Raksha Health Insurance TPA Complaints & Reviews

Worst service by the RAKSHA TPA as per my personal opinion yesterday i was requested for cash less intimation through network hospital at 10 am for 70k it was approved at 4pm for Rs 30k.. and after getting treatment again requested for remaining amount at 6.00pm today till now not approved and my family still sitting in hospital even hospital staff leave the hospital..

Claim number [protected]
Details for Member ID : UIC[protected]RMEBS And
Policy Number: [protected]P[protected]

My mother went on Knee replacement surgery for both leg last year.
Her operation was done on 9th November 2021 with cashless claim#[protected]. She got discharge on 13th Nov. 21 after claim passed by Raksha TPA. After four moths I have started receiving call from hospital that payment is not settled by Raksha. I have started follow-up with Raksha and they said it is pending from Insurance company United India Insurance limited.
I have been chasing with Mr. Sandeep Gupta | Asst. Manager- Corporate Relations Handheld:- [protected]| Email:-sandeep.[protected]@rakshatpa.com
but every time they are giving excuse that data is not uploading. We are visiting their Chennai office. We will update you but it's almost one year now but still they are not able to resolve it.

My daughter was born on 6 May 2022 and was hospitalised in NICU for 1 day and regarding that I have submitted my bill on august 2022 to Guwahati office.Now they are saying that they have enrolled my daughter name in the month of October.I have written mails messages to person concerned but have not received any response till now

Dear Sir/Mam,
My name is Saurabh Thakur working in Bank of India pf I'd 211544. My father Umesh Raikwaparn died from cardiac arrest on 12th February 2022. I am a policy holder in Raksha TPA and my father was one of my dependents. To claim for hospital expenses I have submitted all the medical records to Raksha TPA raipur branch .There were some queries to which I have responded earlier and now it's been 7 months but there is no response from their side despite of reminding so many times. So I request you to kindly look into the matter and rectify it as soon as possible.

Thanking you
Your's faithfully
Saurabh Thakur
Claim no.: [protected]
Policy No.:[protected]
Member I'd .: M58211544BOI

My cashless claim not settled. Still waiting very poor customer service and grievance redressal not functioning.

My cashless claim is not settled. I had to pay amount out of my pocket to discharge my 7month baby and still i am following up with the Raksha tpa .

MY CLAIM OF RS 7230 INCURRED DURING EMERGENCY REJECTED ON FILMSY GROUND BY RAKSHA TPA. ALL PAPERS SUBMITTED THEY ASKED ONE RECEIPT WHICH WAS SUBMITTED TOO AGAIN AFTER OBTAINING FROM MEDANTA HOSPITAL GURGAON. BUT REJECTED EVEN THEN.
AS FOLLOWS:-
THE MemberId : N90215260LICDDNRT
Policy No : [protected]
Policy Period : 01/04/2022 to 31/03/2023
Insured Name : A K Gupta
Company Name : The New India Assurance Co. Ltd.
Employee Number : 215260
Corporate Name : Life Insurance Corporation Of India
Claim in respect of : A K Gupta
Relation : Self
Claim Ref No : [protected]
Dev Officer/Agent Code : NA/
Insurance Company Number : TP[protected]
Hospital Name : Medanta The Medicity
Claim Amount: : Rs.7230

Dear Team,
I have very worst experience with Raksha TPA. Since more than 10 years I am paying my insurance premium and I never did any claim against my policy.
This year I got injured and hospitalized for surgery. In the hospital cashless facility is not available hence I paid all the hospitalization and surgery charges from pocket and availed reimburshment facility.
I have submitted entire file with proper documentation as per Raksha TPA claim settlement form. However, in the claim initially they deducted approx Rs. 65000 from the total billing amount and mentioned unreasonable reason against deduction as per below.
1. Please refer to the attached insurance policy and let me know where you have mentioned the terms and conditions for deduction of the amount
2. AS PER POLICY ONE DAY EXCESS STAY CHARGE NOT PAYABLE ( total rs. 1500 deducted)
3. RS 13000/- ANAESTHESIA CHARGE DEDUCTED AS ANESTHETIST DOCTOR NAME NOT AVAILABLE ( I would request you to kindly refer discharge summary - attached for your reference and for your kind information Dr. Divya mathur MD clearly mentioned)
4. AS PER REASONABLE AND CUSTOMARY, SURGERY CHARGES PAYABLE 50% OF ACTUAL COST. HENCE DEDUCTED RS 7000/-
( Where it is mentioned only 50% of actual cost would be paid).
5. RS.5543/- DEDUCTED AS KNEE BRACE, NULIFE GLOVES, DREZ
SPRAY, CIPLADINE SOLUTION, MICROSHIELD, PLAIN SHEET, N95 MASK, FACE MASK, GAMJEE ROLL, CREPE BANDAGE, DISPO RAZOR, VACCU SUCK SUCTION NOT PAYABLE. ( I do understand non medical payment could deducted by insurance company)
6. RS.25200/- BIORCI SCREW, PLATINUM BLADE NOT PAYABLE ( Biorci screw and Platinum blade both are fixed at the injury place and it will not be removed in future as well. I have discussed with treated doctor and he confirmed that insurance company can not deducted such type of payment, furthermore I would like to inform you that My sister got met accident in last year and she also suffered from same injury and her insurance company not deducted such payment).
7. AS PER POLICY ONE DAY EXCESS VISIT CHARGE NOT PAYABLE
( No policy terms and condition shared with clients)
8. Rs. 15324 - 10.0% Co payment Deduction ( Please explain the deduction reason).
NOTE :- Above deduction terms and conditions are neither informed nor shared by the insurance company/agent.
I have visited hospital and submitted all the relevant documents as requested by TPA team, however still they did not clear my payment ( claim # [protected]).Their customer care number, email id and office are worst for response to client. Every time we got new and different response against same claim.
I would say each and every insurer please do not go with Raksha TPA or Oriantal insurance service. You are investing your money at wrong place, my request you all to change service provider on your next renewal.

