Incident Description – Health Insurance Claim Rejection
In 2020, I was influenced by a television advertisement from PolicyBazaar regarding health insurance. I called PolicyBazaar to purchase a health insurance policy. They recommended Star Health and advised me to take their Young Star Policy, under which I insured myself, my wife, and both my children together.
They asked all the necessary questions at the time of purchase, and I provided all the correct details.
Our first policy was taken in 2020.
From 2020 to 2025, we renewed it on time without any break. During these years, we did fall sick occasionally, but it was only minor illnesses such as cold and cough, which we consulted doctors for and recovered from. There were no major health problems. For some common women’s health issues, tests were done but all reports were normal. All expenses were borne by us. Even the free annual health check-up included in the policy was never claimed.
Our current policy is valid until 23-Sep-2026.
The problem occurred on 29–30 June 2025.
My wife first developed cold and cough. We thought it was a normal seasonal illness that would recover on its own. However, she soon developed a severe headache, high fever, sudden difficulty in breathing, severe pain all over the body, chest pain, and frequent vomiting.
Our brother took her to a nearby hospital. The doctor examined her and said she needed to be admitted immediately. My wife refused, saying she had two children at home and it would be difficult. The doctor said he could not force admission but was advising it for her health.
The first medical note from the doctor clearly shows her BP was very low.
When my wife tried to stand up, she was unable to and said she was feeling blackout and had no strength at all. The doctor again insisted she be admitted. My brother called me to ask what to do, and I told him to admit her as advised.
After being taken to the bed, since her condition was deteriorating, she was given IV fluids (saline). The doctor then issued another medical note, which I also have.
When I reached the hospital at around 8 PM from my office, my wife was still vomiting continuously. I told the hospital that I had health insurance and requested them to apply for cashless claim, as I did not have enough money (I had trusted the insurance company, which is why I chose a private hospital, thinking it was necessary due to her worsening condition. If I had known the insurance company would deceive like this, I would have taken her to a government hospital).
The hospital sent some documents (I do not know exactly which), and I received two messages from Star Health: one confirming a claim request, and another saying it was rejected. The reason given was that hospitalisation was not necessary and treatment could have been done at home (OPD).
This happened on the second day, i.e., 01/07/2025.
Feeling helpless, I repeatedly contacted PolicyBazaar, but it was of no use. I began to feel that my agent was helping Star Health instead of me. However, one assurance was given that I could still get reimbursement.
A person named Rahul from PolicyBazaar told me that my wife’s BP reading in the records was “overwritten” and therefore cashless claim could not be approved. I asked him to send this statement by email so I could check with the hospital, but till today, no such email has been received.
I have the call recordings and all email copies with me, which I plan to update here gradually.
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