Raksha Health Insurance TPA Complaints & Reviews

My claim date is 06/08/2021 August and
there was not settled my claim .
i suffered more difficulties in claim process
its to be bad raksha plan.
i m facing more problems in raksha plans.

Please provide me breakup detail of my claim - [protected]. I don't know why so much time consuming either company commits max 50-60 days for any claim processing. Before 50 days Raksha TPA commits same status i.e., Claim is under investigation. Please share details breakup & reimburse my claim as much as earlier.

Dear sir/madam
I have registered a claim with member id M58341591PNBA and claim has been passed 25 days ago but till now i have not received my payment.

Claim Number : [protected]
Insured Name: Hema Rani
Hopital Name: Smriti Nursing Home
DOA : 17-AUG-2021
DOD : 19-AUG-2021

Please do needful as soon as possible. I'll be thankful to you.

I, Saravanan T, was admitted to KR Hospital on May 9, 2021. As an employee of Imedx, for reimbursement, I have sent all the required original documents to Raksha TPA, Hydrabad through ST courier on June 10, 2021 and the documents were delivered on June 16, 2021, but still they are asking the same documents. It shows that they are not willing to settle the amount. Please take the necessary action to immediately settle down the claim.

My claim no is [protected]. I Dr. Priti Trivedi had been operated 21st May 2021. all original document sent to your Andheri office by courier for reimbursement processing. all query's solved from my end but still case is not re-open from your side can you please cross check & reopen this file ASAP.

My new born baby was adimitted in Jaswal children hospital on dated 13/05/2021.and discharge from hospital 26/05/2021.my member id is M58339777pnba .my baby is hospitisation since 23/06/21 .I sent theclaim document on dated 29/06/21.by speed post. But Raksha tpa mark objection of late submission of claim document. I attached the post hospitalisation bill. Till 23/06/2021.fifteen Day time for submission of claim document. Why tpa demanded late submission reason. I also send the Jaswal hospital registration certificate along with medical claim document. Tpa demanded registration certificate Again.i also attached late submission reason Letter as per Raksha tpa demand.please solve issue

Sir/ madam,
With reference to subject, this is to inform you that myself ankit kumar sahu P. F. 0316709 and Membership ID is M58316709PNBA lodged a online claim in oct 2020 with claim no [protected], the claim was passed in April 2021and then I had sent all the original document via registered post on 26 th April 2021, and still after 4 month passed the claim is not settled yet.
Kindly resolve the matter.

Dear Team,

We have applied for a PNB health insurance settlement claim [Claim no. [protected] ] on 1-Jun-21 with Raksha TPA through mail and email to Raksha TPA Faridabad office but every time, they are asking one another documents.
We have also told if you find any discrepancy in any particular bill, pls remove it from the claim list but every one of their reply comes after 10 days and then they ask same details agains and again which is repeatedly provided in emails.

PFA for 1st mail sent to them on 1-jun-21 with all soft copy which we have mailed them also.
2nd mail is recent sent where we are providing the same details again.

Could you please help in this regard to clear our claim?

Regards,
Nikunj

I have registered my policy in 2016. Due to some reasons, I missed one policy premium which results in gap in my policy. And bank claimed me that they will recover the gap of the policy and continue my policy from the 2016 . So then I undergoes my policy on march 2020. And In july 2021 I went for cataract operation. As I was not aware about any policy details. And I registered the claim through oriental office. And now my claim got cancelled due to the reason that my policy is having tenure of 2 years only. And this needs to be 3 years tenure. But the paper I received I was not aware about this information. And No body told me about the same. Infact the intimation request is also been registered by the oriental office.
And now no one is helping me and simply declining the claim.

Can you please help on same. As the conditions are not mentioned anywhere and was not informed by the bank or a pnb office.

Policy number: [protected]
Name: Arun Vaid
Contact: [protected]

Dear Sir/ Madam.

I beg to state that my son's policy no. 214600/48/2022/367-005 & Health Id no. O[protected]N on period date[protected], But online showing is Invalid, Niramaya Status of Rishi Sen Gupta is not updated.

I have submitted the claim wide [protected] & all queries replied.But claim not processed and also no reason shows.
Plz process or give the reason of non pay.
Gursant Singh
[protected]

SBIG[protected]SBIDELTP- urgent - clearance not done

It's always been the same story.Since morning we waited for approval from Raksha TPA and till late evening we are waiting.

