r/indiahealthinsurance

Have star health insurance comprehensive plan (family floater ) however day by day they are introducing new new procedures before admitting to the hospital risking the claims settlement. Thinking to migrate to govt health insurance or some different company . Star health had earlier denied to any settle genuine claim for a relative admitted for dengue. Had to escalate it further to reimburse it . It has disturbed me . Suggestion.

I want to buy health insurance for my parents from aditya birla as it seems reasonable in our budget.

But when I looked at reviews there were some mixed reviews.

The problem is my dad has hypothyroidism, sugar(insulin), epilepsy and he is 64 so there are only limited plans that will accept or they will exempt this pre-existing condition.

So is aditya birla a good choice for me?

Last year I had an head injury (SDH) due to fall from bike. I had the burr hole surgery in December 2025.

This year,3-4 days back I purchased Aditya Birla Activ One Max. I went through its policy wording and it’s was good according to me.

Later on yesterday the policy bazar executive called me and mentioned that company is providing counter offer with new policy called Aditya Birla Activ One VYTL with shared room and 20% Co payment with PERMANENT EXCLUSION RELATED TO HEAD TREATMENT.

The executive also mentioned that due to my head injury I would never get any better policy in future as well.

I straight forwardly rejected the counter offer and asked for the refund.

I just want to know is it true that I could never get a good health policy even though I am ready to pay higher premium just because I had one head injury and my brain is perfectly fine. Wouldn’t I be able to avail a good health insurance which is really an insurance?

Trying to understand this part of a claim.

Relevant for general public as well.

The First clConsultation Paper is a mandatory document in claim. In most cases the insurer delays decision because this is not available or not in the proper format etc.

But in India medication screening and timely medical consultation are not yet so common, especially in non-urban areas.

People often realize they have diabetic when their legs swell or they fall often or they have severe numbness. (I know these examples - 1. a lady in her 50s consults a doctor when she falls frequently without proper reason. she actually went because of pain after a fall. and she was diagnosed with extremely high diabetes, and nerve damage starting. 2. a man in his very early 60s goes for a kidney stone issue and realizes that he has high diabetic. 3. a man in his 60s had been feeling chest pain and dizziness etc. he said it's gas. and then once he fell down. and he had heart issue and he got a pacemaker now! in all these ppl were basically not very medically aware or they hadn't looked at their life from a medicalized perspective).

What happens in such cases where a health issue is in advanced stage but there's no consultation prior?

Companies usually dont accept the advanced treatment hospital admission papers for first consultation paper.

(in the above case for ex. the doctor himself was not ready to believe that the lady had never had an FBS test!)

So how is this situation handled?

The topmost corporate hospital in my city has claimed an amount of Rs 140000 with the insurer for a common daycare procedure. The estimate given by the hospital to the patient was Rs 15000 but they highly inflated the claim to the insurer. The health insurance company reached out to the patient with email details of claim submitted by the hospital where the reason submitted by the hospital was a different advanced disease that the patient didn't even have. The patient sensing something fishy cancelled his appointment with the hospital just 2 days prior to the procedure date.

He consulted another local doctor who recommended the same procedure. The treatment got completed within Rs 4000 (not in a government hospital if anyone is wondering). Yes! the procedure was that simple & straightforward for which the big corporate hospital initially quoted Rs 15000 to the patient & claimed Rs 140000 to the insurer.

This is an exceptional fraud that we just witnessed. The saddest part is it started with the super-specialist doctor who coaxed the patient to get this simple procedure done from that hospital only even though this hospital is quite far from his house. So they are all in it together!

The patient is 70 years old. So he doesn't want to get into legal hassles. But staying silent & letting it slide just because we got saved seems so wrong.

What steps can we take? Can we raise some official complaints in some online portal? We have all the evidence.

Purchased HDFC ERGO secure Plus policy in June this year. Covered Me, wife both 30 and my son (1).

cover of 20 lakhs base.

Son diagnosed with malaria Last week. Admitted to a hospital in hometown. Hospital had cashless facilities but was not Empaneled hospital.

Hospital took the patient in and started treatment. Simultaneously applied for initial approval for claim. Company on its website has said this comes within 2-3 hrs. But it didnt come on date of admission. I purchased policy directly so there was no agent to help.

Also on company app there is no contact number to reach out to.

