they are not issuing any orders in favour of me. The patient was discharged in 12 may 2017 but till date they have not given any claim. More than 2. Months have been passed.
So it is requested to settle my claims as soon as possible.

Respected sir,
This is inform to you that my mother mrs sabita dutta (Min no[protected] two ipd form was submitted at local durgapur branch, west bengal which claim no [protected] (Amount rs556) & [protected] (Amount rs2707). Local durgapur office said that your claim was processed & transfer your claim amount within 1 month. But sorry to say that claim amounts don't transfer till now. So, plz check my claim & trf amount as earliest. Acknowledge forms also attach.

Policy no.[protected], member i/d-t[protected]sailrkla & min no.-3610772
1. Pre hospitalisation:
Claim submitted along with due details in original receipts to rakshatpa, rourkela, odisha vide speed consignment no. Em[protected]in dt.27/02/2017 and has been received by them on 02/03/2017.
2. Post hospitalisation:
Claim submitted along with due details in original details to rakshatpa,
Rourkela, odisha vide speed consignment no. Em86927976in dt.17/03/2017 and has been received by them on 21/03/2017 and is under rakshatpa, indore for all dealings/settlements.
3. Rakshatpa, rourkela, odisha closed and unable to contact/communicate.
4. Claims of pre & post hospitalisation not yet registered.
5. Madam palak of rakshatpa, faridabad and dr. Shakti, rakshatpa, indore have been communicated along with through several mails for updating status of claims.
6. Status not yet communicated nor the claims have been registered

Reference:
Policy No.[protected], Member I/D-T[protected]SAILRKLA & MIN No.-3610772
1.Pre Hospitalisation:
Claim submitted along with due details in original receipts to RakshaTPA, Rourkela, Odisha vide speed consignment no.EM[protected]IN dt.27/02/2017 and has been received by them on 02/03/2017.
2.Post Hospitalisation:
Claim submitted along with due details in original receipts to RakshaTPA,
Rourkela, Odisha vide speed consignment no.EM86927976IN dt.17/03/2017 and has been received by them on 21/03/2017.
3.RakshaTPA, Rourkela, Odisha closed and unable to contact/communicate.
4.Claims of Pre & Post Hospitalisation not yet registered.
5.Madam Palak of RakshaTPA, Faridabad and Dr.Shakti, RakshaTPA, Indore have been communicated along with throgh several mails for updating status of claims.
6.Status not yet communicated

Reference:
Policy No.[protected], Member I/D-T[protected]SAILRKLA & MIN No.-3610772
1.Pre Hospitalisation:
Claim submitted along with due details in original receipts to RakshaTPA, Rourkela, Odisha vide speed consignment no.EM[protected]IN dt.27/02/2017 and has been received by them on 02/03/2017.
2.Post Hospitalisation:
Claim submitted along with due details in original receipts to RakshaTPA,
Rourkela, Odisha vide speed consignment no.EM86927976IN dt.17/03/2017 and has been received by them on 21/03/2017.
3.RakshaTPA, Rourkela, Odisha closed and unable to contact/communicate.
4.Claims of Pre & Post Hospitalisation not yet registered.
5.Madam Palak of RakshaTPA, Faridabad and Dr.Shakti, RakshaTPA, Indore have been communicated along with throgh several mails for updating status of claims.
6.Status not yet communicated

I am Ranjit Kumar Sinha, retired SAIL employee from Bokaro Steel Plant. My membership details below
Member ID T-[protected]SAILBKRO
Policy No – 52613304, Policy Period – 01APR2016 to 31MAR2017
My wife, Madhu Sinha, is suffering from sever Crohn’s since last decade. Her gastro consultant is Dr Harshal Gadhikar at Deenanath Mangeshkar Hospital, Pune since last 8 years.
She was administered Remicade multiple times as per her gastro consultant, for which we always availed mediclaim and were never denied payment. For all these instances, she was kept under minimum 24 hours observation after the drug administration.
In July 2015 she underwent surgery for ileostomy where her stoma was taken out of her body permanently to minimise damage to other organs due to severe Crohn’s propagation.
After ileostomy the consultant administered Exemptia instead of Remicade as it was a better medicine. Due to the severity of Crohns and complexities owing to ileostomy, the doctor prescribed Exemptia at the hostpital and kept her under minimum 24 hours observation.
Initially all the mediclaims on Exemptia treatment were approved.
On 2nd Nov 2016, due to inflammation of Crohns’, she was again administered Exemptia and kept under 24 hours observation and subsequently released on 3rd Nov 2016.
But this time the mediclaim request to M/S Raksha TPA was denied. We followed up the denial by personally visiting Raksha TPA office (Pune) multiple times and submitted recomendation and diagnosis letters from hospital. But the Raksha TPA officials stated that we go to consumer court and they will not provide the imbursement.
Claim no – [protected]
Claim amount – Rs 39135
Claim date – 9th Jan, 2017
Query Raised date – 9th Jan, 2017
Query Response date – 27th Jan, 2017
Denial Date – 6th Feb, 2017

