RakshaTPA - RakshaTPA not settling claim
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Complaint by: Miral Vikmani on September 30, 2016, 2:57 pm in Insurance All

My father has policy of New India Assurance Co. Ltd.
He underwent cataract surgery on 4th and 11th June respectively for both the eyes.
Within few days we had claimed for the following to which TPA mailed the following query.

MemberId : N9013109195
Policy No : 11140034152500004479
Policy Period : 10/08/2015 to 09/08/2016
Insured Name : MR.RAMESH H VIKMANI
Claim in respect of : MR.RAMESH H VIKMANI
Relation : Self
Claim Ref No : 9021617080778
Dev Officer/Agent Code : 1D13699659
Hospital Name : Saifee Hospital
Claim Amount: Rs.21532

Dear Sir/Madam,

This refers to your Mediclaim filed by you on 16-Jun-2016 against above-mentioned policy.The following documents
are required immediately to enable us to process your claim.

1 Kindly provide Break up of Rs 15000 /- charged on account of CATARACT SURGERY dated 04/06/2016

**Apart from these documents kindly attach a copy of this letter along with your reply.


We are waiting for your early reply for better service.


Regards,
For RAKSHA TPA Pvt.Ltd.

And


MemberId : N9013109195
Policy No : 11140034152500004479
Policy Period : 10/08/2015 to 09/08/2016
Insured Name : MR.RAMESH H VIKMANI
Claim in respect of : MR.RAMESH H VIKMANI
Relation : Self
Claim Ref No : 90221617090099
Dev Officer/Agent Code : 1D13699659
Hospital Name : Saifee Hospital
Claim Amount: Rs.24000

Dear Sir/Madam,

This refers to your Mediclaim filed by you on 28-Jun-2016 against above-mentioned policy.The following documents
are required immediately to enable us to process your claim.

1 Kindly provide Break up of Rs 15000 /- charged on account of CATARACT SURGERY dated 11/06/2016

**Apart from these documents kindly attach a copy of this letter along with your reply.


We are waiting for your early reply for better service.


In both replies they only needed breakup of 15000 which was package charge @Saifee Hospital.. on providing the breakup charge.
They only passed
Claim number 90221617090099 - Rs - 12142
Claim number 9021617080778 - Rs 15800

And the query with 90221617090099 is
Greetings from Raksha TPA!

With reference to your mail dated 19/08/2016 we would like to inform you that we have reviewed the said claim. As per policy terms and condition it is mandatory to submit cost wise breakup for all material and medicine charges paid to the hospital. We would like to inform that we would not be in a position to process the claim without cost wise breakup.

Hence we request to you kindly provide the breakup of Rs.540/- and Rs.4500/- for further assessment of the claim.

Thank you for being our valued customer, we hope the above cliarification addresses your concern.

Assuring you the best of our services.


Regards,
Customer Care Cell

The above query has been cleared of in other claim.. so we as consumer get annoyed by such behaviour of TPA.
Kindly help us get the claim of above

Complainant's Goal: Get claim settled.
Complainant's Target: RakshaTPA
Complaint Location: IndiaMaharashtraMumbai

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