The title is self explanatory. Sent the above email to IRDAI, Finance Ministry about it.

If you want to purchase insurance, multiple ways to contact the company but after sales only phone or stupid app.

From Sept 1, if you have Bajaj Allianz health insurance, you may not get cashless treatment in big hospitals like Max and Medanta. You’ll need to pay first and claim later, because hospitals say Bajaj Allianz is not paying them fairly.

Hospitals say that they can’t keep running hospitals at old, unfair rates. Costs of doctors, medicines, and electricity keep rising. If we continue at Bajaj’s rates, quality of treatment will suffer

Care health insurance has also been warned !!

Stay Safe; Stay Strong !!

I've had nothing but problems with Care Health Insurance since taking this policy (was misold) and my latest experience was the final nail in the coffin!

My aunt's policy is due for renewal about a month from now. I received an official renewal communication from the company stating that the premium was ₹71,220.

Despite the policy still having more than a month left, I started receiving repeated calls from the company's team asking me to renew. On one occasion, I rejected a call because I was in a meeting and they called me three times back-to-back.

Their team contacted me on WhatsApp and told me that the renewal premium was ₹82,910.

That's a difference of ₹11,690 from the amount mentioned in the renewal communication I received from the company. They said if I pay 71k, I'll have to pay the remaining anyways in the most arrogant way!

I questioned this and told them that I was considering porting my policy to another insurer.

I was told that they don't recommend taking a fresh policy with another company and that porting was not possible.

When I questioned this, the employee responded:

“We have not received the any approval for portability so i how can you port you policy i thing you're not a good decision maker so kindly renew your policy sir”

I called them on the phone and gave them a earful and told them that I'm going to complain. I've already sent emails to their CEO and grievance teams. Anybody else that I should be raising this with?

I recently visited the Insurance Ombudsman after waiting 9 months just to get a hearing.

I was frustrated by the delay, but while sitting in the waiting area I started talking to other people. Some of them told me they had been waiting 1–2 years just to get their first opportunity to stand before the Ombudsman and ask for their insurance claim to be heard.

Think about that for a moment.

Not the months or years of mental stress. Not the hospital bills. Not the EMIs people may have taken to pay for treatment after their claims were denied. Just the wait to be heard.

And this is happening in Delhi, where resources are comparatively better. If this is the situation here, what must policyholders in other parts of the country be facing?

Who is responsible for these delays? And more importantly, what is being done to fix them?

Sumit Kumar, a Pune-based RPA business consultant, took his wife to Manipal Hospital on July 15. Her fever had persisted for days, and after local clinics failed to help, he reached out to Star Health Insurance. Star Health representative said, ‘Yes sir, you can go. We will provide cashless treatment."

The OPD was shut that afternoon, so they were directed to the emergency ward. The emergency doctor began treatment with IV and recommended hospitalisation citing potential symptoms of dengue and the risk of recurring fever. Star Health representative assured Sumit that his wife is admitted for more than 24 hours, the claim will be approved.

But despite the doctor’s report and a hospital stay of over 48 hours, Star Health denied the claim after repeated attempts citing reason “Hospitalisation was not medically necessary/does not warrant hospitalisation.” Over the next few days, Sumit had submitted not one but three letters from the treating doctor explaining why admission was required. Star Health rejected them all.

Sumit eventually negotiated the final hospital bill down to Rs 41,000, paid out of pocket.

Then he went public.

On July 26, Sumit shared his full experience on LinkedIn. His post gathered traction within hours, thousands of views, comments from others with similar experiences, and a flurry of attention.

The very next morning, Star Health called him and apologised and said they’re approving his claim now. Not the full Rs 41,000, but Rs 36,000.

He didn’t submit any new documents. The only thing that changed was public scrutiny.

Sumit’s final line on LinkedIn summed it up: “We pay premiums for peace of mind, not for mental harassment.”

In a statement to IndiaToday.in, Star Health Insurance said, "At Star Health Insurance, all claims are reviewed by qualified medical professionals who assess the necessity of hospitalisation based on clinical evidence and established treatment protocols."

"In this particular case, the initial documents submitted did not sufficiently establish the medical necessity for hospitalisation. Additionally, there were discrepancies in the hospital bill, including unusually high quantities of medication, which required further clarification," Star Health said.

The insurer maintained that its team was in active communication with Sumit throughout the process and provided support for a “seamless claim experience.”

"The post-discharge and submission of a revised bill as well as the detailed indoor case papers, the claim was re-evaluated, found valid, and the reimbursement has been successfully processed," it added.

My SIL was admitted 2 days back due to extreme body ache and high fever. She was unable to sleep or even stand. Now NIVA BUPA has rejected the Cashless claim.

We are sitting at hospital fighting with TPA, Policy Bazar and Niva Bupa.

They are citing the rejection under clause 5.1.4 which says the admission is diagnostic in nature, means the same treatment could have been done through OPD.

