₹2.5 lakh for a surgery and 10 days of hospitalization. “The doctor said I didn’t have to worry about the expense because his hospital was empanelled with my insurer, Star Health and Allied Insurance." Gupta, however, sought a second opinion. Another doctor quoted ₹50,000 for the same treatment, with just two days of hospitalization and regular physiotherapy thereafter.
Gupta went ahead, paid the charges and filed for reimbursement. That’s when his struggles began. “Star Health rejected my claim over a document discrepancy.
I had a road traffic accident, but the insurer assumed it was renal tubular acidosis, a kidney disease. I tried reasoning with them, but to no avail. I have written to the insurance ombudsman now," said Gupta.
Such rejections are not uncommon with some insurers. Shishir Bhatnagar, 42, of Noida is paralyzed and has been battling IFFCO-Tokio for the last 12 years over his claim. “I have been paralyzed ever since I fell in a swimming pool during a wedding.
The insurance company, however, claimed that I was under the influence of alcohol when I fell. This is absolutely preposterous and the doctor’s statement at the time of admission clearly rules out any alcohol or drug use," said Bhatnagar. He filed a case against IFFCO-Tokio and it was upheld by district and state consumer forums in Uttar Pradesh.
However, the insurer has now moved the national consumer forum. The promise of health insurance is proving to be a mirage for policyholders like Gupta and Bhatnagar. Many pay high premiums and buy these policies believing that in the event they need healthcare, they will be fully covered.Read more on livemint.com