This is a discussion on Raksha TPA Pvt. Ltd within the Medical Insurance forums, part of the Insurance category; My wife hospitalised and was undergone Cesarean operation and I tried to intimate RakshaTPA by using following nos 022- 42009999 ...
My wife hospitalised and was undergone Cesarean operation and I tried to intimate RakshaTPA by using following nos
022- 42009999 Mumbai & 1800-220-456, but call was not picked up so No Success. After 3-4 days I have contacted HR from QUINNOX.
And they initiated Claim.
They rejected the claim as No Pay for following reasons:
PRIMI DELIVERY -- LSCS DONE As per available documents, patient was admitted for PRIMI DELIVERY from dt 15/10/10 TO 22/10/10 . The claim was submitted to us on 9/11/10 i.e. after 15 days . This claim therefore stands non admissible under clause 5.4
Clause 5.4-- All supporting documents relating to the claim must be filed with TPA within 15 days from the date of discharge from the hospital. In case of post hospitalization treatment (limited 60 days ) all claim documents should be submitted within 7 days after completion of such treatment PRIMI DELIVERY
Neither Quinnox HR or Raksha TPA (Reshma Shende) communicated me about submitting the claim papers before 7 days. I was completely unaware of this
I was going to submit the claim on time but HR told me to wait and not confirmed so I submitted on 3rd Nov which is within the 15 days but HR delayed or Raksha TPA has received it late I am not aware about it.
Why should I suffer because of others.
I need the justice in this case.
My Details are
Unique Policy Number: 020400/48/09/87/00009207