Raksha Health Insurance TPA Complaints & Reviews

Sir, My membership Id is UIC[protected]PNBA, Claim refrence no [protected] claim amount 16341 not yet recieved. I send all details with tpa form of my bank account and cancelled check atteched but they release the amount in the account which was already closed in past. When I Inquiry of this then toll free representive told me to send email with detail, cancelled check scane and close account statement. I provide all details by email to rakhatpa help desk on 6 Aug 2020 but till date i have not recieve claim amount. Please do necessory action on this matter as earliest.

My corporate health insurance is with Raksha TPA, and I had applied for my claim for months and mailing them, still, claim is not passed and no response from Raksha TPA through mail is given.
I was informed once about original prescription of Doctor which was mis-placed in home by me as I shifted my place of residence and then I provided them all original documents and formalities asked by them.
Still my claim in pending and no response from their side is given to me like, it will take few more days to process or these formalities are still pending from my side, atleast they should inform something.
Please guide and help regarding same.

I have submit a hospitalized medical bill of my mother on 06 june 2019 but after 15 days inform me by mail you have not sent original discharge summary and i submit our reply we have already sent original document s of total bills. After that we i meet your reception counter and tells our facts position of bills. We have already sent original bill and discharge summary. He says your bill we be consider for payment. But after some time another mail sent by your representative your claim is late submit for payment kindly give reason and we submit reason for late submission through e mail. After that we inquire that what is our claim position and inform me that your bill sent for head office for approval for payment but till date neither payment has been made nor any information.
Kindly look into the matter and inform.

Claim denied inpiste of claim documents received within 15ays consultation date is 3rd june and you received the documents on 18th june i will send you speed post details if required

Claim no. [protected]

I am ramalakshmi, my membership no uic[protected]obca, i had submit my domiciliary billfor my husband on 29.10.19, and it was confirmed over phone that it had been reached raksha's chennai office at 2.11.19. The claim was not registered so far, and i didn't received any queries by message or e mail. I made a call to this office 7 times from my mobile the staff who picked up the call confirm the receipt of the bill, and give assurance for its registration, but notso far, i sent a mail to its office. If needed i will forward it. Please takeupthe matter urgently and favourably.

Hello there,

Member id : uic545sys2044sccl
Policy no : [protected]p[protected]
Insured name : vishaish pandita
Claim in respect of : angli kumari
Relation : mother
Claim ref no : [protected]
Employee number : sys2044
Corporate name : syscom corporation private limited
Entity name : united india insurance co. Ltd

Claim bills received in 07/2019 and today is 10/2019 and still no amount credited in my account. I am working as a software engineer at idemia noida and i have submitted all the required documents about three months ago and even after the claim amount has been passed there is no reimbursement done yet. Every time i call the tpa or try to contact them through my hr department they keep on saying that there is some problem with the software. I cant understand that why should a customer suffer. What’s the fun of having an insurance policy you cannot rely upon? I am writing all this with the hope that i might get the amount in my account soon after this. Kindly help me as i’m in urgent need of money.

Lots of hope.

Thanks
Vishaish pandita
Mobile [protected]

My name is anchit kumar and my member id is uic[protected]pnba. My child was born on 14 june 2019 and hospitalisation bill of rupees 63634 was sent on 24 th june. Due to emergency situation, i could not intimate to raksha tpa. My case was registered on 10 th july 2019. The placed queries that what is the reason of late submission and why i dont intimate pre hospitalisation? I submitted well on time and i gave reasons of no intimation. It has been almost 2 months.
Each time i call to raksha tpa indore, they state that they have not got any approval from insurance company. They are intensionally delaying the reimbursement. You are requeted to reimburse my claim immediately. They also state that if insuarnce company does not give approval in 15 days, the claim will be rejected. I am very tensed. Kindly resolve my grivence.

My mother got admitted in Maharaja Agrasen Hospital, Punjabi bagh in March 2019. We have availed mediclaim from United India Insurancee, Raksha Tpa(3rd party). But on her discharge Rs. 8000/- we not returned to us stating the reason as the CTScan was not cashed by Raksha TPA as their doctors treated that CT Scan to be irrelevant to the disease my mother was suffering from.
The doctor in Agrasen hospital provided information stating the reason for the test. Still the tpa guys were not convinced.
Now I am stuck in between hospital and Raksha TPA for Rs 8000/-. They are just blaming each other but not taking responsibility. In this case we as a customer find ourselves in a situation where we don't know what action to take. I don't know if the money should come from Raksha Tpa or Maharaja Agrasen Hospital but we are suffering a lot. Earlier my mother suffered due to her illness, after that I suffered for getting that Rs.8000/- back.
Details:
Patient Name:Pooja Nagpal
Date of admission: 5th March 2019
Date of discharge: 9th March 2019
I.P No:1908938
Doctors: Dr. Devindra Sehra, Dr. Pooja Relia
TPA Details: Raksha Tpa
Address:14/3, 1st Floor, Mathura Rd, Faridabad, Haryana 121003
I have contacted persons from hospital, Raksha Tpa and United India Insurance as well. After losing all hopes I am putting this complaint here.
I request to kindly look in the case and help me get my money back.

