Star Health And Allied Insurance Complaints & Reviews

sub : rejected reimbursement of claim :cli/2018/151124/0470387, due to invalid and unlawful cause

policy number:p/151124/01/2018/000064

claim intimation no:no:cli/2018/151124/0470387

Name of patient :urmila tanaji dudhale

Date of birth:[protected]

Valid from:[protected]

Customer id :[protected]

Admission date:[protected]

Discharged date:[protected]

Diagnosis:viral fever

From

Ghumatkar hospital

Dr ghumatkar mangesh dattatray

Near vaishali medical, bajarpeth

rajgurunagar tal-khed dist-pune rajgurunagar pincode : 410505 pune maharashtra

Contact no:[protected]

Email:[protected]@live.in

Policy availed in january 2016. No claims made until now. Now, when we claim for treatment of my wife, they are demanding discharge summary of december 2016 of our different hospital. For not providing that, they have denied cashless claim. Also, they threaten, reimbursement claim will be rejected, if the same details are not provided. Am i supposed to be sharing personal health reports with insurance companies who have not provided financial help.

Hi,

My parent's policy number is p/111117/01/2019/003849. My mother got admitted for angio in april. Rs.25, 000 has been settled by their pension policy scheme and the remaining amount paid by me. I have submitted all bills and documents to star health. They raised query several times and i tried to do my best my end. Insurance person came to hospital a month before and also to my home and inquired all details to clarify few things. I tried to call the number which is shared in the last sms which i received but it is not reachable.

Its been more than 5-6 months but the settlement is not done.

Intimation number is 039647. Very much disappointed by taking this policy.
I would most likely cancel this policy in the next renewal. I will not recommend this to anyone of my friends.

It will be great if i can atleast know the status.

Before this, i heard that it is under financial approval status when i contacted ao but got the query.

Thanks,
Venkat

I was injured during an accident and got clavicle broken. The police took me to fortis hospital which is their network hospital they did all necessarily investigations and found my clavicle broken. I got it operated from a different hospital. Their vigilance officer verified everything from the hospital and the police station and now after all the drama they are saying that they find it as a pre existing illness.

Sir,
Myself 'parag vilas deshpande'. I am having health policy (Policy no p/171127/01/2018/000099) with 'star health and allied insurance company ltd'.
(Branch office :borivali east, shop no 129, 130, 131, 1st floor, hari om plaza, m. G. Road,, borivali east, mumbai 400066). I am paying my premium on regular per annum basis. Mr abhijit desai is my star policy agent and on mid 2017 he filed a claim to star office. He provided...

Dear sir, mam
This side bapi das i m sbi credit card user
Mr. Manoj mujhe call karte hai sbi ke behaf se credit card ke issue ke liye manoj ne mujhse bola ki aapka credit card pe koi bhi anually fees nahi hai mera banda aapke paas jayega aapse signature karwayega aap kar dena maine unke kehne pr kar di aur mere paas verification call pe pata chala ki mere card me 499 ka charge laga hua hai aur card bhi banke aaya hai mere paa 499 charge ke saath but mujhe kaha gaya tha tha ki ispe koi bhi charge nai hai. Manoj mob :- [protected],,,,, [protected].. Dear team meri help kijiye & please take action.

Regards :- bapi das
Mob :- [protected]

My star health police started 21 oct 2017.. This was my family plan. But my wife diagnosed by cancer in jan 2018. But company was rejected the policy said that is pod.. I had all the proof of diagnosed... I want to file legal case... Plz help me i am suffering family problem plz help me
Thanks
Name... Preeti jain
Customer i'd number...[protected]
Phone no..[protected]

Hi, i have submitted my reimbursement claim request through agent and it took 15 days to reach zonal office post which i get query for additional documents. I had sent the scanned documents by email as per the suggestion from the claims department. Now they say to submit hard copy and also there is no proper response even after multiple calls to the claims cell. It is very poor customer service since many people promised call back but none so far. This is the worst experience that i had with and really tierd. Looking for help related to the reimbursement concern.

Hi,

I am escalating this issue to claim department. On 12th october 2018 my dad got admitted in sri kara hospital in secunderabad and initial the insurance got approved for 80k based on that we admitted and got operated. Now the claim got rejected saying that in inpatient file they have updated the pain is there from 4yrs and they are saying this was not disclosed during the policy. The inpatient was updated wrongly and some it was rewrite i am not sure this was happens by doctors or the reviewer from insurance department. Saying 4yrs was purely miss communication and duty doctor already given the explanation in return saying the pain is there from last one year also i have produced the x-ray which we took last year.