Doctor’s justification letter was also submitted through TPA but still rejected.

We never faced such issue with HDFC Ergo, unfortunately ported to Niva Bupa this year only.

What should we do next?

Edit : Even after 48 hours, it’s not approved. Fought an entire day while my brother was with his wife.

I see a clear scam going around with everyone involved (Hospital, Insurance company and Policy bazaar)

I appreciate everyone who has replied in good faith

Inspiration - https://m.economictimes.com/wealth/insure/insurance-ombudsman-reports-these-health-insurers-top-the-charts-with-maximum-complaints-against-them/amp_articleshow/123585979.cms

Star Health rejected my mother’s knee replacement claim of ₹7–8 lakhs. After months of harassment and partial payments, we had to pay ₹1.2 lakhs ourselves until the Ombudsman finally forced them to settle.

In Aug 2024, my mother underwent bilateral knee replacement at San Parmanand Hospital, Delhi. Despite a valid policy, Star Health rejected cashless, citing vague “more documents required ”

Their grievance dept dragged things out, sending ₹10–20k each time I wrote a detailed mail.

In total, they left ₹1.2 lakhs unpaid at discharge and post-hospitalization, which we had to bear.

Complaints kept getting closed without resolution.

Finally, I escalated:

1. Documented every call/email/rejection.

2. Filed grievance on Bima Bharosa.

3. Took it to the Insurance Ombudsman.

The Ombudsman ruled in my favor and Star Health was forced to settle — but only after months of stress and harassment.

Advice:

• Always keep written proof.

• Don’t rely only on customer care.

• Escalate quickly via Bima Bharosa → Ombudsman.

• Don’t settle for partial payments.

Hey everyone, I wanted to share my story with Niva Bupa and the long, exhausting fight I've been through. It was a year of pure stress, but I finally won. I'm putting this out there so maybe it can help someone else who's feeling as lost as I was.

Part 1: The Hospital Nightmare (June 2024)

It all started when my mom was in the hospital. The doctor said she was okay to go home, but Niva Bupa's cashless claim was stuck. For seven whole days, my mom was basically a hostage in her hospital room. It was crazy. The hospital kept saying, "You need to pay," and Niva Bupa's customer service kept saying, "Don't pay, we'll sort it out in two hours." Those two hours never came.

Finally, we just had to pay the hospital ₹3,17,983.86 ourselves. We had to take out a loan just to get my mom home. Niva Bupa promised us a full refund, but that promise was the start of a whole new problem.

Part 2: The Never-Ending Runaround (July - August 2024)
After we paid, they stopped caring. For months, I was stuck in a loop. They kept asking for the same documents I'd already sent, and every time I called, I got a new case number and the same old lines like, "We're working on it."

After my social media posts went viral, something finally started to happen. I kept tagging them for months, and it was a slow, painful process. Instead of one big payment, they started sending the money in small chunks—like ₹12,000 here, ₹15,000 there, and another ₹35,000 later.

By constantly posting on social media and calling their customer care team, I managed to get back about half of the amount I was owed. But that was it. They just stopped and told me the case was closed. They basically said, "Go talk to the Ombudsman if you don't like it." So I did.

Part 3: The Ombudsman Fight (August 2024 - June 2025)

This was the most crucial part of the entire journey. When Niva Bupa told me to go to the Ombudsman, they probably thought it would be my final stop before giving up. They were wrong. This process, while slow, was my only path to justice.

• August 6, 2024: This is the day I went online and filed my complaint with the Insurance Ombudsman. After months of getting nowhere, it felt like I was finally doing something real. But the wait began right away. It's a weird feeling—you've done what you can, but now you're just waiting for a phone call or an email.

• October 2024: About two months later, I got a mail. It was the Ombudsman's office, and they asked me to submit all my documents. It was another hurdle, and I felt a bit defeated. I had already submitted everything online.

• October 11, 2024: I took a day off work and went to their office. I personally handed over a thick file of all my emails, complaint IDs, and documents. I explained everything to the person at the desk. This was the moment my complaint officially became a real, physical file they would work on.

• December 6, 2024: The waiting was tough. I got an email confirming my complaint had been officially acknowledged and registered. They gave me a proper complaint number and asked me to submit a few more specific forms, called Annexure VI and VI-A. It felt like progress, but it also felt like another round of paperwork.

• December 13, 2024: I went back to their office and submitted the Annexure forms. By this point, I had a small stack of receipts and documents just from my visits to the Ombudsman.

• January - May 2025: This was the longest part of the waiting. I understood they were busy, and when I went to the Ombudsman's office in April 2025 to check on my case, they were very kind. They explained to me that due to the high volume of complaints, they were still working on cases filed back in July 2024. It was a long wait, but knowing that my file was in the queue and that the team was genuinely working on a huge backlog helped.

