Raksha Health Insurance TPA Complaints & Reviews

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)

Dear sirs, my family mediclaim policy no. 243501/48/2014/1406 in name of Satish Kumar Solanki . My son Saksham Solanki suffering from full body pain till 09.09.14 to 27.09.14. I am submitt original bill & required document to Oriental insurance co ltd, Jalore office on 01.10.14 . I am not received claim in one month. How reason to Late claim please clearify. Please send claim of Rs 53974.80 immidiately & oblige . Satish Solanki. Email I'd [protected]@yahoo.in

i WAS ADMITTED IN SAGAR HOSPITAL, KUMARASWAMY LAYOUT, BANGALORE THROUGH CASHLESS FACILITY ON 29th OCTOBER 2014. INITIALLY I WAS SANCTIONED SOME AMOUNT. I WAS DISCHARGED ON 31st OCTOBER 2014 AND NECESSARY DOCUMENTS WERE SENT TO RAKSHA TPA BY THE HOSPITAL AROUND 1300HRS. BUT IN VEIN I DIDNOT GET ANY SETTLEMENT TILL LATE NIGHT. WHENEVER I ASKED ABOUT MY STATUS IWAS INFORMED BY THEM WITH IN 20-30 MINUTES I WILL GET APPROVAL. AFTER SOME TIME THEY DIDN'T PICK THE PHONE THOUGH THEY CLAIM IT IS 24 HRS HELP LINE. ON 1st NOVEMBER I GOT MONEY AROUND 1000HRS AND FINALLY IWAS DISCHARGED FROM HOSPITAL. NOT ONLY THIS I WAS TOLD NON MEDICAL EXPENDITURE I HAVE TO BEAR. BUT THE DEDUCTED MY AMOUNT FOR SURGICAL AND ANASTHESIA PROCEDURE ALSO. i WONDER WHAT THEY THINK OF NON MEDICAL FACILITY. I THINK THEY ARE CHEATER. DON'T OPT FOR RAKSHA TPA.

I was passed (sanctioned) post hospitalisation claim but the same is not being credited to me by Raksha TPA despite number of reminders and telephonic calls. None of my e-mail is being replied by Raksh TPA, now they are not responding to my phone calls.I have spent heavy amount on phone calls. I am surprised how such companies are awarded with ISO, that stands for quality of services.

Policy No. [protected]P[protected]
Lata Gandhi
[protected]@gmail.com

My policy number[protected] and member id number N90V002154VTIB Very very poor response from ur side for cashless approval and as well as I called Ur pune and mumbai customer care I am very upset from your service and My policy number[protected] and member id number N90V002154VTIB ganesh ukirde [protected]

Dear sir, i am requesting u that i have a policy in raksha tpa so my wife is ill so many checkup in Asian hospital faridabad then after i found according the all test report is normal but my wife is no relief after my wife admit in goyal nursing home palwal after checkup found my wife fiver /tiefied so the raksha tpa only approvd goyal nursing home bill but not approvd my asian bill so i am requesting u please approvd my bill and claimed settled. MY ID CARD NUMBER -UIC[protected] POLICY NUMBER - 221000/48/11/06/00001627 MOBILE NO.- [protected]

With respect to Member ID [protected] Policy No. 124200/48/2013/7433 allotted by Raksha TPA, I wanted to lodge the complaint that on account of hospitalization for 3 days due to infection & fever during 8 months pregnancy , Oriental Insurance/Raksha TPA has declined to re pay 14,603/- to hospital. This company have n number of reasons for refusal. However I am paying premium since 5 years to this company. In short this is a fraud company. People should aware and spread the message in mass.

My claim no is [protected] i had update all the required. Documents to raksha by mail but its sad that i did not receive any claim amount instead i was told that u hav not submitted any reqired papers. I hav all the proofs that i hav send the emails and even the documents needed for the claim now what to do further???

Hi;


Its regarding my insurance claim That i submitted on 8Th of Feb 2013.as per told by executive i need to call wiThin week to know The status i called 25times to customer care number i.e [protected] & also marked a mail to Their official id but no proper reply received after calling so many times now They telling its not yet enrolled please help me into That wiTh whom should i contact to know The status.

my details are:
Name:Neelam bajaj
policy number:121200/48/2013/2196

for furTher information required please contact me on [protected] or email me on

[protected]@rediffmail.com

Greetings Team,

My father was admitted in hospital and got operated for "surgery of genito urinary system". First Raksha tpa approved the amount and later they had cancelled it.When I contacted them they told me submit all the documents, once patient will get discharge and we will look into this. I submitted all the documents on 28 dec 2011 and now they had rejected my claim stating that ' claim denied on ground of exclusion clause'. When I spoke to dr in thunga (Mumbai) hospital they advise me since the operation was an emergency , they need to provide approval.

