Raksha Health Insurance TPA Complaints & Reviews

I am amit ranjan. my raksha tpa member id is M58326543pnba. i had lodged a claim in last week of nobember 2021. my claim was passed on 16th of december 2021. but claim is yet to be setteled. i made complain through email as well as telephone to customer care but are they are not resolving my complain. i am completely fed up this time. kindly look into the metter and please suggest whether i should move to other channel to complain. my mobile no is [protected] and email id is [protected]@gmail.com

Sir, I am bank employee and my pf no 85031, I have submitted bills/ documents as per delivered by hospital to raksha TPA, but later on mail received that some bills are not attached, than I collected the same and sent by registerd post to office raksha TPA Chandigarh, but till date no any reply and not sanctioned my claim, I have many times call to raksha TPA office Delhi and they informed me to call Chandigarh office, than I call and get mobile bo. but that gentlemen picked my call and said I am on leave Monday I will try to settle claim, but after that he never picked my call., . so please lodge my complaint to settle my claim as per my entitlement as bill submitted .my policy no is[protected] and claim no [protected] dt 19/10/2021.

regards

Gurmej singh
mob [protected]

Even after query reply claim not proceed

This is to bring into your notice that I Mridula Madaan is a policy holder of PNB oriental mediclaim policy ( Policy no - 231290/48/2021/1754) from past 8 years. I have been consistent in paying my premium on time. I have a complaint regarding my hospitalization last month.

As on 24/1/2022 I was admitted to Max hospital Mohali due to severe infection in my legs. I was admited to emergency and was shifted to ICU for exceptional medical attention. After the infection was controlled I was shifted to the shared room for regular treatment.

I was discharged on 2/2/2022 and during that time I was told that I have to pay Rs 55851 from my pocket as there were certain expenses termed as Consumable charges and Non medical items which were not covered under the policy.

According to my understanding if Iam admitted to hospital then Iam expected to be taken care off completely. How can a patient being hospitalized know that their treatment is bifurcated into different expenses which are covered or not covered in their policy? I have not undergone any surgery and still the bill was too high but I have not raised any doubts on the same.

According to the hospital Bill and policy guideline I understand that ICU charges has a limitation of Rs 10000 per day which is acceptable. However, the other charges - Consumable charges and Non medical items are not acceptable and should be reimbursed to my account.

I am enclosing the Complete hospital Bill summary and my policy for your reference.

I would request you to please review this claim and reimburse the amount paid by me. Incase you need more information please contact me.
Sent mail also on crcm email id but no reply received. Pls contact [protected]@yahoo.com

Sir,

This is in reference to claim no. [protected]

Member ID : SBIG[protected]SBIACHD

Policy No.: [protected]-01.

Please note that this medical policy belongs to my husband Mr. Mam Chand who unfortunately passed away during treatment.
Now, I (spouse) am claiming reimbursement on behalf of him.
It's been a long time since his claim settlement is pending. I have submitted all related documents personally in your office. But still I have not got the claim. Kindly treat the matter sympathetically as due to my old age I am unable to follow up and in urgent need of funds.

I am hoping for your kind consideration in this regard.

Swaran Lata w/o Late Sh. Mam Chand

Claim number : [protected]
Member id: SBIG[protected]IITBV
The CRCM saying claim rejected due to ectopic pregnancy but it was not the case and when contacted telephonically they say different things. Everything was submitted and every document was checked multiple time. While in the last they rejected the claim on false grounds. Such fraud company don’t know they ask for paying premium if they have to reject everything at the end.

I am member of raksh tpa of sbi gen insurance of retired pensioner work member is.SBIG[protected]SBIDEL and submitted bill of my wife SHARDA TARA with claim number [protected]whereas angoplasty was done by tpa mediassist of orient insurance company and adviced TMT after 6months under angoplasty but now I have only sbi gen insurance policy and no alternate to submitt bill to you which I have referred to you before test for cashless and adviced by you to submitt bill after test for payment which it is submitted to you.kindly pay test bill rs1500 Out of bill

Member Id M58307991PNBA
Policy Number [protected]
Insured Name Mahesh Kumar Jajoriya
Patient Name Sonu
Relation Wife
Admission Date/ Discharge Date 15-NOV-2021 / 18-NOV-2021
For the Treatment of Spontaneous vertex delivery,
Hospital Name mittal hospital and research centre
Claim Amount Rs. 51152/-
Cheque No No Cheque Number
Approved Amount Rs.47692/-(Net Payable)
TDS Amount: 0
Deduction NON MEDICAL ITEMS, PREPARATION PART, SUPPOSITORY APPLICATION CHARGES, VACCINATION CHARGES, WARMER CHARGES,

Claim number[protected]
Sir my name is Sandeep Kumar Jyani member ID M[protected]PNBA my tpa claim is of February 2021 and it's about 1 year my claim has not been settled I want to complain against tpa Chandigarh office against amandeep, shubham, Rohit and Mr Kunal Brar who is misguiding me from the last one year and has not settled my claim which is already passed. They are mentally harassing me from the last one year if my claim not settled I will complain in civil court

Subject: MemberID:-SBIG[protected]SBIADEL Claim No:-[protected]

Dear Sir,
I have submitted all required documents by Speed Post on 24/12/2021 confirmation of Delivery Status screen shot attached with this mail, I have sent 4 to 5 reminder till date but your claim manager not taken any response although he has sent reminder again and again today I have received another reminder through email.
I am not understand that why he will not process my claim?