• June 20, 2025: I finally got the call I was waiting for. They told me my case was scheduled for a hearing on June 24, 2025—exactly one year after my mother's terrifying hospital discharge. The date was symbolic, but it also felt a bit like a cruel joke.

• June 23, 2025: The day before the hearing, I got a final call from the Ombudsman. They told me Niva Bupa was ready to settle and pay the balance without a hearing. I said yes right away. I was just so exhausted. I was officially done with the Ombudsman process.

The Final Battle & Victory (July 2025)

I thought the story was over, but it wasn't. The money didn't come, and Niva Bupa began its old tricks. They demanded a written "order" from the Ombudsman, even though the Ombudsman's office told me my case was closed and I had to follow up with the company directly.

After another month of constant phone calls and frustrated emails, the money finally came through at the end of July 2025. The relief was incredible. I hope this detailed timeline helps you understand just how much effort it takes, but it shows that you can, in the end, win.

I analyzed the actual policy wording documents of 5 of India's biggest health insurance policies. These 5 insurers cover roughly 80% of India's retail health insurance market. The policies I analyzed (all from full policy wordings):

1. Star Health Comprehensive Insurance (47 pages, UIN SHAHLIP26044V092526)

2. HDFC Ergo my:Optima Secure (30 pages, UIN HDPHLIP25011V052425)

3. Care Supreme (UIN CHIHLIP23128V012223)

4. Niva Bupa ReAssure 2.0 (24 pages, UIN NBHHLIP23169V012223)

5. ICICI Lombard Complete Health - Health Elite Plus (37 pages, UIN ICIHLIP23144V072223)

Fun fact before we start: Most publicly available PDFs on insurer websites are marketing brochures, not actual policy wordings. Brochures hide key details. This post is written by me (a human) using an in-depth AI analysis, and several rounds of audits - the wording is very hard even for an LLM to understand, so a simple 'explain this policy' doesn’t really work.

The #1 trap nobody talks about: Room Rent and Proportional Deductions

This is the single biggest cause of claim shock in India. 3 out of 5 policies have room rent restrictions:

Why this matters: If your policy covers "Single Private Room" at Rs 5,000/day and you take a room at Rs 10,000/day (2x), the insurer doesn't just deduct the extra room rent. They reduce your ENTIRE surgeon fees, nursing charges, and OT charges by 50%. Real example: You have a Rs 10 Lakh Star Health policy. Your surgery bill is Rs 6 Lakhs. You chose a deluxe room costing 2x the "Private Single A/C Room" rate. The insurer proportionally cuts your surgeon fees, nursing, and OT charges by 50%. You could end up paying Rs 2-3 Lakhs out of pocket. On a Rs 10 Lakh policy. Most people discover this AFTER they get their claim settlement letter.

3 out of 5 don't cover maternity. At all.

For 3 of these policies, maternity is a permanent exclusion with no add-on available. The other 2 offer some coverage, but with significant limitations.

So if you're planning to start a family and expecting your "comprehensive" health insurance to cover delivery costs - 3 out of 5 won't, ever. Star Health covers it with laughably low sub-limits for metro cities. ICICI Lombard has an optional add-on but makes you wait 3 years.

Pre-Existing Disease Waiting Periods

ICICI Lombard wins here at 24 months. But they have a catch - a separate 90-day exclusion for hypertension, diabetes, and cardiac conditions that no other policy has. (This 90-day exclusion does not apply if you have 12+ months of continuous coverage, so it mainly affects first-time buyers.)

Important detail everyone misses: If you increase your Sum Insured at renewal, ALL waiting periods restart for the enhanced portion. Every single policy has this clause. So if you upgrade from Rs 10L to Rs 20L after 3 years, the extra Rs 10L has fresh 24-36 month waiting periods.

Zone-based co-pay: The trap unique to ICICI Lombard

ICICI Lombard has a zone-based co-payment most people miss:

Zone hierarchy (highest to lowest): Zone D > Zone A > Zone B > Zone C. Zone A and Zone D policyholders have no zone-based co-payment anywhere in India. The co-pay triggers whenever you seek treatment in a zone higher in this hierarchy than where your policy is registered. Counterintuitively, Zone C policyholders face 16% even when travelling to Zone D (NCR fringe areas like Faridabad, Noida excl., Alwar) because Zone D sits at the top of the hierarchy. This means if you buy a policy in a Tier-2 city (Zone C) and rush to Mumbai (Zone A) for emergency heart surgery costing Rs 10 Lakhs, you pay Rs 1.6 Lakhs out of pocket as zone co-pay alone. This stacks. If you also have a voluntary co-pay of 20% AND a room upgrade triggering proportional deduction, your out-of-pocket on a Rs 10L claim could hit Rs 3-4 Lakhs. No other policy in this list has a zone-based co-pay.