Kindly let me know what would be my next step ?

Many thanks

Amit Tiwari
[protected]@yahoo.co.in

Reference to our so many verbal reminders and letters still the company has not reimbuse our medical bills. We have submit all necessary documents regarding our medical claim but the company has always demanded fresh/new documents. We enclosed herewith the all documents related to our medical claim for your records and take necessary action to lodge consumer complaint against Insurance company and their TPA.

I am the employee of SBI LIFE INSURANCE CO When i admitted to my mother in the Appolo Hospital New Delhi in the month of April 17th 2011.after confirmation of all guillines which was told by my seniors I went to Delhi for my mother treatment that time my mother was suffering from severe pain due to unknown cause as well some nurological problems jabalpur doctors could not find out the exect cause and advice to appolo hospital .After all quires from company and Hospital I admitted to my mother in the APPOLO HOSP.under cashless scheme Hospital fax the papers related to treatment with the estimated amount of RS-75000/= Seventy Five Thousand company RAKSHA TPA apporoved 45000/= forty five thousand rs against 75000/= but I was socked and surprised to see the such type of neglageny and non coprative behavior during that time.at the last movement of Hospital payment I was very much disappointed because I was in a impression that treatment cost will be paid by the Raksha Tpa .but compay danie the claim and in a very critical situation i called to my few close frirend in delhi and barrow the amount and paid the Hospital bill then Hospital relieved to my mother .I never forget such incident in my life which happend with me due to this I lost my trust in mediclaim policy of raksh tpa which provides services to corporates

thanks


Nikhil Ranjan
policy no-UIC54514288SBI

dear sir / madam
Regarding my claim.I was been hospitalized from 15/03/2011 to 19/03/2011 at parel hospital at (parel bhoiwada) I was been affected by Pulmonary kochs. i have submitted documents whatever they needed i have pd the cash to hospital but when i have putted the documents for claim they are saying claim non payable under clause 2.3(c) at the time of admitted i was very weak & i couldnt speak to any one it was very bad condition for that reason i was admitted & it was my goodluck that by taking medicine & saline there was improvement in my health. Is it fair after paying cash to hospital they are saying it is non payable & i am not too high salary guy at the time of paying bill to hspital i have borrowed money from someone else because i was confirmed that i will get my money back and after that i will pay him back
Insured name Narendra gangan
ID number 05564367DGFCM
Policy num 121200/48/2011/12220
Claim num [protected]

Thanks&regards

Narendra gangan

They are requesting indoor case papers from us. We have submitted original case papers and also sent photocopies many times.....

But all the times they are saying the same thing:

With reference claim <Policy no > we request you to provide the below documents to process the claim further.

1)Kindly provide the complete set of indoor case papers with history admission sheet with detail operative notes.

Regards,
CRCM Cell


I also mail all the necessary documents to them but still they requesting the same. So please help me for the same.

Thanks
Regards
Haresh Bhojani

TO THE CONCERNED AUTHORITY WHOM SO EVER :

I HAVE A MEDICAL INSURANCE SINCE 2009 WITH IFFCO TOKIO its TPA Raksha IS THE THIRD PARTY COVERING THE INSURANCE. WE HV RENEWED THE INSURANCE ON 31ST OCT 2010 & RECEIVED THE POLICY & DID NOT RECEIVE THEIR CARD TILL DATE.
BY THE TIME MY WIFE SEEMA MET WITH AN ACCIDENT IN TWO WHEELER & AFTER MRI SCAN IT WAS CONFIRMED THAT SHE HAD A LIGMENT TEAR IN RT. LEG & NEEDED A SURGERY .

