Raksha Health Insurance TPA Complaints & Reviews

Dear Sir/Madam,

This mail is in regard to the Unfair Insurance Payment or Settlement for my details mentioned below.

Name of Insurer: VASANTBHAI VIRJIBHAI PATEL
Policy/ Claim No: - Policy Number[protected] / under Claim no- [protected]
Claim Amount: - Rs. 143450.00
Sanctioned Amount: - Rs. 99110/-

Please find our submission on your settlement description: -

Heads Deduction Amount (Rs.) Remarks
Deducted under Investigation charges as the Investigation charge 2400 These investigation reports which will drive the treatment further should be sanctioned, I am unable to understand why Rs.2400 is cut, Put for your explanation on this
ICU Charges 39800 Rs. 18, 050/- per day is as per the AMC circular dated 11/12/2020 issued by Mr. Mukesh Kumar IAS.Please relook to this and confirm balance amount credit - we have also submitted proof of our ICU hospitalization basis your demand, Put for your review and credit
Medication 2940 Why ? Not able to Understand Please explain in details - We have not taken any package, whatever is paid was claimed.
Total 45140

Sir, I want to urge you that I have been into financial deficit in this bad phase of Covid and hence such a deduction is unfair, making a deep dent and not acceptable to me.

Request your reconsideration and prompt actions on balance Credit.

Regards

Vasant Patel
M – [protected]/[protected]

DEAR SIR/MADAM,
I AM CONTINUOUSLY FOLLOWUP REGARDING MY Claim intimation of policy no. 252400 / 48 /2021/630 DT 25.01.2021
BUT NO RESPONCE UR SIDE REMINDER1, 2 MANY MAIL SEND BUT NO ANSWER I CALLED TO RAKSHA OFFICE AFTER PICKUP ONE OR TWO DETAILS CALL DISCONNECTED.

IN FUTURE IAM NOT SUBSCRIBE WITH RAKSHA POLICY

all doctors releaving documents discharge card couriered through speed post dt 07.04.2021 & soft copy send through mail

IF ANY ISSUE CALL ME [protected], MAILID [protected]@gmail.com

regards

ashok kumar goel

Since 3 months I am contacting their staff for deductions in my claim but no justified answer has been given.my only concern is that when same hospital bills has been passed by them in second claim then why they have deducted amount of the same hospital bills in first claim.when I asked one of their staff then he threatened me that he will reject the second claim also which has been passed already.
No one answer my question and also they demand again a confirmation letter by hospital after 4 months of hosptalization. I have already provided a confirmation letter by hospital, now after 4 months the hospital is not giving any letter as they have already provided.
Very poor service from this company

I need Item wise details of deduction from Hospital Final Bill, which are not provided despite my repeated requests.

As I've been writing continuously but no response is coming back.
I request you again to reprocess my claim.
number [protected] for Raj Kumar Rai
I have even submitted my documents multiple times, all of the documents that were asked for.
Please look into the matter ASAP

Given below are 2 Screenshots of Claim Settlement Letters of Raksha TPA for Oriental Insurance Co, and of HDFC Ergo for your reference and records.
There is a Very Important Difference between the two, as the Instructions for Amount Deducted from the Hospital Final Bill, to be Paid by the Patient or Not.
While Raksha TPA has Clearly asked the Insured to Pay all the Deductions, HDFC Ergo has asked the Hospital Not to Charge it...

I have contacted many times to raksha tpa office regarding deductions in one of my claim but didn't get satisfactory answer also recently one of staff talked very rudely and also threatened me that he can also reject other claim which has been passed by the company.
Very rude behavior and very unsupported staff.

Have submitted the claim with bills to the Raksha TPA Office on 18th of March but there is no update yet from them
Today I just had a call with Customer Care and from there I got to know that claim was denied because pre and post hospitalization cover is not there.
In claim there was 10422 INR during hospitalization because some medicine was not there in hospital and I bought myself from hospital TPA I was told that you can claim directly to Raksha TPA.
But There is no proper response from Raksha TPA they are ignoring my mails

Claim rate is very low.beacuse of this reason I loss 20000rupees from my side.
This health insurance company not accepting total bills because of this reason I loss 20000rupees.hospitals total amount collected from side.that total bills not claimed by this health insurance company.please take action

My raksha TPA member ID is O[protected]JETAIR and claim no. is [protected]. About 15 days have been passed past filling of reimbursement claim but the claim is still in 'processing' stage. Please look into the matter to settle the claim at the earliest.

My father ( Mr Suresh Kumar Mittal) and mother (Mrs Madhu Mittal) were admitted in Maharaja Agrasen Hospital Dwarka on 14/4/21 as they were covid +.
Unfortunately, my mother and father got expired on 1/5/21 & 3/5/21 respectively.
The total hospital bill of Rs. 10, 00, 000 + (bill attached). The person who looks after Tpa claim in hospital said that my parents claim file has been mailed to Raksha Tpa and Rakha Tpa is neither replying to hospital email not approving the claim. It’s been more than 10 days and the claim is not getting approved.

I tried calling Raksha Tpa customer care number but the executive kept my waiting for more than 25-30 minutes on hold and at the end call used to disconnect.

I talked to M Mohammed (TPA customer care executive) and he told me that hospital has not submitted the to Raksha TPA whereas hospital TPA person (Mr Deepak & Mr Vijay) told me that they have uploaded all the documents of both Suresh Mittal & Madhu Mittal on online portal to TPA.

