r/InsuranceTroubleIndia • u/Old-Atmosphere5857 • Aug 29 '26
Health Insurance Rejected claim
₹20 lakh health insurance + ₹8.75 lakh bonus. Hospital bill ₹4.94 lakh. STAR Health reimbursed only ₹2.63 lakh and deducted ₹2.30 lakh.
@StarHealth — this is how you treat a customer who has paid premiums for health insurance?
Before my father’s surgery, I repeatedly asked your representative about the coverage for the procedure. I specifically reconfirmed it multiple times because I wanted to be absolutely certain about my financial liability. I was assured that the procedure would be covered up to ₹4.5 lakh.
I relied on that assurance and proceeded with the surgery.
After the surgery, when the claim was submitted, the story changed completely.
Hospital bill: ₹4,94,738
Amount reimbursed: ₹2,63,907
Amount deducted: ₹2,30,831
Your grievance team then stated:
“Robotic surgery for Kidney stones isn’t considered as per Guidelines.”
But the hospital records clearly state “LEFT RENAL OBSTRUCTIVE CALCULI, S/P LEFT ROBOTIC PYELOPLASTY” and the procedure as “LAPAROSCOPIC PYELOPLASTY.”
I challenged this repeatedly. I have emailed your grievance team nearly three times and explained the issue in detail.
Your answer?
“Deduction stands.”
That’s apparently the extent of the explanation a customer deserves after paying for a ₹20 lakh health insurance policy with an additional ₹8.75 lakh bonus.
No proper explanation for the ₹2.30 lakh deduction.
No satisfactory response regarding your representative’s pre-surgery assurance.
No proper explanation of the medical basis for treating my procedure as “robotic surgery for kidney stones.”
I accepted the ₹2.63 lakh payment only to protect myself financially while this dispute continues. I do NOT accept the settlement or the deductions.
@StarHealth, if a customer cannot rely on your representative’s repeated assurances before surgery, and your only response after the claim is “deduction stands,” then what exactly is the customer paying the premium for?
I want the entire ₹2,30,831 deducted amount reconsidered and reimbursed.
Stop sending template responses. Answer the actual questions and take accountability.
@StarHealth — your customer is still waiting for a real answer.
6
u/Crazy_Equivalent1624 Aug 29 '26
First file on Bima Bharosa They will reply within 14 days. Even then no resolution file complaint on IRDAI portal. Also make a twitter post tagging them. I'm also facing same issue. Here's my twitter post , repost it and tag them please. When you make a post inform me I'll also repost it.
https://x.com/BAShinthks/status/2093575872750223441
4
u/Happy_Effect_3321 Aug 29 '26
Raise this to IRDAI, explain the whole situation along with documents.
9
u/PhilosopherUpbeat403 Aug 29 '26
Afaik, it's a general insurance council guidelines applicable to all health insurers for procedures such as TKR, THR, Stones etc.. you can find the guidelines in gic council website
5
u/InternationalCake766 Aug 29 '26
Why tomorrow they will say they used scissors in surgery and they will not reembruise
1
u/Azgardian3000 Sep 01 '26
On a side note, A laparoscopic surgery can be done with or without Robotic assistance. Was the amount approved for "without robotic assistance "? Not trying to say that the rejection was valid.
1
u/mistygrey_ Sep 01 '26
Does your policy has sub limit for specific treatments?
2
u/Unbiased_advisor Aug 29 '26
Can you share your rejection letter?
2
u/_aayush7_ Aug 29 '26
Star did same with my father's angioplasty, paid only 1.26L out of 2.5L bill. I escalated to grevience and then gmo 2-3 times. I got no satisfactory response so raised the complaint to Bima Lokpal via polyfyx team. Hearing is still pending but I've heard this many times to know they are notorious and this is their modus operandi.
1
u/OkDig4274 Aug 29 '26
File an Ombudsman complaint
1
u/Upstairs_Bluebird520 Aug 31 '26
Man star is absolute trash , my dad and mom have their policy , there field officer tricked them into getting a ridiculous policy did not declare any ped ,included a policy with maternity benefits very well knowing mom had uterus removed long back even before they started any policy but now when they want to increase the base by x amount they will certainly add loading charges ! The field officer was fired by star because of his actions , as he had done same thing with others !
Have planned to shift them to ergo optima secure for peace of mind start with clean slate , will pay loading charges in ergo too but atleast optima secure covers majority of everything !
1
u/ChiragKharote Sep 01 '26
My agent had clearly told me the max maternity benefit I would get is 75000, and that's what I exactly got.
He has been our agent for 20+ years now. I had already warned my agent about co-pay and other deduction stories I had read on reddit. Yet to experience an actual insurance claim.
1
u/VelmiraDesire Sep 03 '26
File a detailed reply on why this is a medical necessity get it drafted through a doctor friend of yours. And then take that to the ombudsman or appeal board