Sir, I must accept one of the biggest mistakes in my life was to rely on Star Health and buy your mediclaim policy for my parents.
Last week only (12th October 2011), I had to take my father to the hospital and he had to be hospitalized. Unfortunately just after two days, my mother also fell ill and had to be hospitalized. My father was diagnosed with “Arbo Viral Flu” and mother was diagnosed with “Chickengunia & Typhoid”. We intimated your claim department for the same and got the claim number. The same day of their admission in the hospital, the survey by your doctor was done. We got the initial approval of INR 8K for each of them. Everything was fine till this point of time.
The problem came when the final bill by the hospital was generated and sent to your office for the approval (total bill of INR 19153 for my father & INR 31802 for my mother). In case of my father, your office people said that they cannot go beyond the cashless approval of 13174 for this particular disease. While in my mother’s case, these people told me that when all the reports are fine then why she was kept in the hospital for six days, so they cannot pass the cashless claim of further amount.
Sir, I would like to contradict some of their points here:
1. Where in the policy, it is written that for certain diseases the cashless amount cannot go beyond (considering the sum assured)
2. When you people do not provide 100% cashless benefits then why do you claim for the same during the selling of the policy? If this is well communicated to us then we can consider buying other companies’ policy rather than yours. This way there is no sense in buying the insurance policy
3. Unless and until the tests are conducted, how would you diagnose the disease? Even if the reports come out to be fine it does not mean that there was no requirement to admit the patient. Assuming the doctor must have felt the need to do the same
4. Even if you feel that the hospital prolonged the stay or conducted some non required tests then you must delist this hospital from your panel. As we went to the hospital which is a part of your panel only.
5. If you conduct the survey to check if the patient is genuinely admitted in the hospital then it’s your responsibility to check if the hospital is conducting the required checkups during the course of the patients stay. So your company y should make much more visits. In this case we gave our go ahead to the hospital after getting the initial approval from your company only
6. Being laymen, how can I understand if the hospital even in your panel is doing the genuine checkups or not.
Sir, I would like you to look into this matter and do the needful. I am submitting my documents for reimbursement, please do the needful otherwise I can take this matter to higher authorities as well (including consumer court, IRDA, state department of insurance, etc). In this case, I had to pay for the rest of the hospital bills from my pocket which completely negate the benefit of taking an insurance policy.
Details of my parent’s policy and claim is as follows:
Father’s name: Pawan Kumar Gupta
Policy number: 1765014-1
Claim number: 0080023

Mother’s name: Sunita Gupta
Policy number: 1765014-2
Claim number: 0080594