Apollo Munich Health Insurance — Claim not settled not received a single rupee

Address:

Gurgaon

I would like to share my experience with my Health Insurance Company APOLLO MUNICH(now being referred as HDFC ERGO)

I am of the opinion that Health Insurance shall not be used for small health issues, but it will be helpful at time of critical hospitalization.

My opinion was proved wrong. I am paying Rs40000 pa towards my family health insurance, but I had not received a single rupee for critical illness which cost me nearly 11LACS. But the insurance company troubled me a lot.
The apps, Technology of Insurance Company is only a marketing strategy, but could not give the customer a single rupee.

Policy number: 130100/11301/AA[protected]
HDFC ERGO ID : [protected]
CCN No : RC-HS[protected]
Claim 760370

My wife suffered acute CEREBRAL SINUS VEIN THROMBOSIS, nearly 90% of brain veins are blocked and the doctors of Continental Hospitals graced and by their grace, my wife survived. But please see how the Insurance Company responded in this whole episode.

For the cashless claim, the hospital and Insurance company corresponded with each other. For a claim amount of Rs160000, Insurance company sanctioned just Rs30000, but please note that Rs160000 of claim amount is all medical expenses and Insurance Company came forward to pay just Rs30000. Before discharge from hospital, for another claim of Rs10lac, Insurance Company sanctioned another Rs30000

Hospital people submitted all relevant documents and finally they said
“We had done our best, the Insurance company not responding properly, you have to pay bill by yourself”. In this way, I could not get a single rupee from Insurance Company and have to bear nearly Rs11lac by myself.

Following are the experiences with respect to my reimbursement claim
The claim just disappeared from the app
When asked about reimbursement through gmail “Your concern was registered”, “Your issue was resolved” are the replies but not single paisa.
When approached their office at Hyderabad”we are now in transit from Apollo Munich to HDFC ERGO, we don’t have module to know your claim status”, “We are not at all concerned with HDFC ERGO”, “staff are leaving the company due to covid”. These are the replies
God only knows how my reimbursement will be settled. All the original medical reports I submitted are at the mercy of HDFC ERGO.