Please help us on the way forward in this case.
Regards,
RK Sinha
[protected]
Pune

Deposit amount payment not received from the hospital. I have checked from the portal of raksha tpa, the cashless claim was passed on 12.03.2016 for our claim no.:[protected] but till date the hospital raksha tpa has not reimbursed us the amount.

On follow up with the customer care of raksha tpa on [protected] and [protected], they have no idea why the payment is not made.

As per the policy, within 45 day, we should get the amount back.

Sir
I hv taken a family floter health insurance plan from Raksha TPA c/o Escort Corporation Center. I hv file a re imburment claim for my policy but they are denied my claim due to unnecessary query. I hv replied all query but no response. Please guide me
NEERAJ Jain
Muzaffarnagar
[protected] Mobile

Dear Neeraj,

As telephonic discuss with Heena ...Friday evening-19th Feb-(7:02PM) you assuring me due to coming Saturday & Monday insurance officer n holiday...Will 100% resolve your problem max Tuesday or Wednesday .Neeraj is following same .I have drop the SMS (Wednesday-Neeraj-10:40am & Heena 01:28 PM) both of you but problem remain same/no reply/no action.

Humble Regards,
I have no words...Pls chk trailing mail. (23Oct-2015 to 25th-Feb-2016)

Would like to bring to your attention the issue faced me due to the Raksha TPA Team.
Have discussed a lot and requested the medical cliam, but the Raksha TPA Team is not willing to bring support met . Started facing lot of issues due to the Raksha TPA with United India Insurance Team lack of timely support .Mentioning below the issues faced due to the Raksha TPA Team…...
A. Raksha TPA Team (Mr Neeraj ) not attending call or SMS regular bases, I have done 11 SMS to Neeraj –Reply Zero, …...41 Call regular bases attending only one call…….. Coordination and communication gap between - Me & Raksha TPA Team.Pls chk trailing mail carefully.
B. He does not have time for Customer Service …….leading to Poor service .
C. Doing Mail/SMS/Ph Call ………for more than 115 days.
D-I am lacking confidence….. for medical help By Raksha TPA.
Would request for your immediate intervention.
****Every time only one reply by mail -We are still in process of getting the approval from Insurance company
Why are harassment patient, till the time she is not good condition, Sorry for you, you can directly touch with hospital(On line transmission-Patel Hospital Pvt Ltd, Civil line Jalandhar Ph No[protected] Fax No[protected], www.patelhospital.com ).I am working in MNC but feel it working in Government service…… where we are playing mail to mail .
When writing complaint letter .you want to keep it short and to the point to help ensure that your mail will be read in its entire .If you write below trailing mail l, it’s highly unlikely that someone will down and real all mail. The Complaint letter should be addressed to the hospital. The address and contact information of the patient ………should be available on the hospital’s website .
If I am wrong or giving you false information to you, pls take the legal action me or patient.
Regards,
Deepak Nautiyal

Regards,
Deepak Nautiyal
[protected]