(On day 2)

I sent 10-15 mails to company they replied but the replies were vague. Like we will do this in 36 hrs, 24 hrs etc etc.

One guy called me and assured me it will be done within 6 hrs.

Still no luck.

On day 2 everything company sent few people to investigate about the medical condition of my son. In hospital room. This was our first point of contact with company. I felt little relieved.

On day 3 the initial approval came- which approved like 60% of claimed amount.

I was little disappointed, but the insurance helpdesk guy at hospital said this doesn’t mean anything at time of final approval. And every thing apart from disposables will get covered.

During discharge process the claim was appproved within 2 hrs and all amount apart from disposables got approved.

As the hospital was not empanneled disposables were not covered in cashless treatment. But my plan covered disposables. I will claim that in reimbursement lets see.

Overall a good experience. But need to have some contact number which will guide us in case of emergency.

So i will recomment to buy policy from agent or policy bazaar as they have a agent contact who will guide us in claim filing.

Thats all. Health insurance is a must. I saved 50k with one decision and was not worried financially in this emergency.

Absolutely horrible experience with Care Health Insurance. I genuinely regret buying this policy.

I submitted my claim along with all the documents provided by the hospital. And what did Care do?

REJECTED.

The reason?

Apparently, the doctor didn’t explicitly write on the consultation paper that this was a first-time diagnosis.

Now here’s the ridiculous part:

👉 The hospital discharge summary already clearly states that there was NO past history of this disease.

So the information is literally there in the medical records.

But apparently that’s not good enough for Care.

They now want me to go back to the hospital and get a separate “justification letter” from the doctor because the doctor didn’t write those exact words on the consultation paper.

🤦‍♂️ Seriously?!

How is a discharge summary from the treating hospital not sufficient evidence of the patient’s medical history?

Why should a patient have to run around a hospital asking doctors to write additional letters just because an insurance company decided that one particular document doesn’t have the exact wording they want?

And the worst part?

Instead of actually looking at the complete medical records and understanding the case, it feels like they are simply looking for technicalities to reject the claim.

Premium? Take it. 💰
Claim? Suddenly there are 100 questions. 📄
Already submitted documents? “Please provide one more letter.” 🤡

I bought health insurance for exactly this reason — so that during a medical situation, I wouldn’t have to worry about the financial burden.

Instead, I’m now spending my time fighting with the insurance company and running back to the hospital for additional paperwork.

If this is how Care handles claims, then what’s the point of paying premiums for years?

⚠️ If you’re considering buying Care Health Insurance, PLEASE do your research.

Don’t just look at the premium, coverage amount, or fancy benefits advertised during the sale.

Look at the claim experience.

Because insurance is only useful when you actually need it.

Right now, my experience with Care has been extremely disappointing, and I genuinely regret choosing them.

Sharing this so that anyone considering Care Health Insurance can think twice and do proper research before handing over their hard-earned money.

Hello all,

My friend's father has admitted in the hospital and the dcotors have deiced to go with bypass surgery.

Manipal is rejecting the cashless with below reason. Can anyone suggest or help on what's the next step?

Denial Reason: We have received claim documents of <name redacted> admitted at Yashoda Super Speciality Hospital since 30-09 with CAD unstable angina. Claimant is covered under Manipal Cigna health insurance since 18-08 Based on the information available at this stage, we're unable to determine the medical history and assess the claim. liability. Additional verification or investigation may be required to confirm the admissibility of the claim. Hence, we're unable to approve the request on a cashless basis. We regret our inability to admit this liability under the present policy conditions, We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.

Denial Remark: We have received claim documents of <name redacted> admitted at Yashoda Super Speciality Hospital since 30-09 with CAD unstable angina, Claimant is covered under Manipal Cigna health insurance since 18-08-2024 Based on the information available at this stage, we're unable to determine the medical history and assess the claim liability. Additional verification or investigation may be required to confirm the admissibility of the claim. Hence, we're unable to approve the request on a cashless basis. We regret our inability to admit this liability under the present policy conditions. We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.

I did spoke spoke to the claims representative regarding shat documents they need that will help for investigation and there is no information received.

They say it has been decided by their panel of doctors that this needs more investigation, like a broken record.

Every question is replied with the same answer.

Has anyone faced this before from Manipal Cigna. Can you please give any suggestions. We have already paid 4L+ to the hospital and are in serious need of help and suggestions.