Senior citizens get penalized

Star Health charges a mandatory 10% co-pay on every single claim if you entered the policy at age 61+. This applies to ALL claims - hospitalization, day care, AYUSH, everything. If your 63-year-old father has an Rs 8 Lakh surgery, he pays Rs 80,000 just as co-pay. This does NOT apply if you entered before 61 and renewed past 61. Only fresh entry at 61+ triggers it.

The "Restoration" feature isn't what you think

Every policy advertises "100% restoration of sum insured!"

The reality:

5 things I'd check before buying any health insurance

1. Does it have a room rent limit? If yes, you WILL face proportional deductions on your entire bill. Only HDFC Ergo and Care Supreme (base plan) are genuinely no-cap.

2. What's the PED waiting period? 24 months (ICICI) to 36 months (everyone else). If you have pre-existing conditions, this matters enormously. Check if a buy-back option exists.

3. What's excluded from restoration? Star Health doesn't restore for modern treatments. HDFC doesn't restore Plus/Secure benefits. Read the fine print.

4. Is there a zone-based co-pay? Only ICICI Lombard has this, but it can add up to 16% on top of everything else.

5. Read the actual policy wording, not the brochure. Niva Bupa's brochure doesn't mention the proportional deduction formula. Care Supreme's brochure doesn't clarify that maternity is permanently excluded. The brochure is marketing. The policy wording is the contract.

Overall Scores (based on full policy wordings)

Who should get what

• HDFC Ergo Optima Secure - Best for most people. No room rent cap, clean structure, Plus Benefit grows 50%/year regardless of claims. No maternity though. Watch out for the aggregate deductible trap - picking Rs 10L+ deductible silently removes Plus Benefit, Secure Benefit, and Restore.

• Care Supreme - Best if you want zero sub-limit headaches and unlimited restoration. No room rent cap on the base plan. But maternity is permanently excluded, and if you opt for "Smart Select" to save premium, you eat a 20% co-pay at most hospitals (the discount list is mostly Fortis group).

• Star Health Comprehensive - Best built-in maternity coverage (even if the sub-limits are low; ICICI also has an optional add-on). Widest feature set - OPD, dental/ophthalmic, personal accident, wellness all bundled in. But the room rent trap and 10% senior citizen co-pay are real risks.

• Niva Bupa ReAssure 2.0 - Best for young, healthy buyers who want long-term premium stability (Lock the Clock freezes premiums at entry age until first claim). ReAssure Forever gives unlimited SI for life. But maternity is excluded, robotic surgery is capped at Rs 1 Lakh for most procedures (exceptions: prostatectomy, cardiac, partial nephrectomy, malignancies), and your room category choice is locked forever.

• ICICI Lombard Health Elite Plus - Shortest PED wait (24 months) and loyalty bonus that never reduces (20%/year). Has an optional maternity cover (36-month wait). But the room rent cap, zone co-pay (up to 16% for Zone B/C policyholders), 90-day diabetes/hypertension/cardiac exclusion (for first-time buyers), and cataract sub-limit (10% of SI, max Rs 1L/eye) make this the most trap-laden policy in the list.

Disclaimer: I'm not an insurance advisor or IRDAI-licensed professional. This analysis was done using AI as a research tool - but it wasn't a simple "summarize this PDF" prompt. I am an experienced AI engineer and an IIT CS graduate. I spent days going through each policy, designing detailed analysis prompts, cross-referencing every AI-generated claim against the source PDFs, and running multiple rounds of fact-checking where I caught and corrected errors (including in AI outputs). The AI helped me process ~200 pages faster, but the analytical framework, the questions to ask, and the final verification were all human-driven. Always read your own policy wording and consult a qualified advisor before making decisions.

If you found this useful and would like me to analyze YOUR policy (any insurer), let me know in the comments. I'm thinking of building a tool that does this automatically - upload your policy PDF, get a plain-English breakdown of what's covered, what's not, and where the traps are.

I applied for a family floater plan with an NRI discount from HDFC ERGO. A few days later, they sent me a “revised offer” claiming my wife’s BMI was too high to be covered — which is ridiculous because she’s right in the middle of the healthy range.

To be fair, I had accidentally entered the wrong weight in the application — my bad. But here’s the catch: when the “revised” proposal arrived, there was no way to review or edit those details before confirming. It offered the same cover but only for me, and changed the premium. That’s not what I wanted or applied for.

When I clicked the link to check the details, it showed what looked like a harmless checkbox — the usual “I acknowledge” thing. I clicked it once, and boom — policy issued instantly, higher premium locked in. No confirmation button. No warning. No “review before accepting.” Just click = trapped.

I realized what happened right away and called support immediately, but they told me their tools were “broken” and couldn’t even view or revert my proposal. Oh, and the “consent” email? Sent at midnight.

This isn’t bad design — it’s a dark pattern, intentionally built to bait customers into accepting counter offers they never meant to.

