Raksha Health Insurance TPA Complaints & Reviews

I had claimed reimbursement of expenses for my father's eye operation on 31/12/2020 and the claimed documents received at their Guwahati office on 19th January, 2021. I am an employee of PNB (Member Id- M[protected]PNBA). Till today i am not getting any amount of the reimbursement.

Amount deducted without query and not received call on[protected] at Raksha health insurance TPA Pvt.ltd.

Dear Sir,
My name is Sachin Gupta, I am a Senior Manager at Bank of India Jiwaji Chowk Branch Gwalior (M.P.). -[protected]

My insurance policy was from your TPA, whose policy number is UIC[protected]BOI.

There are currently 4 claims pending in your TPA more than 7 months, for which I have mailed to your department several times and have spoken to Swati ji and Jagat Pal, farooq mohammad several times over the phone and mail dated-19.11.2020, 21.11.2020, 26.11.2020, 01, 07, 08, 10, 11, 14, 19, 21, 31 Dec 2020, 01.02.2021, 12.02.2021, 15.02.2021 but till date I have the following claims pending.

1. [protected]- Total claim Rs-10240 but pay only Rs. 2740 (एम्बुलेंस का भुगतान मुझे नहीं किया गया )

मेरे द्वारा आपके Raksha TPA में क्लेम भेजा गया था जिसका क्लेम नंबर [protected] है मेरा क्लेम कुल रूपया 10240/- का था जिसमे से मुझे मात्र 2740 रूपया स्वीकृत किया गया है मेरे द्वारा भेजे गए bill में​ एम्बुलेंस का भुगतान मुझे नहीं किया गया है
​कृपया पुन मेरे क्लेम को चेक कर मुझे एम्बुलेंस का भुगतान किया गए

2. [protected]- Rs. 30444/- Claim pending

3. [protected]- Rs. 3248/- Claim Pending

4. [protected]- Rs. 36392/- but pay only 2500/- (Ambulance difference and hiring a nurse Charge not paid)
Regarding this claim I gave the following Representation in your TPA-
the policy's point number According to 3.13 -“Taxes and other charges: all Taxes, Surcharges, Service charge, Registration charges, Admission Charges, nursing, and Administration charges to be payable. Charges for diapers and sanitary Pads are payable if necessary as part of the treatment charges for hiring a nurse/ attendant during hospitalization will be payable only in case of recommendation from the treating doctor in case ICU/CCU, neo natal nursing care or any other case where the patient is critical and requiring special care.” the above amount is covered in TPA Dr.'s recommendation has been attached by me with the said claim. (Recommendation and policy Para 3.13 copies attached)

Please do need ful.

Sachin Gupta
[protected]

I, nikhil Gupta, employee of PNB with member of M58304736PNBA, claim my medical expenses incurred on my wife for delivery which costs nearly 76000, as my wife costs two operations, one is cesarean and other one is hysterectomy. As per your policy. The cost of Cesarean on delivery is RS 75000/. And also my wife gone undergone other operation as per bill sent to you.
I got only 40000/ .
Please let me know the less payment

Regards
Nikhil Gupta
[protected]

Dear Sir

I would like to inform you that, my self KASHINATH BAURI. I have one policy of you company. Tha transaction number is M58202729pnba debited by December 2020.

I future inform you that, I have submit one clam on this policy. But till now I am not get clam money from company side. And I also frustrated and manipulated from company agent.

I hereby request you to kindly settlement my clam, as soon as possible. Please help me IT IS VERY URGENT.

Regard's
KASHINATH BAURI
Mobile number - [protected]

Dear sir/mam,
My reimbursement claim was recently settled for less amount then claimed stating reason that the CT scan films were not attached.However I had attached the films and also informed several times regarding the same on your mail id [protected]@rakshatpa.com.I had also received the confirmatory mail accepting the receiving of films at your end.claimid-[protected].Rs 2500 was thus deducted on false note.Kindly do needful and process the deserved claim.

