| Address: | 2 Gotri Vasana Road, Vadodara, Gujarat 390021 |
| Website: | www.rakshatpa.com/WebPortal/Login/Anonymous/checkClaim |
Dear Team,
I have very worst experience with Raksha TPA. Since more than 10 years I am paying my insurance premium and I never did any claim against my policy.
This year I got injured and hospitalized for surgery. In the hospital cashless facility is not available hence I paid all the hospitalization and surgery charges from pocket and availed reimburshment facility.
I have submitted entire file with proper documentation as per Raksha TPA claim settlement form. However, in the claim initially they deducted approx Rs. 65000 from the total billing amount and mentioned unreasonable reason against deduction as per below.
1. Please refer to the attached insurance policy and let me know where you have mentioned the terms and conditions for deduction of the amount
2. AS PER POLICY ONE DAY EXCESS STAY CHARGE NOT PAYABLE ( total rs. 1500 deducted)
3. RS 13000/- ANAESTHESIA CHARGE DEDUCTED AS ANESTHETIST DOCTOR NAME NOT AVAILABLE ( I would request you to kindly refer discharge summary - attached for your reference and for your kind information Dr. Divya mathur MD clearly mentioned)
4. AS PER REASONABLE AND CUSTOMARY, SURGERY CHARGES PAYABLE 50% OF ACTUAL COST. HENCE DEDUCTED RS 7000/-
( Where it is mentioned only 50% of actual cost would be paid).
5. RS.5543/- DEDUCTED AS KNEE BRACE, NULIFE GLOVES, DREZ
SPRAY, CIPLADINE SOLUTION, MICROSHIELD, PLAIN SHEET, N95 MASK, FACE MASK, GAMJEE ROLL, CREPE BANDAGE, DISPO RAZOR, VACCU SUCK SUCTION NOT PAYABLE. ( I do understand non medical payment could deducted by insurance company)
6. RS.25200/- BIORCI SCREW, PLATINUM BLADE NOT PAYABLE ( Biorci screw and Platinum blade both are fixed at the injury place and it will not be removed in future as well. I have discussed with treated doctor and he confirmed that insurance company can not deducted such type of payment, furthermore I would like to inform you that My sister got met accident in last year and she also suffered from same injury and her insurance company not deducted such payment).
7. AS PER POLICY ONE DAY EXCESS VISIT CHARGE NOT PAYABLE
( No policy terms and condition shared with clients)
8. Rs. 15324 - 10.0% Co payment Deduction ( Please explain the deduction reason).
NOTE :- Above deduction terms and conditions are neither informed nor shared by the insurance company/agent.
I have visited hospital and submitted all the relevant documents as requested by TPA team, however still they did not clear my payment ( claim # [protected]).Their customer care number, email id and office are worst for response to client. Every time we got new and different response against same claim.
I would say each and every insurer please do not go with Raksha TPA or Oriantal insurance service. You are investing your money at wrong place, my request you all to change service provider on your next renewal.
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