I can’t understand why they are telling 2 different thing. After loosing my parents I am facing much emotional imbalance and now TPA is giving me mental tension about this case.

I have attached all the bills copies and policy details as well.

Kindly help me in this case.

You can contact me at below details:
Deepak Mittal
[protected]

Details of policy are mentioned below:

Policy No. - [protected]-01
Name: Suresh Kumar Mittal

Dear Sir/Madam,

Respected sir/Madam,

My name is Sandeep Kumar Jyani pf 1359116 working at b/o Arniwala sol 030110. Sir last year in November my 3 years old son fell sick and hospitalised then my son admitted in delhi child care hospital sriganganagar rajasthan from 21 to 24 November 2020 then dr told us for meckel's diverticulum test then we went to SDMH hospital jaipur where we tested him meckel's diverticulum and the report was positive then asper doctors advised in December my son got major operation and admitted in Dr Dua Hospital at sriganganagar rajasthan from 14 to 21 December 2020. It was very unbearable pain for my son and after operations we also frequently visited all the doctors as his pain was not stopped after operations also then again in February 7 my son has suffered accute pain and infections in intestine so then we admitted him Jubin multispeciality hospital sriganganagar rajasthan where he was admitted from 7 to 14 February 2021 again his medicine is still in process and we also went to Jaipur in March asper doctors advise for the rest of the test. He is still not recovered.
Now I have applied mediclaim 3 bills first bill was of November which I sent in February first week and second of December bills sent in March first week to Raksha Tpa whose receipts are with me after calling from many months they registered my claim in mid April now they are again and again harassing me to send the reasons for delayed submission of bills which I have already sent and another objections was to provide them inpatients facilities certificate which I have also sent them as it was very difficult for me to travel in another state due to lockdown in rajasthan but I managed to reach there and got the certificate as they demanded.
Now again they raised new query to harass me as to send them to fill form A duly filled which was already completed asper my knowledge.
And now the matter is about my third bill of February this time they are asking original discharge summary and doctor final bills this is really a joke I have sent them original discharge summary and doctors final bills with doctor's stamp on it.but still they are asking pre-printed receipt of doctors final bills which have already been submitted.i have photo copies of all discharge summary and doctors final bills.
Now lockdown has imposed in Rajasthan due to which I can't enter in rajasthan border again and again. Sir I called them many time then they registered my claim as after receiving documents in February they are registering my claim in April now sir you may assume who is delaying the bills and asking me to reason for delayed submission.
Sir my mediclaim bills has been delaying intentionally and if my bills not cleared I have no option to file a complain against Raksha Tpa to All Indian Bank Union and Ombudsman for mentally harassing me.
Because I have all records and courier receipt.As I have submitted all the original and relevant documents which they asked for but they are again and again making same deficiency to harrass me. Sir I want to ask why this TPA is if they can't process my claim.
Hope for a solution at head office level Soon.

Regards,
Sandeep Kumar Jyani
Pf 1359116
Tpa member id M[protected]PNBA

I raise a complaint on 05 April 2021 regarding claim not pass till date and said complaint is closed says that complaint is resolved
There is no response about the complaint, then how said complaint was close without resolving it

Claim no. ([protected]); Member Id: UIC[protected].
My above claim is more than 1 yr old. I hd initially lodged claim with M/s Star Healthcare on agents advice, but due to sub limit being exhausted my claim was rejected and original documents were returned. Raksha tpa RM has refused to pass my claim alleging that my claim amount has been paid in part by Star Health despite my giving them claim amount disbursement certificate stating amounts recd from previous hospitalization and claims and nothing from above mentioned claim.
Request you to please resolve the issue.

I raise a claim vide claim id [protected] and also send reply of query dated 07 dec 2020 within 15 days i.e. on 20 dec 2020 but your company rejected my claim without any intimation
Please do the needful

Name sunder pal garg claim amount rs.41398 claim no.[protected]

My wife is admitted for hernia surgery and has been requested to discharge today. From afternoon we have been trying to reach via email and phone to get the claim approval and there has been no proper response from Raksha TPA.

I have a 7 months old kid as well and my wife is getting mentally stresses because of this situation, as we need to stay one more day due to lack of response from the so called 24/7 team.

During the pandemic situation it's really hard for us to stay at hospital, risking ourselves.

Also there is no proper escalation matrix. When asked them, they said no supervisor to escalate.

Sir I submitted claim of my wife right tube raptured claim no.[protected] I submitted all documents provided my Hospital but after continuing giving reply my claim recommended for non pay

Sir I have submit my daughter tuberculosis treatment claim ref no.[protected] dt. 09.01.2020 and my member ID N90227702LICGKP. I am employee of LIC OF INDIA BO-2 GORAKHPUR UP. I had sent all query document for ct thorax and suporting investigation dt 05.11.2019 by our office latter dt.15.12.2020 and mail 25.02.2021. Kindly look into the matter and resolve my issue and early settelment of my claim.

Thanking and regard

SATYA BRAT
AAO LIC OF INDIA
BO-2 GORAKHPUR UP.
ID NO N90227702
MOB. [protected] & [protected]

Respected sir
Whoeith regards kindly i inform you that my claim no [protected] has been taking longer than usually.inspite of i submited all related document as per query raised.but it seems there is no carefully attention about my claim settlement no information is updating about claim status.
Plz acknowledge the same
I will be thankful to you