I have submitted all the bills for the claims requested but RAKSHA TPA is asking for the same bills again and again. Please note the docket numbers of the courier sent:

Z61556564
Z38052081
Z61556563

Please note below my details:
Name: Akanksha Kasera
Member ID: N90IGA4871INAR
Claim number: [protected]

Request you to kindly look into this matter as on priority.

This is to bring in to your kind notice that I had a delivery with C Section whose all the bills and documents were attached and submitted to Raksha TPA in hard copy for Claim Reimbursement amounting Rs 95771/- but the amount approved for reimbursement is Rs 45155/- stating that Pre and Post Amount is not payable and the receipt and various bills have not been attached. I submitted all the Original bills and receipts since my treatment started...

I have submitted all original documents to Raksha TPA from our circle office Rewari and visit by your staff to hospital also and this time my claim status shows ' recommended for non pay ' kindly give me the reason for non payment of my claim. You have raised many quaries regarding this and I have completed all and send to your office. Now nearby 2 and a half month not give a single reason my claim rejected why? Kindly look into the matter and resolve my issue and early settlement of my claim. The detail of status attached for your reference.

Thanks and regards
Laxman
[protected]
Sr Manager
PNB CO Rewari

I have applied to raksha tpa for reimbursement of claim vide claim No [protected], [protected] and [protected] for my policy No UIC[protected]BOI The request for the release of corporate buffer has been sent to raksha tpa officials but they didn’t release the buffer and rejected the claim citing sum insured exhausted Its been more than 4 months. They have not processed the claim neither they replying my mail despite of sending 14 reminders. I have mailed to crcm ( raksha portal) but they have not replied. Their complaint portal is not allowing me to register as it has technical issue. Kindly help me.

Sir my member ID is UIC5454047IBAPB..I aM EMPLOYEE OF BARODA U.P BANK...I had sent all document for medical claim at 21 Dec 2020 to regional office Khalilabad but after some time my claim had query those document which I sent to regional office Khalilabad...my wife is suffering from cancer.I took claim before many time without any problem...plz sir solve my problem...my all original documents are lost by raksha tpa agent...🙏🙏

A claim for An amount of Rs 19004 was submitted In November 2020 which was delivered to Raksha but entered into system on 22/12/2020.Now to my Uttar surprise, without raising any query regarding the claim, an amount of Rs.9352 only has been credited into my account. Rest of the amount deducted without assigning any reasons. That is without raising any deficiency or raising any query into the system/Portal of RakshaTPA. It is a Harrassment to a senior citizen.
Please look into the matter and get it resolve.
Thanks
Satish Kumar Gulati Arora

I have raised query against your settlement voucher many times but your team is not responding properly as I have sent you a mail with the conversation with your team. I am very disappointed that raksha tpa is doing this kind of mistake that's why I have to register a complaint against your team . This is my wife's claim of august month. They have settled this claim in november month but when I saw settlement voucher than I found that they have added 32092/- in laboratory service charges but my bill was 33610/- for laboratory service charges and 9190/-for diagnostic non lab and total amount of lab services is 42800/-.and I have sent mail many times but they are not trying to understand our problem and not giving any satisfactory answer. I am sending you bill's copy and settlement voucher's copy for your reference. Please do the needful as soon as possible.
Thanks and regards
Inder mal jain
Member id SBIG1445056ESBBJSBIJPR
CLAIM NO [protected]

17/11/2020 ko 15:26 ka day care ka approval aaj 18/11/2020 ko 11:55 tak nahi aaya aur customer care se baat karke request karo to bolte hai abhi ho jayega 17/11/2020 ko patient ka treetment nahi ho paya hospital se wapas Aana pada aur irdai k circular k hisab se 3 ghante me approval bhej dena chahiye but aapke tpa ne na hi koi request suni aur na hi koi reason dia aur Abhi tak approval nahi bheja aur 18/11/2020 ko fir se date change ka approval mangna padega aur aapke tpa se koi madad nahi mili abhi tak aur kal se lagatar customer care se baat karne k bavjood koi kaam nahi kia aap logo ne ek ghante baad to mail seen ki aapne aur hamara mem I’d no hai N90230109LICKANRT