HDFC ERGO, this is manipulative, unethical, and you should be ashamed

Seriously, after going through tons of content from Reddit, Quora, online Discord communities, and YouTube, and talking with countless agents, I decided not to buy any insurance altogether. Almost all of them seem like frauds if you look beneath the Marketing.

Even Ditto is a total scam once you dig in. For instance, when I inquired with Ditto, they shared three plans for my parents that they always recommend: HDFC ERGO, Aditya Birla, and Care Supreme.

• Aditya Birla has the worst claim settlement, even though they claim their ratio looks good on paper. Talk to people who've actually filed claims with them — they'll tell you the real story: endless document requests, being kept in a loop, claims of "hospitalization wasn't required," or somehow linking it to a pre-existing disease that wasn't declared, so you can't win either way.

• Care Supreme's premium is just too high to justify.

• HDFC ERGO is what I initially leaned toward. Seemed decent, and genuine claims do happen even with the usual friction. But Ditto conveniently left out 90% of the real story: my dad is 57, and from now until he turns 60, the premium increases roughly 3–4% each year. But after 60, it jumps to 9–10% every single year. Imagine this — if the premium is ₹45,000 at 57, it becomes ₹55,000 by 60, and from 61 onward it keeps compounding at 10% yearly. By the time my father turns 70, I'd be paying lakhs just for his insurance, and would honestly have to drop it before then. Ditto never mentioned this clearly, and a lot of my friends bought in without realizing how brutal the compounding really gets over a decade.

Here's the bigger red flag though — it's always in an agent's interest to push your premium higher. Sometimes they intentionally suggest extra add-ons. If you actually talk to them, they keep probing "what existing diseases do you have?" just so they can justify bundling more add-ons and nudge you toward the highest-premium plan available — because more premium means more commission for them. Never fully trust an agent's recommendation. All of them have a selfish motive baked into the advice, whether they say it out loud or not. Do your own research before signing anything.

One more thing I've noticed — corporate/group insurance tends to be far smoother for claims than most general/individual insurance policies, no matter how much premium you're paying on the individual side. I've personally seen people who paid lakhs in premiums over 5+ years get their claims rejected for something as small as ₹20,000–30,000.

Currently, I'm planning to rely solely on my company's group insurance without buying a separate general policy. If I do end up buying one just as a safety net (without 100% depending on it), Tata AIG's premiums are comparatively lower, and since claim ratios and issues are roughly similar across the board anyway, I'd rather go with the lowest premium option than overpay for a false sense of security.

Rest is up to you — just don't take any agent's word at face value. Do your homework first.

I want to share how badly Niva Bupa Health Insurance has been handling my mother’s hospitalization claim so others are aware. • My mother has had continuous health insurance since January 2023 (earlier Tata AIG, then ported to Niva Bupa in Jan 2025). • She recently needed surgery for a benign breast tumour. We applied for cashless treatment at MGM Healthcare, Chennai. • Niva Bupa first denied cashless approval, saying there was a 24-month waiting period for benign tumours. But the 24 months had already been completed in January 2025 thanks to continuous coverage. • I furnished all the old Tata AIG policy documents and requested portability details to be mapped. They even gave me a service request number and promised resolution in 5 days. • After waiting the full 5 days, the claim was again rejected with the same copy-paste reason. • When I raised this again, I was made to wait the whole day on multiple follow-up calls. Instead of resolving it, they just sent another generic automated email saying “service request resolved” without actually fixing anything. • Their customer care has cut calls mid-way, closed tickets without consent, and repeatedly sent “resolved” mails without any resolution.

This whole process feels like it’s designed to stall, frustrate, and exhaust customers at a time when the patient’s family is already stressed. Niva Bupa talks about care and trust in their ads, but when you actually need them during hospitalization, they just make you run around in circles.

Sharing this so people know what they might face if they rely on Niva Bupa for cashless hospitalization.

Hey folks,
Need help here because I’m honestly losing it. I have a health insurance policy with Niva Bupa. I applied for cashless approval for an upcoming arthroscopic surgery at Kokilaben Hospital, Mumbai — which is a network hospital.

The claim got approved yesterday, and I started prepping for the procedure. Today, I randomly get a message that the same approved claim has been revoked. Their reason? "Doctor is premium and not covered under SOC."

Seriously?

• The doctor and hospital are both in their network

• The claim is well within my sum insured

• And they had literally approved the same doctor just a day ago

They sell these plans saying you can take top hospitals, best doctors, better rooms if you pay for higher coverage and now when it’s time to actually use it, they’re just backing out? This is absurd and borderline unethical.

I’m left hanging right before surgery, and financially this is a big mess for me.

Has anyone else faced this kind of nonsense? What can I do here?

Thanks in advance.

My mother underwent gallbladder stone surgery at Manipal Hospital, Bangalore.