My mother has an "the oriental insurance co. Ltd." insurance with policy number "252900/48/2019/2362". This insurance is managed by "raksha health insurance tpa pvt. Ltd.".

Recently my mother suffered with breastcancer and had to go under masectomy surgery on 3rd july. By gods grace she was diagnosed with stage-1 cancer and required further test "endopredict" to be done to determine further treatment. The cost of test is rs. 2, 20, 000.
As per the doctor and company doing the test, this test is reimbursable under "chemotherapy" category.

For the same, i tried to reach out to "raksha health insurance tpa pvt. Ltd." to determine whether the test would be covered under their policy or not.
This was urgently required as the amount of test was not small and had impacted us financially.

For the same, i tried to contact the helpline number given on their site "https://www.rakshatpa.com/" on "21st july". I kept calling on all the numbers present on the site for multiple times throughout the week. Following was the ordeal i faced:
1) in every call, i waited for ~10 minutes for my number to come. Then when my number came, i waited for another ~5 min for "the agent who was never available". And finally pressed "3" for getting a call back which i never received.

This is something i would never expect from a company who is in insurance business. How would a person in emergency contact them?

2) after giving up hopes on getting help via helpline number, i mailed them with my concerns on "july 24th". When i did not receive any reply for next 2 days, i sent another mail on "july 26th". I finally got an email from them on "july 29th" which did not answer my concerns but was rather generic in nature.
Then i received another email on "aug 1" asking for prescription. I thought finally someone is going to look into my issue and hence shared the required documents on same day itself. But to my surprise, i never received any response from them even after sending 2 reminders to them.

I think this company is fraud and do not have enough resources to run an insurance business. We have been customer of this insurance since couple of years and have paid multiple premiums. We hope them to serve their customers in difficult times which this company has clearly failed to do.

I would like to get strict action against this company so that other people are not fooled by their tactics and lose hard earned money which they could have invested in other insurance companies.

I have admitted to amrit hospital on 08th june 19 via cashless scheme intimation done query came and reply also been done by hospital and me on the same day from email
Amrithospitalrdr gmail com and my personnel mail like almost 1000 mails daily since 8th june 19 still the cashless claim is not settled all the time call center and all the numbers mentioned in your site are saying mail not received we have sent mails to all the email ids mentioned in your site
[protected]@rakshatpa com
[protected]@rakshatpa com
[protected]@rakshatpa com
Raksha [protected]@com
Info [protected]@com
Claimchd [protected]@com
Kkandpal78 [protected]@com after one month they are saying to pay the amount hospital and apply offline claim
And hospital are also asking daily for payment and your raksha tpa is not responding favorable in any case
What is the mistake we have done by taking policy from you we have genuinely done all the process correctly
Why should we suffer kindly check into this and process the approval the earliest

Claim number: [protected]

I have applied my wife hospitalised docs for reimburesment to raksha tpa, faridabad last year, but still claim (Claim no...[protected]) is pending,, i am so much harrashed as what to do.. Tpa blaiming on insurance company for pendency and insurance company blaiming tpa... As it is showing that they are making fool o[censored]s... Shame on this tpa serivce, i will never say any body to buy this tpa policy a s making people fool... I will also port my policy next time... Really shameful sercvice... Totally mentally harrashed... Such company should be banned... Regards gopal singh...[protected]

My member id o556c5003078epm

Last year i had a heart operation and i had claimed partial amount from raksha tpa insurance company. My personal insurance company reimbursed rs 2 lakhs immediately and remaining amount of rs 50000 i wanted to get from this corporate insurance company. Though i had sent all the documents as required by the company, they 're sending mails each time ' insufficient document'.in spite of sending documents repeatedly, i didn't get my reimbursement at all. This company uses many weapons to deny the legitimate dues to its insurers. Due to their callousness, i suffered a lot. This is a wake up call to all before selecting their insurance companies.

Above said policy brought since 15 oct 2017 by shri narsingh prasad (My father) is admitted at sarvodaya hospitalat 16.03.2019 and discharge on 21.03.2019.

