Health is an area people give more thought than life and for the that matter to get adequately covered I have decided to use the expertise of a prominent insurance broker Policy Bazzar. The advantage is that they give the comparison of all insurance company and their informed sales team was more than willing to support and suggest me on the right health insurance product according to my budget and need.
Based on their advice I selected ABH policy Active Fit Plus, which gives value to your healthy lifestyle. There were some clauses in policy wording I was not comfortable with, in the way they will be construed once such incident happens. And I requested them to cancel the policy. While enrolling me to the policy they took (read debit money from my account) only 48 hours, whereas to cancel it with in free look in period they said will take 12 days. I was reminding them of the fact, and they kept assured me it will be done on due course.
Unfortunately, in the meantime, my son met with a fall while playing in the courtyard with his sibling and fractured his left arm requiring hospitalization. On prodding with policy bazaar team has my health insurance been cancelled prompt replay came it is still not cancelled and i can make a claim. And further requested me to drop a mail to hold cancellation, where in I dropped a conditional mail stating that subject to clearance of this mail then I will continue with the policy. My pretext was if this claim was accepted I can be rest assured that future claim will be hassle free. I was apprehensive as the reason suggested by them for cashless claim denial will not be raised as an objection or not.
Considering the confidence provided by Policy Bazzar customer care, that due to their deft in handling many health policy, they will be able to prevail upon the insurance company incase of any denial.
With a double mind i made a claim for the hospitalization required to treat my 11 year old sons left arm fracture
Insurance claim administration team sought clarification on the submitted claim and I followed up with Policy Bazaar dedicated representative provided to contact for claim assistance. At that point, i learned that they will inform my query to ABH and latter will mail response. Policy Bazzar dedicated team is only a post box, which actually delays my feedback. Hospital is a place no one will like to prolong the stay and would like to get discharged and stay at comfort of your home for speedy recovery.
Therefore, i started talking to the insurance company toll free directly and was responding to their clarifications in coordination with my hospital insurance team. Total 3 rounds of clarification were sought and same clarification was sought twice too. The mail and hospital address were not marked correctly in initial clarification. This resulted in delay in response from my hospital insurance team. I intervened and helped my insurance team to guide proper response to the Health insurance.
After the third clarification, my pre-authorization was approved it was mentioned initial pre-auth approval.
All these times, the dedicated insurance representative was dumb founded in addressing my request for guidance. And I realized that I will have to fend off myself.
After Pre-Auth, my hospital submitted the final bill. During this time I got information from the ABHA that my cashless claim has been denied. The reason for denial is fracture from left arm injury is a pre-exiting disease (PED).
I called policy bazaar, and enquired about the same and they said it is true you cannot make a claim on this. I asked how injury due to accident be clubbed with PED.
Then I realized the folly of description of PED. During the questionnaire from Policy Bazaar while enrolling into the insurance enquired me about any hospitalization or surgery to any of the family members, it was told that my son had a fracture on left arm and now it is cured. And in the column under PED it was mentioned that " Left arm injury and related complications". Not even in in my wildest dreams and on one from the insurance company informed that any future injury to left arm will not be covered. And will be set aside as PED even if from any accidental injury until the waiting period expires.
On quizzing the same with the policy bazaar team for denial as this new injury was totally unrelated to previous one and way out to get may claim they raised their arms reading out the policy wording.
Then I suggested them to cancel the policy as I have already requested the cancellation, they said as per TnC of insurance once a claim is admitted you cannot cancel the policy too.
Neither the implication of PED, nor my right to closure of the policy dissolution after making the claim was not informed by the policy bazaar.
Therefore, my plea is to either get help in getting may claim or refund the insurance amount.
I have taken a policy for 3 years by paying Rs.60000 cicra and top of it I will have to bear the hospitalization bill of Rs. 50000 cicra. Further I will have to bear this insurance for another 3 years with all these pitfalls exposing me to mercy of almighty so that no accident happens to my family until the expiry of policy period.
Policy Bazaar customer support has been notified about the posted complaint.