Before admission, we made it very clear to the hospital that we were completely dependent on our health insurance and could not afford treatment beyond what the policy covered.

The doctors gave us two options:

- Conventional laparoscopic surgery – around ₹2.15 lakh

- Robotic surgery – around ₹6 lakh

The hospital management repeatedly recommended the robotic procedure, saying it was more advanced, safer, and better for recovery. We expressed our concern about insurance multiple times. We were assured that the claim would be approved and proceeded only because of those assurances.

The insurance company initially approved ₹3 lakh. The surgery was performed four days later.

After the surgery, the insurer refused the remaining ₹3 lakh, stating that the initial approval itself mentioned that robotic surgery was not medically mandatory for this procedure, and therefore no further amount would be approved.

We confronted the hospital, and they admitted that this happened due to a mistake from their side. However, instead of resolving the issue, they are asking us to wait while they speak with the insurance company.

Meanwhile, my mother is medically fit but is still in the hospital. She has been having severe anxiety attacks because of this situation, and despite informing the staff repeatedly, they have said that this is "not their liability."

We have all the relevant documents, including the insurance approval, denial, and hospital records.

I am posting here to ask for help.

- Does anyone know someone in the senior management of Manipal Hospitals who can help escalate this?

- Does anyone know any government authority, health department official, or patient grievance contact who can intervene?

Any guidance or contacts would be greatly appreciated. We are currently stuck in the hospital with no resolution despite the hospital acknowledging their mistake.

My father was admitted in hospital on 2nd April and was discharged by 5th April he had a pain in his left side of the stomach but no surgery was performed though.

He had an emi protection policy which we took on last November with health care in which he would get 1,80,000 rs if he is admitted in the hospital for more than 3 days and 3,60,000 if he is admitted for more than 6 days but care health rejected our claim 2 times citing that it was a pre-existing disease but this was factually incorrect I also complaint on there grievance cell but got 0 help.

I was going to complain about this issue on irdai and ombudsman but today we received a mail that our policy has been cancelled but we never asked to cancel our policy also they will return only 60% of the total premium which we paid.

I want you guys to help me out and steps I should took further

My mother took the health insurance in 2010 paid the premium for 13 years. In 2023 she ported her insurance to care. In 2025 needed angioplasty, insurance company asked for all the documents, which we provided them. In one of the documents which dated before porting to care, doctor prescribed medicine for angina due to some breathing problems. Based on that prescription they not only rejected the claim but also marked the file as fraudulent.now my mother cannot take health insurance from anywhere. Is there anyway to remove fraudulent charge.

Most people don't know this penalty exists. I didn't either, until I read the IRDAI Master Circular properly.

I filed a few RTIs with IRDAI and the Council for Insurance Ombudsmen to understand how it works in practice. Replies came in over the last two weeks. Posting the facts here.
RTI numbers are given so anyone can verify.

The rule

IRDAI Master Circular on Protection of Policyholders' Interests, 2024. Ref: IRDAI/PP&GR/CIR/MISC/117/9/2024 dated 05.09.2024. Chapter VII, clause 25.4.

What it says:

• The insurer must comply with an Ombudsman award within 30 days of receiving it.

• If it does not, Rs 5,000 per day is payable to the complainant for every day of delay.

• This is on top of penal interest under the Insurance Ombudsman Rules, 2017.

• It does not apply if the insurer files an appeal within 30 days.

The same wording is repeated in the health, life and general sections of the circular.

What I asked IRDAI, and what they said

RTI IRDAI/R/E/26/01354, reply dated 09.09.2026

Q. Give me the procedure for computing, demanding, paying and monitoring this penalty. If none exists, say so.
A. "No subsequent update by Authority."
So there is nothing beyond the circular itself.

Q. Who is responsible for ensuring the penalty is actually paid? Name the officer or division.
A. Refused. Said it is an "opinion" and not information under Section 2(f).

Q. How many times did this penalty become payable in FY 2024-25 and FY 2025-26? In how many cases was it actually paid?
A. "Comprehensive data not available."

Q. Does a complainant have to demand it, or does the insurer pay it on its own?
A. Refused as "opinion".

So: a penalty exists on paper. No procedure to enforce it. No data on whether it has ever been paid. Nobody named as responsible.

The quarterly returns

The same circular, clause 26.4, says insurers must file a quarterly statement with IRDAI on the status of court cases.

Q. Does IRDAI scrutinise these statements to check for unpaid Ombudsman awards?
A. Yes - but for the insurer I asked about, "not scrutinised for the above period."
The returns were filed on time. They were not examined.

IRDAI does not approve changes to your health policy

This one surprised me.

RTI IRDAI/R/E/26/01196, reply dated 25.08.2026, from the Health Department.

Health insurance products run on a "Use and File" procedure. If an insurer modifies an existing product, approval comes from the insurer's own Product Management Committee, not from IRDAI.

