Is medical insurance a cheat/fraud in India?
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I got a Raksha TPA corporate medical insurance policy for me and my family members. Before 6 months my mother was diagnosed with skin cancer. I submitted all the documents for the claim but Raksha TPA is asking for the same documents again and again. They sometimes inform that they are processing the claim and later again call me up and deny to process the claim asking for the same things. I even submitted original receipt and discharge summery twice but nothing is happening. One thing I am sure about is that this company is a big cheat and I am not able to find any escalation matrix. Already sent the email to IRDA & Bima Lokpal but they are busy in sleeping. 
Any suggestions to get the money out of their pocket else I will lose my trust in so called “Insurance”.
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@UberDeals wrote:
try social media , twitter ( popular now a days )
tag almost all who are somehow related to your insurance, also tags competitors
They are not available on both the platforms. 
ANnA HAZARE JAISA DHARNA DE DO
Contact Ombudsmen!
@hese wrote:
Contact Ombudsmen!
Sent email before 5 days. They don’t respond at all. 
Who is the original insurer. A TPA only works as a managing agent of the insurer.
@BUTTERFLYBOY wrote:@hese wrote:
Contact Ombudsmen!
Sent email before 5 days. They don’t respond at all.
Brother unfortunately that’s the reason for going for cashless. These tpas find excuses in everything we submit to reject claims
@panchabhut wrote:
Who is the original insurer. A TPA only works as a managing agent of the insurer.
Don’t know much. It says Raksha TPA. And they are the dumbest people I ever came across. 
Check your original policy document and premium receipt. The name of the insurer would be clearly written.
IRDA is the regulatory authority. You can follow this escalation matrix.
http://www.policyholder.gov.in/repor...px#
Sorry for your mother. Once I saw a similar case, the insured at last contacted the local newspaper to publish an article only then the company reimbursed the amount. While I have friends who have never had any trouble getting insurance for health bills. Maybe it depends on the company.
@BUTTERFLYBOY wrote:@panchabhut wrote:
Who is the original insurer. A TPA only works as a managing agent of the insurer.
Don’t know much. It says Raksha TPA. And they are the dumbest people I ever came across.
You might be surprised to know how clever/cunning these people are, maybe they’re just trying not to pay you the money
Just a minor query, are there any early symptoms of skin cancer?
@$hubham wrote:@BUTTERFLYBOY wrote:@panchabhut wrote:
Who is the original insurer. A TPA only works as a managing agent of the insurer.
Don’t know much. It says Raksha TPA. And they are the dumbest people I ever came across.
You might be surprised to know how clever/cunning these people are, maybe they’re just trying not to pay you the moneyJust a minor query, are there any early symptoms of skin cancer?
Yes I am looking forward to file a consumer complaint. She was diagnosed last year and operated later on to remove that smaller part of the skin under her eyelid. This claim is for that treatment.
@thrifty_indian wrote:
Sorry for your mother. Once I saw a similar case, the insured at last contacted the local newspaper to publish an article only then the company reimbursed the amount. While I have friends who have never had any trouble getting insurance for health bills. Maybe it depends on the company.
When I was working with Times of India, then the insurer was ICICI Lombard & my colleagues never faced any issues whenever they filed claims. Later on I moved to Rocket Internet’s venture where they had Raksha TPA and trust me this is a complete crap. They don’t even respond properly.
@panchabhut wrote:
Check your original policy document and premium receipt. The name of the insurer would be clearly written.
IRDA is the regulatory authority. You can follow this escalation matrix.
http://www.policyholder.gov.in/repor...px#
Thanks @panchabhut it will help for sure.
Guys I got my claim approved today. It took me one complete year to fight Raksha TPA but their attitude never changed. Finally I wrote them an email to go legal against them if they didn’t not settle my claim within 7 days of time which they responded by closing the claim and I remained helpless again.
But I decided to fight a social media war against them the way @UberDeals suggested and wrote to National Insurance (Original insurance company) on Twitter which they responded very quickly for and assigned my case to their Sr. Manager from customer service department who ensured me to get it approved asap. I sent him a presentation with screenshots as per serial no which would prove that I sent documents to RakshaTPA a number of times and they kept assuring me for the claim approval but things never moved far.
Thank you very much for the support and suggestions.
@thrifty_indian @panchabhut @PaytmKaPoojari @UberDeals @Navneet @hese @$hubham
got to know that my advice worked for you @BUTTERFLYBOY
@UberDeals wrote:
got to know that my advice worked for you
Yes It really did. I found out the original insurer as suggested by @panchabhut and then worked as per your suggestion.
BUTTERFLYBOY
I honestly think that in order to get what we (rightfully) deserve, ordinary citizens of this country have to battle enemies i.e. citizens within our nation.
Something similar happened with an acquaintance of mine, he was admitted in a private hospital for about a month. They billed him some 50k+ for that but the insurer denied paying 100% of the coverage, up to ~30k even though he was eligible for it.
Now the hospital came to his rescue, somewhat with mailing him the insurer’s billed amount i.e. the amount that they released/sanctioned however didn’t pay the person. So in essence someone at the insurer ate 20k+ of the poor guy’s claim & now I’ve suggested him to go to consumer forum, after he’s been calling them for over 3months, since the hospital (staff) have given him some proof to strengthen his case.
Ab sahi kahe to aise log har din milte hain, bas aam aadmi aajkal ye dua karta hai ke bure waqt me aise neech logo se pala na pade 
try social media , twitter ( popular now a days )
tag almost all who are somehow related to your insurance, also tags competitors