Care Health Insurance — Rejecting claim

I, Kushal Narang, am filing this complaint on behalf of my mother, Mrs. Poonam Narang, the insured under a health insurance policy issued by Care Health Insurance Pvt. Ltd.

Despite being assured of cashless coverage by Care Health representatives, our claim was unfairly rejected during a medical emergency. My mother was hospitalized at Fortis Escorts, New Delhi on 21st Sept 2024 for angioplasty. Prior to admission, I confirmed the cashless eligibility through Ms. Riyansha Gupta’s office and the insurer’s call center (Call Ref: [protected]). Based on this confirmation, we proceeded with hospitalization.

However, the pre-authorization was later denied without clear justification, causing severe financial strain—we had to arrange ₹4, 00, 000 at short notice. The denial letter lacked specific reasons, and there was a clear lapse in timely communication, resulting in emotional and financial distress.

We request IRDAI’s urgent intervention for claim approval, compensation for mental and financial hardship, and strict action against the insurer for misrepresentation and violation of fair practice norms.

All relevant documents are available on request.