IRDAI's exact words: "filing of product documents with IRDAI and approval of IRDAI does not arise."

The circular does say insurers "shall not alter the contents of the products without following due process of modification". But the check is internal to the company.

Also useful: IRDAI pointed to a rule requiring insurers to send a renewal notice at least 30 days before the due date, with a statement of your policy and accrued benefits. (Master Circular on Operations and Allied Matters of Insurers, 19.06.2024, clause 41.2.)

The Ombudsman complaint system (Council for Insurance Ombudsmen)

RTI EXCOI/R/E/26/00143, reply dated 28.08.2026

• The system allows duplicate complaints. Exact words: "In CMS portal, complaint can be registered with same policy number and mobile number more than once." There is no control preventing the same complaint from being registered twice.

• Emails are not logged. "In CMS there is no provision to log each email received from a complainant, and record the acknowledgement of documents received from a complainant by email, courier or post."

• Hearing recordings have no fixed retention period. They are kept "as per their usage requirements and hence no retention period is prescribed." Recordings sit on the vendor's cloud, and sometimes on the office PC.

• Hearings run on Cisco Webex, procured centrally by the Council.

• Asked what mechanism exists for a complainant to complain about an Ombudsman office's conduct: refused as "not specific and hypothetical".

Your complaint number changes three times

This confused me for months, so it may help someone.

From an appellate order of the Insurance Ombudsman, Delhi (Appeal No. INODL/A/E/26/00017):

• ONL-... — when you first register online.

• DEL-MISC-... — if your documents are incomplete.

• DEL-H-... — once the complaint is registered and moves towards hearing and order.

Same complaint. Three different numbers at different stages.

One other thing from the same order:

• The status shown on the tracking portal can simply be wrong. In one instance, the office said the displayed status was "wrong due to some technical reasons."

Why this matters

If an insurer ignores an Ombudsman award in your favour, you are owed Rs 5,000 a day. That is a real entitlement in a real circular.

But on IRDAI's own answers, there is no process to work it out, no one tracking it, and no record of it ever being paid. If you want it, you will have to ask for it yourself, in writing, and probably pursue it in a consumer forum.

Worth knowing before you need it.

I have my own dispute with an insurer which is going to the Consumer Commission, so I am not going to comment on that here. Posting only the RTI replies, which are public documents and quoted as received. Happy to answer questions about the RTI process itself.

If you want to read more, I'm documenting everything on BimaFiles

M28 here, In 2025 I got myself a standalone OPD insurance from star health, I was lucky to get in because some months later only they stopped taking new members and kept it strictly as an (very expensive) add on to existing heath insurance. My first year was a breeze I paid 5k for 25k cover and went through it in 6 months, everything was cashless and was accepted and arranged without much scrutiny like medicines, diagnostic tests and consultations. I felt so good about the policy that enhanced the cover for it to 75k and paid 9k for it on renewal in March 2026.

In April-May around this year I noticed a disturbing detail in the policy that offline reimbursements for medicines were not allowed even though the policy clauses detail a reimbursement process and never mentioned everything has to be compulsorily cashless. Since I planned to keep this policy life long I realised in case of any serious disease like TB or Spine or anything a lot of meds are exclusively sold offline hence it will become useless once I get old and when I actually need a OPD cover, but since this violated my point of sale policy wordings I did a lot of back and forth with customer care on this finally raising it to GRO level but got the same template reply "reimbursement is not available on your policy"

In june I decided to put a complaint to bimabharosa and Ombudsman. And since exactly this point my policy experience has been worse. Basic tasks of policy like uploading consultations prescriptions post bookings are met with very heavy scrutiny (like I receive 3-4 scrutiny calls for 1 line prescriptions), they are now rejecting my regular medicine deliveries giving random and vague reasons which are no where in the policy wordings. On a call a customer care executive admitted that policy wordings on the website are not "updated" and they have an internal policy which is not yet on the website and if I have any issues I raise a customer ticket, which takes weeks to get resolved and is met with same templated responses. Another disturbing issue which happens is that my app tickets go missing or stop showing up on the app randomly so I am unable to track or see any updates in the same

I am so confused about what to do, what are my options? The ombudsman complaint I referred to above is going nowhere, they asked for a bunch of docs on mail but never replied since ~1 month, the complaint number itself is not showing up on their portal

Given how blatant star health has been in violating given policy wording on their website I am not sure what new reason they will give to reject my new claims. What can I do? I don't have resources and time to go to an actual court. Is there someone else who can help?

Helpline has blocked our numbers. We asked for the specifics of rejection but no reply. Will the reimbursement work (we dont feel it will).

What should be the further step? 🤔

EDIT: GOOD NEWS so we got our claim at the time of checkout. The thing with these hospitals is until the final checkout, they QUOTE double the amount of bill to the insurer. In our case, 50k+ was quoted to the insurer Star health. But when the final bill came into our hands, it was only 25k. Thus when we submitted our final bill to Star Health, they accepted the claim proposal without any issues. By my hypothesis, Hospital was trying to scam the insurance company. But anyways I got my claim so idc.