The initial claim was approved that is the reason we have admitted in the hospital and if the claim is rejected due to small miscommunication at this moment from where can i get the 5lacs and today my dad need to discharge and unfortunately i am also not there. This is purely un-faith to me. I would request again to the claims department to reconsider this where as a i dont have any role and i am 100% eligible for getting the insurance.

If there are any such issues initial insurance also should not get approved so that we can think of the financial position and plan accordingly. I dont see any meaning if the initial insurance got approved and final bill got rejected. I can understand if the partial amount only is getting approved because some hospital charges but not the fully claim in getting rejected.

As a fair customer if this is not getting approved then i should go to justice from irda and get the explanation from them why i am not eligible when i do not have any mistake from my side. And the mistake made from either hospital people or insurance reviewer on adjusting the numbers on the inpatient file and if required i will lodge the fir asking to find who modified the years in inpatient file.

I would request again to claim department to consider the claim currently we are waiting for the response from claim team and i would like to leave the hospital until i get a proper response from the team.

Please find the patient and claim details as below
Patient name: katakam chandrasekhar
Policy number : p131127/01/2016/004481
Contact number: +91 [protected]

Thanks
Marthand

Respected sir/madam,

With due respect i wish to inform you that i am medical policy holder of your reputed star health india company since last two years. My medi-claim policy number is p/171219/01/2018/001411 which renewal premium was due on 05.07.2018, however i have submitted the renewal cheque of rs. 37011/- (Cheque no. 020851 dated 30.06.2018 drawn on allahabad bank, anand) deposited to you on 02nd july, 2018 before due date. But due to some technical reason (Signature differ) my above cheque was returned by the bank. I wish to inform you that bank did not informed me regarding the cheque returned intimation and i was out of station during the above period so i didn’t get the cheque returned intimation sent by you.

I herewith heartily request you to kindly renew my above policy as i am paying the regular premium since last two years. This was happened due to oversight so kindly consider my above case positively on humanitarian grounds and do the needful by renewing my above policy. I am 62 years old person and i am paying the regular premium and now i will be in big loss at this age if my above policy will not be renewing.

I wish to inform you that i assure you that this type of mistake will never happen in future. Moreover i wish to inform you that i am ready to fresh medical check-up if needed and required by you.

I heartily request you to kindly consider my case as genuine and renew my above policy at the earliest.

Kindly do the needful and obliged.

Your early action in this matter will be highly appreciated.

Thanking you in anticipation.

Yours faithfully,

Gajera mohan jivraj,

Hi, this is vijay kale.
I had taken a policy from star health and allied insurance (Referred to as star insurance in further body).
While taking the policy i had clearly mentioned that i smoke as well as consume alcohol occasionally. Copy of form as acquired by the insurance agent is attached below.

On 15th sept, 2018 there was a lot of pain in my abdomen and i was suffering from unusually high bp.
I met my doctor the very same day and i was suggested to get an endoscopy done.
Since endoscopy is not easily available nearby in panvel, i called up a few hospitals and decided to get my endoscopy done at zen multispeciality hospital, chembur.
On monday morning i reached the hospital and they immediately admitted me. One of the reasons that i chose this hospital to get treated as the cashless facility available there under a tie-up with star insurance.

Before admission, i had presented my insurance card to the tpa of that hospital and informed him that this is under the cashless scheme of star insurance.
To my surprise, the hospital asked me to deposit 20, 000 as a security deposit telling me that this will be refunded after the claim is settled.

My treatment started completely worry-free as i thought i am under the protection of my medi claim plan. After endoscopy, i was diagnosed with a disease called duodenitis.

When the doctors asked me did i drink, i made a full disclosure about when i last consumed alcohol.

I was admitted for a period of 2 days and on the day of discharge just a few hours before the billing i was informed that my claim by star insurance has been declined. The copy of claim decline by star insurance and the reasons are attached below.

The reasons for declining my claim as per the communication received reads as below.
"we note that the insured patient has been admitted with complications traceable to - duodinitis following alcohol consumption. Expenses for such treatment are not admissible in accordance with exclusion no.9 of the policy."

On contacting the insurance agent i got the point no 9 (Also attached below) and reads naturopathy treatment.

It is very clear from the attached screenshot that they have mentioned point no 9 which was supposed to be the point no 7. Which reads as intentional self injury and the use of intoxicating drugs.

Giving these baseless reasons they rejected my claim. A few points which i would like to highlight.
1. During taking this policy i had already informed them of my occasional drinking habits.
2. Duodenitis - can happen by bacterial infection as well and by taking an overdose of alcohol as well. And i had just consumed 2 units of alcohol. That too 48-72 hours before i faced the issue.