Ref No. : [protected]/24
Dated : 14.06.2021
Member ID : O[protected]

I am regularly sending mails to Raksha TPA, not a single respond coming from there side
Why they guys are recommending for Non Pay
I lost my father during Covid Wave 2, we submitted each n every genuine documents
They guys are not giving proper & genuine reason

My wife has suffered from covid 19 due to which oxygen level come very down because of which I admitted my wife at abha nursing home Kanpur where I got a bed and I file a claim on May 21 but I do not get a claim. now they are refusing to give claim saying that patient has past thriod I am taking Mediclaim policy since 2011 and my wife has throid in 2016 how they can refuse the caim on this ground please check otherwise I have to fight in court

Hello Team Raksha,

This Reminder for cashless settlement payment of patient name-Patient Name - HITESHKUMAR PATEL Claim no-[protected] was discharge on Month of Dec-2020 but Patient payment not settled in our Accounting so please provided settlement letter or UTR no.

Please feel free to revert for any future query.

I have deposited my hospital hard copy at your indore branch on 31 May 2021 But till now they have not uploaded the file to the portal. Because of that claim in unsettled till now.
Member I'd M58345076PNBA

Claim no: [protected]
My mother, Savita Chopra, MemberID: SBIG[protected]SBIDEL
Policy No:[protected]-01, was admitted to Fortis Hospital Shalimar bagh on 28th May - 30th May and had to get angioplasty done.

This was supposed to be a cashless experience but Fortis informed us that the contract with raksha TPA has expired and the amount needs to be paid entirely by us. We had no intimation from Raksha TPA about this. Due to this, we paid the entire amount and filed the claim.

The claim has now been put on hold as certain documents are needed:
1 Kindly provide Break up of Rs 254700 /- charged on account of PACKAGE dated 28/05/2021
We have checked with Fortis and they have mentioned that they do not provide a package breakup. The same is mentioned on their estimate form. This was ideally supposed to be a cashless hospitalization but Fortis informed us on the 28th May that their contract with Raksha TPA has been revised and they cannot allow a cashless hospitalization. Due to this, we were forced to pay the money from our own pocket. There is no way to arrange for the breakup. Fortis is on the panel of Raksha TPA, then they must know this already.

2 Kindly Provide Sticker for Stent used in the surgery.
All the surgery related physical boxes (stents and others) have already been sent.

3 Kindly provide Self Attested Xerox copy of Photo Identity Proof for the Patient : (Aadhar Card /Passport/ PAN card/ Voter Identity Card/ Driving License/Letter from Recognized Public Authority duly affixed with photo).
We will send the same. The requirement for this was nowhere mentioned on the downloaded Raksha TPA claim form.

4 Kindly provide Original Pre-numbered, Preprinted duly signed and stamped Receipt against the Final Hospital Bill
We have checked with Fortis. The inpatient summary bill of Fortis clearly mentions the amount paid by the patient Rs 3, 35, 346. Fortis does not provide any other receipt than this. Then why is a separate receipt needed.

We have been told that without the receipt and package breakup the claim cannot be processed further as Raksha does not work according to Fortis. At first, it is an issue with Raksha TPA that their contract with fortis was terminated. It is due to this a cashless experience turned into a claim settlement. How is it the fault of the patient?

Is this a way to cheat senior citizens of their hard earned money.

Please look into this matter and process this claim forward without the need of any additional receipt and package breakups. Reach out to me on [protected]. I am Rajiv Chopra, the son of Mrs. Savita Chopra.

Member ID SBIG[protected]SBIACHD
I filed one claim and for the last two weeks, this is approved but not getting the amount in my account. Whenever I do a discussion on this executive says that you will get the amount in one or two days and I am listening this from last two weeks.

I need the amount because I have to clear my debts and to be honest other companies like ICICI and others will not take such a long time in payment.
If you still need more time then kindly clear the whole scenario.

Tushar Kashyap
[protected], [protected]

My compliant was repudiated only on the ground of non admission for 24 hours. Juts to inform you that I fell prey to Covid 19 and during my Covid treatment, I was denied hospitalization by the hospitals due to non-availability of beds in the hospitals and therefore, all necessary arrangements with regard to patient care/treatment were made at home along with drips, injections, medicines and glucose which was made available by a nearby clinic and its staff.

I have uploaded bank details for reimbursement of subject claim. As per information given by customer care details are still awaited. I have also sent details at email [protected]@rakshatpa.com, , finance.[protected]@ralsha.com&[protected]@rakshatpa.com as advised by Customer Care but still status shows bank details awaited.
Kindly look into it and expedite my reimbursement.