Cataract treatment claim from my aunt (who is a senior citizen also) was submitted to Raksha TPA Lucknow team in first week of July '22 yet it has not been settled after almost 2 months. The worst part is their response mechanism. Their contact center and mail system are of no use as nobody seems bothered to resolve customer complaints. Escalation mails are not answered back. The contact center executives are so naive with no idea how to handle customer grievance. I have been doing follow up since last month but of no use.
I will strongly suggest not to use Raksha TPA services for your health insurance.

Cataract treatment claim from my aunt (who is a senior citizen also) was submitted to Raksha TPA team in first week of July '22 yet it has not been settled after almost 2 months. The worst part is their response mechanism. Their contact center and mail system are of no use as nobody seems bothered to resolve customer complaints. Escalation mails are not answered back. The contact center executives are so naive with no idea how to handle customer grievance.
I will strongly suggest not to use Raksha TPA services for your health insurance.

Hello sir/madam,
I have not received any update on my previous emails.
I would like to reiterate I HAVE SENT THE DOCUMENTS (Hospital certificate and Pharmacy Bills ALONG WITH Cancelled cheque) to Stellar Sphinx, 4th Floor, Above Himalaya Book World, Road No-1, Punjagutta, , Hyderabad, Telangana 500034

MemberID:-O[protected]MANSPL
Claim No:-[protected]

It was delivered on 16 August. Raksha team is not responding to my emails and whenever I call they say the documents are not recieved which is not true, because I have checked with DTDC courier partner and they confirmed the documents were signed and recieved at the office

My claim no [protected] has been passed since 45 days but not any sanction amount credited to my bank account i m tired for that situation so pls credited on urgent basis, not any reply from your side, so pls credited in 1 or 2 days in bank account

My claim no [protected] has been passed since 45 days but not any sanction amount credited to my bank account i m tired for that situation so pls credited on urgent basis, not any reply from your side, so pls credited in 1 or 2 days in bank account

Dear Sir/Madam, My self Sujit my claim no. [protected] passed since 45 days, but not single rupees credited to my bank account I'm tired for that, pls transfer urgently to my bank account n inform me, I'm very tired for that issue. Thanks, Rahul, [protected]

Dear Sir/Madam, My self Sujit my claim no. [protected] passed since 45 days, but not single rupees credited to my bank account I'm tired for that, pls transfer urgently to my bank account n inform me, I'm very tired for that issue. No any mailing reply from Raksha TPA also.Thanks, Sujit, [protected]...

My claim no.[protected]
The said claim was submitted under group insurance policy of BOI on 12.5.2022. The claim is passed long back passed amount
Rs.57319. Even after more than three months the claim is pending for payment.
This is undue delay. My phone [protected].Email [protected]@gmail.com

Claim id [protected]
After 8 months still payment not recieved

I had submitted claim for Rs 9467 God reimbursement. However an amount of zts 4450 has been paid tome and balance amount has been disallowed. In this connection it is stated
1. Doctor had advised to monitor sugar level regularly in order to watch the sugar level. Advised to purchase glucometer fid the purpose. The cost of glucometer and test stripes have been disallowed. As per insurance Co instant rules the cost of glucomter and test stripes (an important item)these items are admissible as may be seen from Annexure II attached TO NABARD circular of OPD facilities
Further an additional amount of Rs 2100 has also not been paid. This amount represents spectacles and lens charges. These items are also reimbursable under NABARD instructions. It is requested that the case may Pl be seen in the light of instant guidelines and rules and reimbursement may be paid in full

Dear Sir/Madam,
We submitted the Original Documents to the TPA Office and we received acknowledged copy as well but still they told us submit the Original documents we cant received the OG Copy.

actually we suffering more for my calming processing...

so we requesting you to please try to understand my query because second time Doctor will not provide the documents because its gone 3 to 4 months.

After the following they told us submit the Original Documents but sir how it is possible to submit again the OG copy.

Please find the acknowledge copy of my submitted OG documents.
requesting you to please help of this case. its my humble request.

Revered sir, it has been 3 months we have filed claim, all originals sent to amd raksha ta office, awb [protected], dt 30-5-22, they raised a query for which never got an intimation, on follow up came to know abt same, got an email id frm customer support of aget handling my case vikas.[protected]@rakshatpa.Com, no reply since 2 months 4rm his side, called again cust care rcvd diff email id swati.[protected]@rakshatpa.Com sent her several emails till date no reply... Rcvd email reg cancellation of claim due to no reply again sent email to above both 20 days ago dinesh.[protected]@rakshatpa.Com. No reply till date from any one of them. Can somebody explain what is going on please and reply me back on [protected]@msn.Com. Thanks and regards