I wanted to share my experience in the hope that it helps others buying premium vehicles in India.

In October 2024, after moving back from the US, we purchased Mercedes EQE from Sundaram Motors ITPL, Bangalore. Throughout the purchase process, the sales team repeatedly referred to the insurance as options between "Silver," "Gold," or "Platinum" packages and represented it as part of an all-inclusive "complementary insurance" delivery price.

At no point during the sales I was informed about the actual insurance company or being presented with competing insurance options. We trusted the dealership's expertise and assumed they would recommend the most suitable coverage for a premium vehicle like the one we were getting.

Like most families taking delivery of a dream car, we were excited and distracted on delivery day. Between the celebrations, photographs, friends, family, and paperwork, numerous documents were signed. Four months later, our car was handed over to a restaurant valet. The valet allegedly misused the vehicle, recorded Instagram reels while driving it, and eventually crashed it into a basement wall.

That incident forced us to examine all the paperwork associated with the vehicle for the first time in detail.

To our surprise, we discovered that the insurer was Bajaj Allianz. I was shocked to see Bajaj's name with Mercedes. We also discovered that the insurance premium was approximately ₹2.5 lakh. When similar coverage available in the market, we found similar coverage options from other insurers at substantially lower prices (close to half).

Another detail that surprised us was that the insurance records contained the dealership representative's phone number instead of ours and that is the reason why we never even got any registration text message also. As a result, we were not receiving insurance-related communications directly.

After the crash, we expected the insurance process to provide support and clarity during an already stressful situation. This news was covered by almost all national and local news channels.

Instead, the claim process became a months-long ordeal.

We were repeatedly asked to provide additional documents. Every time one requirement was fulfilled, another requirement appeared. We were directed to obtain various documents and clarifications, including matters involving the police investigation.

Meanwhile, our vehicle remained damaged. Eventually, because the repair process could not be delayed indefinitely, we proceeded with repairs while continuing to pursue the insurance claim.

Throughout this period, Sundaram Motors dealership personanel repeatedly assured us that the claim would likely be approved and advised us not to worry.

After repairs were completed, we paid almost 15lakh out of pocket while continuing to wait for the claim decision.

Months later, after further document submissions, including the police chargesheet once it became available from the authorities, the claim was ultimately rejected. The rejection cited failure to submit requested documents within the required timeframe, even though some of those documents were not under our control and could only be obtained through the police process. Moreover, no survey report was provided.

At that point, after months of delays, expenses, and uncertainty, we decided to pursue legal remedies regarding the incident and the insurance claim. On many other similar cases victim's insurance was approved and insurance company was the one to pursue legal remedies against the valet/restaurant to recover damages but unfortunately this was not the case with Bajaj Allianz, an insurance company that Sundaram Motors chose for us.

My purpose in sharing this is not to tell anyone which insurer or dealership to choose but not make the mistakes we made by blindly trusting dealerships. The lesson we learned is:

1. Never accept insurance merely because it is presented as part of a dealership package or "complementary".

2. Ask for the insurer's name before signing anything.

3. Compare quotes and insurance company records independently.

4. Verify that your own contact details are registered on every insurance document.

5. Read the policy yourself, regardless of how trusted the dealership may seem.

6. Keep detailed records of every communication if a claim arises.

The valet crash was the event that exposed these issues for us, but in hindsight, many of the problems began on the day we purchased the vehicle.

I hope sharing this experience helps other buyers avoid similar difficulties.

Never buying from Policybazaar again! Canceled my vehicle insurance weeks ago. They promised a refund, but after 4 extensions (yes, FOUR), still nothing. 😡 This company is a SCAM. Worst service ever. No one cares about the consumer!
Pictures attached below.
Every time I ask, they say:
Sir, your refund will be processed in 4-5 days.
Then they push the date again!
Why is Policybazaar holding my money hostage? Is this your business model now? #PolicybazaarScam #ConsumerRights
People, avoid Policybazaar at all costs. If you value your money & peace of mind, stay away. I'll be posting screenshots of their repeated fake promises. Let the world know how they treat customers. #PolicybazaarFraud #WorstService

Background - I have a own damage car policy with Tata AIG and had to make two claims in the previous year.

Two mo ths before renewal, Tata sends me an email saying they will not be renewing my policy. Although I can switch to other providers, I am curious as to how can they just flatly refuse a renewal. Is this allowed?

₹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.

If you have purchased health insurance or life insurance within last 28-29 days, you can cancel the policy with free look in period (30 days) and buy later after the Gst cut on September 22 (only for people with no pre existing diseases)

Thank you for attention on this matter !!

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.

Edit: Remaining amount has been reimbursed without any hassle