मैंने स्पीड पोस्ट के द्वारा निम्नलिखित documents एक ही लिफाफे मे भेजे थे जिनका विवरण इस प्रकार से है:-
1. CT KUB Film dated 04/02/2021
2. Chest X Ray dated 12/02/2021
3. देर से क्लेम जमा करने का पत्र
4. एक और क्लेम Rs.3018 का भेजा था

ये स्पीड पोस्ट 29.12.2021 को आपके कार्यालय को प्राप्त हो गई थी जिसका प्रमाण है कि मेरा क्लेम जो मैने इस लिफाफे मे भेजा था वह आपके द्वारा भुगतान के लिए क्लेम संख्या [protected]/24 dated 11.01.2022 अंतर्गत सबमिट कर लिया गया है।
इसके अलावा मेरा late submission letter भी आपको मिल गया।
फिर CT KUB aur Chest X Ray उस लिफाफे क्यों नहीं मिला? इसका मतलब आप मेरे क्लेम का भुगतान नहीं करना चाहते है।
कृपया मेरी शिकायत को गंभीरता से लेने की कृपा करें और इसकी गहराई से जांच की जाएं और मेरा क्लेम तुरंत पास करके उसे मेरे खाते में जमा किया जाए।
धन्यवाद।
जगदीश कुमार
[protected]
[protected]

My claim is not settled by raksha health insurance tpa.

My claim number is [protected]. Claim was passed but according to your staff statement, amount of Rs1127/- was deposited in the account which was closed? I am in contact with them for the last two years. Several times I've given the account number as demanded by them.
Amount hasn't been credited yet.
Please check and credit the amount in my account.

Neelam sikka

Hello- I raised my claim on Dec 18 on Raksha portal and got first and last response on Dec 24 asking to provide further documents. I did provide all the documents via e-mail to Pooja Keluskar (pooja.[protected]@rakshatpa.com) and also uploaded all docs on portal .

I asked if I need to do anything further, after that I sent 4 reminders and cc second and third escalation Mr. Darshan Surve and Amit Hegde. NO response yet. Shockingly, when I called Mr. Amit Hegde he was looked like no idea of my email(not sure if they are responding 24 hrs turnaround eamil). I explained everything and sent him personal email and called again, but still no response. I am just hopeless while communicating with the team.

who should I reach when third escalation point Mr. Amit himself is not helping in responding mails.

I argue some one either call me or respond my email ([protected]@deloitte.com) asap.

I have done my Video MER through Raksha for LIC policy No[protected]. However the medical report submitted is incorrect Gender and inspite of many requests they have not corrected.

Due to this my LIC policy has not been revived. All costs associated needs to be brone by Raksha TPA including interest on the policy as your call centre numbers are always busy. We also tried called Manjunath ( [protected]) who handled our case from your side.

My member ID is O[protected]N & sent an reimbursement claim to Raksha TPA on 3rd Nov'21 & received by them on 8th Nov'21, since that time I'm getting query letters regarding documents which I have already submitted originally via courier but again it's showing under queries which cause o[censored]n-necessary delay in claim processing. The major requirement of documents is "Disability Certificate" which I have kept original in my hand & the photocopy of the same has been provided by courier & query reply tool.

I'm attaching such document herewith for your kind reference.

So, it's humble request to you that please check the further documents & process my reimbursement claim as soon as possible.

Claim number [protected] and [protected]
My mother is suffering from tuberculosis (Granulomatous mastistis, consistant with tuberculosis). I have requested for the claim as mentioned above in raksha tpa, but my claim was rejected with the reason that the illness is not covered under domiliciary claim. But actually tuberculosis is mentioned in domiliciary claim. I don't know why raksha tpa rejected this. Actually my mother was diagonised with this decease on august 2020 and i got the hospitalisation claim from raksha tpa as cashless. But from 01/10/2020- 30/09/2021 our bank made insurance tie up with safe way tpa. I got all my domiliciary claims approved for the last one year perfectly by safe way tpa. They sanctioned me 100% of claim. But from 01/10/2021 onwards our bank started a new tie up with raksha tpa. Now rapsha tpa rejected my claim for which i got approved by safe way tpa for last one year.

I need a solution

Hi
MY mother went through Spine surgery on 14 August in Artemis Gurgaon...basis my policy i am eligible for pre and Post expenses

Since i had heard of missing bills in transit...i myself went to Faridabad office and submitted Original bills and Scans...to my surprise the receiving is done by a guard who just dumps them in an open box and doesn't give any receipt too

I have been following up with them to reimburse me and they keep asking me for Original scans ...which i have already submitted...obviously i couldn't have kept the photocopies of XRAYS

the reports for these XRAY's are also sent to them

i need help to get reimbursed as its intentional avoidance and unfair practice

Vineet tandon
[protected]
Policy Number – 131300/48/2021/6904
Claim Number - [protected]

Submitted two different admission dates claims on 14 th sept 2021 rs.36575/- and rs.32440/-settlement of the claims is pending from 2 months no ahy update from raksha or not replying the mail.

My father had cataract surgery from non network hospital. I think thast the only reason for non settelment of claim because i have submitted all the original documents... and what they are continuously asking is original bill of hospital which i have already submitted.Now, I have photocopy of all original documents. They sent me 2nd reminder durig peak covid time in april, 2021...and after 15 days since not able to reply to them they repudiated the claim.
CLAIM Ref No: [protected]
Attaching the documents(Blurred Mobile number)

I am submitted all my documents on raksha app but they didnt respond properly also his app doesnt respond on documents submission thats why my submission of documents got delayed also their toll free not working also now i submitted all original documents for query number [protected] but it is closed by tpa without consulting with me. Kindly solve the issue and clear my claim amount. Thank you