When i was taking the policy i had clearly mentioned that i consume alcohol and that too very occasionally and when the doctor asked me i made a complete disclosure about the same.

Star insurance did not even verify the actual reason and declined my claim.
According to me this a general fraud which insurance companies run and i seek to get justice out of this complaint.

Details of incidence and the resolution i seek areas below.
Date of admission - 17th and 18th september.
Customer id[protected]
Desired resolution - acceptance of claim and refund of complete treatment amount of rs. 20, 000

Dear sir,

I want to raise complaint against star health insurance.

Spam calls coming from star heath every day.
I have requested them to remove my dnd registered number from thier database.
But every time they will keep disturbing.

Sick company. How are they calling to dnd number inspite of requests to stop calling.

Please take strict action against these kind of spammers

My daughter - r. Ritharshana was having fever and cough and was admitted in dr. Jayasekharan hospital and nursing home, k. P. Road, nagercoil, tamil nadu on 05/09/2018.
Doa-05/09/2018,
Dod-10/09/2018.
I was denied the claim for no apparent reason.
I called up the customer care and was informed that my baby had a pre-existing cleft palate condition and hence the claim cannot be accepted. However, cleft palate was surgically treated without making any claims.

The current claim is has no relation to it and hence i would like to request a refund for the hospital bill amount - rs 11215. Pfa medical summary

I have done a health insurance policy on[protected]. My policy number is p/161130/01/2019/020183. They misguided me about the mode of payment. Now they haven't send any hard copy and cash card to me. Moreover when i requested to cancel the policy and refund my money, they are not paying any heed to my complaint. Now i want to cancel my policy with starhealth and allied insurance within the free look period of 15 days and my money back. Please help

Subject: refused my patient's mediclaim by starhealth mediclaim insurance company.

Respected sir

Details given bellow

under the consumer protection act, 1986

Consumdisputes redressal forum at pune -irda and
Ombudsmen
1. particulars of complainant

Name:-ghumatkar hospital, bajarpeth, c/o dr ghumatkar mangesh dattatray, near vaishali medical, bajarpeth tal khed dist:-pune. Maharashtra 410505.
Contact no. Mobile number:-[protected], [protected]

Email [protected]@live.in, [protected]@outlook.com

2 particulars of the opposite party
Mrs. Sushama dhumal
Head - zonal underwriting
Pune zonal office
Star health & allied insurance co. Ltd.
2nd floor, venkatesh villa,
Ghole road, shivaji nagar.
Pune-411004
Land line. No.[protected]
Phone numbers:[protected]/[protected]-28288800
Claim intimation number: cli/2018/151128/0502099
Name of the insured-patient : gauri yogesh ghumatkar
Age : 31 years 1 months
Sex: female
Product name : family health optima insurance - 2017
Policy number : p/151128/01/2018/000152
Policy period: from : 29-jun-17 : : to : 28-jun-18
Diagnosis : dengue fever
Date of admission: 12/12/2017 ghumatkar hospital – bajarpeth

Date of discharge:15/12/2017

3. Subject: refused my patient's mediclaim on basis of treatment done in my hospital by me bams doctor .


4. Details of the complaint
Refused my above mentioned patient's mediclaim on basis of treatment done in my hospital by me bams doctor.
Hospital is registered at civil surgeon aundh, pune
. I have all physician, surgeon, pediatrician on call round 'o' clock.in my hospital hospital registation no 391.

Name:-ghumatkar hosoital, bajarpeth, c/o dr ghumatkar mangesh dattatray, bams registation no.: i-41871-a1
My hospital is having registration under nursing home act with civil surgeon pune. Over all this. I have mbbs md (Physician), pediatrician mbbs dch, gynecologist also. By law i have authority to right allopathic medicine in maharashtra about this, i have provided all necessary document. This claim is not my first claim with starhealth mediclaim insurance company, all claims except 3 privious claims are setteled well with same prescription and investigations reports with mý letterhead and registration number and previous 3 rejected claims are also refused to pay due to same reason
. So this is mental harracement and make great loss of my dignity and devaluation of my degree.
5. Related laws and information of rules and regulation made by maharashtra government
My colleague have given application on 16/02/2018 to drug administration authority of pune , maharashtra under right to information act (Rti) 2005, section 6 (1) regarding authority of bams doctors to use allopathic medicines . drug administration department replied me that this official information comes under control of maharashtra council of indian medicine (Mcim), mumbai, maharashtra. Hence drug administration department handed over my rti application to mcim, mumbai under rti act 2005, section 6 (3). Mcim replied me regarding authority of bams doctors to use allopathic medicines. i want to highlight some points regarding above subject by reference with information given by official government authority. (1) . As per circular declared by mcim on 25/01/2017 reference mcim / 1701374 / 2017 bams doctors which one have registered in a , b and a -1 register of mcim have legal authority to use allopathic medicines. (2). above bams doctors have legal authority to issue any type of medical certificate and this certificate is valid for all government, semi - government and private official purposes. (3). As per circular dated 25/01/2017 by mcim, bams doctors are also labelled as qualified medical practitioners hence as per bombay nursing home act 1949 they have legal authority to take hospital registration certificate on his own name. And respective authority is binding to give hospital registration certificate as per bombay nursing home act to bams doctors. i am also attaching copy of some official documents received by government authority. All these documents with you for official /legal purposes.