Sir, I am LIC OFFICER(AAO) posted at ETAH Branch OfficeE Salary Roll No-234267. I have Submitted all paper regarding MY WIFE, S Cliam to RAKSHAK TPA PVT LTDLucknow Through my DIVISIONAL OFFICE ALIGARH on 03.11.2015, Neither They are not settle my wife, s claim nor giving any answer. SOME BODY OF TPA LUCKNOW PERSON FIRST PAY RS.10000 THAN CLAIM WILL SETTLE.WHEN I TRIED TO TALK BY CELL PHONE ON 06.1.2016 TO LUCKNOW TPA, MR. RAKESH WHO IS EMPLOYEE, DEAL & TALK MISBEHAVING AND TELL ABUSES, ASK UNCONTROLLABLE BAD MANNER THINGS WHICH I CAN NOT WRITE IN THIS COMPLAINTS, SIR WE LIACIAN.I BELIEVE AN HONESTY .OUR INSTITUTION TEACHES TRUST AND HONESTY. LIC HAS CONTRACT THE ABOVE TPA ON BEHALF OF YOU. I REQUEST YOU PLEASE SETTLE MY WIFE, S CLAIM. MY CLAIM AMOUNT ABOUT RS.57200/ ALL DOCUMENTS HAS BEEN SENT TO LUCKNOW RAKSHAK TPA. Ajay Kumar Garg LIC OFFICER Branch Office ETAH Cell no-[protected], [protected] mail- ajay.[protected]@licindia.com

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

My father underwent coronary angioplasty on an emergency basis, and he was ready for discharge in two days. However, the claim procedure for cashless was inordinately delayed for more than 72 hours, as Raksha TPA Private Limited who was the third party handling my father's claim for oriental insurance company had no records with it of any of his policy details from his past. And Raksha instead wanted to back our claim with all the policy copies SINCE INCEPTION, along with documents of ALL THE OPD CONSULTATIONS AND MEDICAL TREATMENTS. My father being 78 year old and the policy being in force since decades we could not avail all those policy copies. And since he had no illness prior he was not on any long term medications, ever which was communicated to the office. And the processing team at Raksha said, since Raksha TPA had no information with it of past polcies, even if we submitted those copies it could not have cross verifed those for many days, until they got official copies from oriental insurance office. As a result of which my father who was otherwise medically fit for discharge overstayed in his suite in the hospital for three days, incurring additional bills. On contacting the coordinator, Mr. Harish [[protected]; [protected]] from Bangalore, he declined to offer any intervention, who just said that he was with his wife, and wished not to bee bothered. In my professional life, I have never come across such a shallow excuse. And Mr. Harish refused to address this issue three days in a row while in office or otherwise. And I cant help but worry about him and his family's healthy, considering that he was busy for so long - I just pray for his family. Considering that across India hospitals are running so short of beds due to dengue an such illnesses, I am sure Insurance companies should be doing their bit by processing claims in a timely and professional manner. And any excuse will only worsen the situation for people wanting admission but lacking beds.

Summary: Raksha TPA needs to get its act together. Some key frustrating incidents: Asking for attested copies when originals have been submitted Lack of response even after requested documents are submitted multiple times Instead of clearly giving the decision on settlement, they are leading us on a wild goose chase and coming up with frivolous reasons and demands for additional documents. for details pls refer to the policy no and claim no below policy :[protected], customer id no: PO33745778 of kanav Goel

reimbursement of mediclaim is becoming tedious job. we do take medi-claim to ease and make our life sorted but this is becoming really complicated process. Despite repeated requests on e-mail and in person to the tpa that we will not be able to submit death summary as if now(the reason for this has been already communicated to them) and my case already been closed by TPA.other document is already submitted to TPA. we have only been asked for more and more documents to clarify the illness and claim. i have been running from pillar to pillar but misguided by everyone, insurer say that TPA will do and TPA say insurer will do.I really don't know which door to knock and whom to consult . I am getting mentally harassment by this process as my condition is itself is not favorable as i am burn patient not fully recovered and i lost my father in due course. brief:- my case has all ready been authenticated by TPA from hospital itself. Document submitted are:- o All original investigation Report o All receipt worth rs 8.65 lakh approx and my claim is of 6 lakh.(include corporate bonus) computer generated bill with receipt detail. o all the medicine detail which was provided to my father during hospitalization. Affidavit o Photocopy of death certificate issued by udyaan hospital with death of reason mentioned on that. o photocopy of death certificate issued by municipal corporation Patna, Bihar. o Application in writing explaining and requesting the same. My father was admitted to the udyaan hospital on 16th sept'14 and was death on 2nd nov'14.On the admission of my father, same day information was communicated to TPA. I lost my father in due course, This is really painful and topping to that following this medi-claim has become mental harassment . what is required by my side apart from the above communicated thing, will really obliged and expecting a positive and last solution from you. with regards vinita (vini.[protected]@gmail.com)