Raksha Health Insurance TPA Customer Care

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..

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 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

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]