Dear sir,
My baby was born in 18th feb 2020. He has kept under new baby care unit for better treatment. I have submitted all original documents with your Bhubaneswar office but after 4 months they raised query and i have submitted the query. They told that its for Vaccination so they made it non payable. but the bills and documents i have submitted where not a one rupees was for vaccination. plz settle my claim otherwise i will complain in ombudsman. My claim no-[protected]

With Regards
B S Samal
[protected]

It was on 03.09.2020 that i parimal staff of PNB(eOBC) has personally handed reply of my query Membership ID UIC[protected]OBCA To MR ANUJ [protected]. Now its been month and my reply still has not been proceed.

As such your good office is requested to please look into the matter on urgent basis and help me resolve this issue.

Please feel free to call me regarding this matter

I Darshana working in Bank of India having PF no.184661.I have submitted my claim on 11.12.2019.from that date am continuously taking follow up with Miss.Swati Malusare Mob.No [protected](Who is very arrogant). She has given me every time wrong information ... Very bad service by her.
Details of the follow up through mail.
1. Submission of claim on 11/12/2019 through speed post no.EM[protected]IN
2.Reply received on 8th January 2020 from TPA-Name Mismatch with policy
3.Confirmation regarding Name change given by us on 15th January 2020.
4.Daily follow up with Swati Malusare... She was not picking up call.. And not respoding to mail.
5.As per telephonic talk had with swati Malusare she informed we require confirmation mail form HR dept.
6.HR dept send confirmation mail on 12th Feb 2020 & again on 14th Feb 2020
7.After sending all required details I tried to call her lots of time but she is not responded to my call.
8.Since March-July 2020:reply from Miss.Swati- I'm working from home. I will update you shortly and asked to contact to Mr.Jagat Bhadur (Executive Corporate relation)
9.on 18th July2020 -i sent reminder as Extreme delay in Claim settlement... reply received from Mr.Jagat Bahadur-Details acknowledge, update you at the earliest.
10.reminder mail sent on 10th August 2020, 24th September 2020- No response from Raksha Tpa so many times I called Swati Malusare she is not picking up call it is really painful to note that it has been a year and the claim is not yet registered nor settled.

Thanks & Regards
Darshana
Bank of India

I am kumari neha working in bank of india, having pf no. 185841. I have submitted my claim on 10th aug 2020. I have talked to miss swati madam. She has given me wrong information & said me your claim has already been registered. When i had talked to mr farukh he said your claim has not been registered and i will registered your claim within 5 min. And my i got message that my claim has been registered within 5 min.
Now my claim is non payable and again i talked to mr. Farukh for returning my original documents to my zonal office. He said me to talk to swati madam. I am continuously called swati madam but she is not responding my call. When i called from other number she picked, after which i told her to send my original documents to my zonal office. She said please mail me to send original documents i will send it tomorrow. I have already send her mail twice but i have not received any mail regarding this. Now when i am calling her she has not picking my call and blocked me. What a pathetic service she is giving... Very bad service by her.

Please send my original documents to my raigad zonal office (Bank of india) if claim has not been passed. And revert me back regarding this on my email i'd kumari. [protected]@bankofindia.co.in

Thanks and regards
Kumari neha
Manager bank of india
Raigad zone

I have submit my wife pregnancy claim no[protected] on dtd 21 feb 2020 to 23 feb 2020 amt 72459. But company paid to me 37253. I have submitted another claim no
[protected] frm dtd 7 feb to 15 feb 2020 amt 44407 and company paid me 37747. Only these claim have submitted by me and no another claim presented by me.

1) claim no: [protected], date: 22nd july
2) claim no:[protected], date: 10/9/2020
3) claim no: tp[protected], date: 24th oct
4) claim no: [protected], date: 22nd june 2020
5) claim no: [protected], date: 9th sept 2020

Regarding all the above claim status i fill like torcher and i am very much disappoint regarding this and also i am not satisfied regarding the claim and i will take advice according to terms and condition and the i will tell about it in next 15 days.