All the formalities full filled as per quarry asked by raksha tpa upto 6: pm but he said lastly that it is not applicable in case of brain related issue. Asking for terms & conditions of the policy by customer care denied to provide same.

You are requested help me to resolve of non payment of hospital bills.

With regards,

Raj kumar chourasia,

S/o shri narsing prasad

I have lodged claim of pre and post hospitilazation under member i'd: pnba under policy nos:
1. [protected] of rs 10570/- and
2. [protected] of rs 8969/-
Both calim are rejected /not by raksha tpa pvt ltd without any intimation.
My wife delivered baby with complications, doctor mentioned delivery date 20 jan but she delivered on 11 jan due to complications. And due to which delivery is cesearian.
Now they denied claim amount saying not payable. As it is clearly mention in irdai cir no: irda/hlt/reg/cir/146/07/2016 dated 29.07.2016 that for pre hospitilzation it is 30 days and for post it is 60 days.
I have submitted all the original documents to them and also discharge copy of hospital. From 11 jan to 14 jan my wife admitted to hospital which already covered under cashless (Again proof submitted).
But they straightly denied my pre and post hospitilazation claim saying it is not covered under my policy. Toatal amount due is rs 10570 + 8968 = rs 11539/-
This is harrassment of customer and due to wrongful rejection of claim of the expense of hospitalization, i have suffered a lot & also received great mental agony, harassment and the attitude of insurance company seems to be deficient, negligent and careless one.
It is clearly mentioned in the irda circular. The people of raksha tpa are unprofessional they even not contacted me over phone or mail before rejection.
Irdai is controlling authority of insurance in india. I don't whether they are compling irdai guidelines for insurance.
I hope, in consumer complaint site i will definite get justice & it will be a great example for insurance companies, who cheating customers.
Waiting for your early positive response.

Thank you

My policy no is 243100/48/2018/1237
I had filled my claim on 4 sept 2018 but till today no cheque received not proper reply. They assured me that i will get cheque in 5-6 days from last 1 month, they try to miss guide me. I think company just want to delay the matter by giving new dates to me.
[protected]
Please let me know when should i get my payment.
Please co operate
Lalit agarwal
[protected]

According to my policy, if the refractive error is more than (-4) it is covered, please refer to the attachment. My refractive error is (-6.25) and (-5.25) respectively but still the cashless has been denied.

They are not telling us the reason why are they denying and it's been more than a week. I was not expecting this atleast for a corporate mediclaim.

Strict actions need to be taken again raksha tpa. We are paying them and in need they are of no use to us.

Dear sir/madam,

In above reference my name is saurabh jain i am employee of a private company my policy no. Is 252400/48/2018/7441 i am regular claim medical bill for reimbursement of my son who fully dependend on me but my indor out door hospital paper is not available hospital is written his indoor case sheet are a secured property of the hospital and cannot be handed over to any body. However they are really available for perusal by any authorized person with in the premises of he hospital and his claim no. O[protected] is [protected] however this claim is registered 18 july for raksha tpa faridabad now refused my claim neither information received me verbally talk me your claim has been refuse your paper has been not satisfaction i am already all paper are originally submitted by courier. I humble request you pls settled my payment as soon as possible without any delay.

Regards

Name saurabh jain

My health insurance policy is with raksha tpa and i have requested for. Claim to raksha tpa lucknow bcoz i. Was admitted to the smart care hospital kanpur unnder the observation. Of sir kalim ahmed. Khan so i have forwarded the claim. Documents. To the lucknow branch and they have provided with the claim no - [protected], [protected]
Now they are saying that the mental illness is not covered under the policy but according to irdai from 10 august 2018 every insurance company has to cover the mental illness. But they are refusing to follow it please help me to get my claim processed.
Contact number-[protected]
Contact name-sanjay chaurasia

I have submit claim no:[protected] in the month of dec 17, claim process in april 18 and send voucher and inform amount credit in the account as of 1 of may 18 but as per verify of my ac amount was not credited. After several mail and call to tpa official inform wrong amount send to sbi instied of icici bank. I have resubmitted bank detail as on 14 july 18 but amount not credit in my account till dare after several reminder to crcm.

This is my first experience with raksha tpa pvt ltd — pre & post hospitalisation expenses reimbursement.

What i realize that there processing of claims provide me smell o[censored]nfair practices. The hospital claims settled in 4days to 7 days mostly 10 days but the claims of real customer the insurer remain pending thereat and even the
Mails are not responded.

I like to remind the company that from insurer they exists, so please also give attention on the insurer claims also.