Raksha Tpa — Mediclaim (SAIL)

Address: Pune, Maharashtra, 411045

Website: www.rakshatpa.com/Sail_Web/loginForSAIL.jsp

I am Ranjit Kumar Sinha, retired SAIL employee from Bokaro Steel Plant. My membership details below
Member ID T-[protected]SAILBKRO
Policy No – 52613304, Policy Period – 01APR2016 to 31MAR2017
My wife, Madhu Sinha, is suffering from sever Crohn’s since last decade. Her gastro consultant is Dr Harshal Gadhikar at Deenanath Mangeshkar Hospital, Pune since last 8 years.
She was administered Remicade multiple times as per her gastro consultant, for which we always availed mediclaim and were never denied payment. For all these instances, she was kept under minimum 24 hours observation after the drug administration.
In July 2015 she underwent surgery for ileostomy where her stoma was taken out of her body permanently to minimise damage to other organs due to severe Crohn’s propagation.
After ileostomy the consultant administered Exemptia instead of Remicade as it was a better medicine. Due to the severity of Crohns and complexities owing to ileostomy, the doctor prescribed Exemptia at the hostpital and kept her under minimum 24 hours observation.
Initially all the mediclaims on Exemptia treatment were approved.
On 2nd Nov 2016, due to inflammation of Crohns’, she was again administered Exemptia and kept under 24 hours observation and subsequently released on 3rd Nov 2016.
But this time the mediclaim request to M/S Raksha TPA was denied. We followed up the denial by personally visiting Raksha TPA office (Pune) multiple times and submitted recomendation and diagnosis letters from hospital. But the Raksha TPA officials stated that we go to consumer court and they will not provide the imbursement.
Claim no – [protected]
Claim amount – Rs 39135
Claim date – 9th Jan, 2017
Query Raised date – 9th Jan, 2017
Query Response date – 27th Jan, 2017
Denial Date – 6th Feb, 2017

Please help us on the way forward in this case.
Regards,
RK Sinha
[protected]
Pune