WE AFTER 2 MONTHS AS PER DOCTOR ADVICE TOOK REST & IN FEB 23RD WENT TO APPOLO - BANGALORE FOR SURGERY & PROVIDED ALL THE DETAILS REQUIRED AS PER THE INSURANCE COMPANY & ALSO HOSPITAL HAD GIVEN THE ESTIMATED & SINCE THEN TILL 6TH MARCH THE INSURANCE COMPANY HAS DELAYED THE APPROVAL DUE VARIOUS REASONS WHICH ARE NOT AT ALL DUE OUR NEGLEGENCE & WE WOULD LIKE TO COMPLAINT ON THIS MATTER & WANTED THE NECESSARY DEPARTMENT TO TAKE ACTION & WE SHALL PROVIDE ALL THE DETAILS REQUIRED TO TAKE IT FORWARD AS PER YOUR SUGGESTION. REQUEST TO HELP US OUT IN TAKING UP THE COMPLAINT & TREAT THE MATTER AS MOST CONSUMER WHO MAY FACE AFTER PAYING THE DUE & NOT GETTING THE SERVICES AS COMMITED TO US.

MURALI.K & SEEMA

POLICY NO : 52141771

CONTACT NO : [protected] (BANGALORE)

MAIL ID : [protected]@yahoo.co.in or [protected]@multitec.net.in

I have claimed on 31/08/2010 for cash less medical at Jaipur Golden Hospital to Raksha TPA against my policy covering my 10 years old daughter Mansi Sharma having I-card No. N2108850, but they refused to provide cashless facility stating apply for reimbursement. Now I send all relivent documents with my claim of reimbursement on[protected], but after 15 dyas they again ask for the previous record including First OPD. I send all the available OPD record and treatment plan prescribed by Dr. UCD Notiyal at the time of Discharge, by email 4 times in the period of 2.5 months but no replay or status report received form their side. In last on[protected] I submitted copy of all OPD and prescription of Dr. Notiyal through my agent by hand, and he assured me that I will get my claim amount within 7 days. But on[protected] when I did not get any cheque , I checked the status on Raksh web site, They are again demanding same documents vide their letter dated 18.11.2010 (dispatched on[protected] by UPC) which is not received at my given address till now. It is also marked as final reminder and titled as File will be closed if reply not received within 15 days)

Kindly provide me address of ombadman of Rohini Delhi Area to whom I can approch for justice.

Raksha TPA handles my health insurance claims for Oriental Insurance Company. They neither setle my claim nor respond to my e-mails. Even the insurance company does not respond to my registered letters. Totally frustrated. Kindly advise.
Vijay Chand Sood
Mobile [protected]
mail: vijay.[protected]@gmail.com

TPA called Raksha TPA has refused a genuine claim for my mother's surgery by giving a silly technical reason that the claim needs to be submitted to them within 7 days of discharge from the hospital( our papers reached them on 8th day as per the acknowledgement though they claim to have recd. on 10th day. Their exclusion clause was never highlighted , mentioned in the small( 2''x 3'') pocket guide in a small print.I have communicated with United India Insurance Co.but not much positive response from them so far
Dr.Abhijit Kher
[protected]
[protected]@niramaymothercare.com

NO COMMUNICATION ON PROCESSING OF MEDICLAIM POLICY BY RAKSHA-TPA, BHOPAL
Dear Sir,

1. Details of Mediclaim Policy : Name: Abhishek Sikdar, Policy No. 152801/48/2010/186, Member ID : O[protected]MANIT

2. Abhishek Sikdar is my son and is presently studying in 4th year at MANIT Bhopal. He was seriously injured and was admitted at "People's Group Hospital in Bhopal, Tel :[protected]/4221092; from 08May2010 to 11 May 2010. As per above policy details the said Hospital was covered for cashless transaction.

3. The Hospital management has flatly refused Cashless transaction. So we paid the entire bill and contacted Officer-in-charge of RAKSHA-TPA at Bhopal: Mr Manish Ratlani. As per guidance of Mr Manish Ratlani we filled-up the Insurance Claim Form and handed over to him with a covering letter containing all details of the documents attached, Copy of our covering letter given as an att(doc file).

4. We were informed by Mr Manish Ratlani that the claim will be delivered latest by three to four weeks time.

5. It is more than four weeks now, but there no response from any office of RAKSHA-TPA, on E-mail/post/telephone : I tried on all means, but there is just no response. As such I am constrained to send this mail to you for seeking your assistance.

6. An early reply is solicited please.

Regards,

Col AK Sikdar
Cell : [protected], Ph:[protected]R)/227875(O).