6. Details of attempts made to get the matter complained of settled and result thereof: (I) personal negotiations also done with starhealth exicative : (Ii) written communication with trader/opposite party also done: i have contacted many time with starhealth mediclaim insurance company refused around 20 times from date of patient's discharged 15/12/2017. But till they refused to pay. I have made email complaint but still same response. I have attached refused claim intimation notes. I made email complaint on their email address with trialling

With jago grahak jago organisation.
7. Compensation claimed for financial loss due to the negligence of the opposite party purpose of consumer complaint against starhealth mediclaim insurance company :
I want reimbursement to my patient around 1 lac and compensation to me making my previous all refused claims under same cause for about 15 lacs with effect from my first claim refused date under same cause, for my mental harassment and making devaluation of my degree in patient's mind. Make me fill inferiority due to this for this 9lacs.

8. the forum/state commission has jurisdiction to entertain the complaint in view of -

This is happening everywhere and this all mediclaim insurance company refusing claim by bams doctor in maharashtra. They will got lesson from this incident. There is big financial loss to middle class people who made claims at this insurance company at village level and their claim got regected due to same reasons. So please help them to get proper service. Claims being made only after treatment at village level when patient got relief, only then he go for claims setteledment. Then consumer should have to got his benefit.

A) section 11 (I)/sec 17 of the consumer protection act (B) the extent of amount involved being rs:15 lacs

(D) the cause of action having accrued at: rajgurunagar

Limitation that the present complaint is being filed within the period prescribed under section 24a of the act. —

prayer

I/we, the above named complaint/complainants respectfully state before the hon'ble forum/commission the complaint as follows:



It is therefore prayed

(I) that opposite party be directed to reimburse the amount with delay of payment of claim to patient rs...1 lacs...

(Ii) complaint may please be compensated to the tune of rs...14lacs. For my privious total mediclaim rejected with same cause and for the mental agony and harassment caused to myself in the due course.

(Iii) cost of litigation may also be awarded suitably.

Place:rajgurunagar

Date :10/09/2018

dr ghumatkar mangesh dattatray

Ghumatkar hospital bajarpeth khed.

I, dr ghumatkar mangesh dattatray s/o - dattatray baban ghumatkar resident of rajgurunagar tal:khed dist pune, 410505 — do solemnly declare and state that the particulars stated above are true to the best of my knowledge and belief and no part thereof is false and nothing material has been concealed therefrom. The annexures are exact copies/translation of their originals. I undertake to pay any sum required for the conducting of test in the laboratory as per the provisions of sec. 13 (1) (D) of the consumer protection act, 1986

Jay jinendra
Dear sir
I have a jio policy. Policy no: 0186706
The star health insurance company claim process is very slow and not properly. We have submitted all original paper for a claim process but star insurance company have a quvary for medical report not submitted. So i have reopen claim and submitted zerox paper. (Dt:[protected]
Today star health insurance company agent (Surat br.) said that the claim is under process.
I have not completely satisfied so reply soon.
Yours faithfull,
Vishal r shah

Star health services too poor. Thats a fraud company. Don't go with star company. Mene 13 aug ko star ki health policy purchase ki but itni baar contact karne par bhi 25 din mein pocily ki hard copy nahi mili.. Jab yeh company 1 month mein policy ki hard copy nahi bhej sakti tho yeh claim kya process kare gye..
Dont waste time with star health insurance

Varinder bansal
[protected]

1. I had put up a claim of hospitalization+post hospitalization rs.66602/- for which i have received reimbursement of rs.53244/- hence there is a deduction of rs.13358/-. Upon enquiry i was informed that the room rental charges exceeds the limit, hence proportionate deduction @ 20% has been made in all other expenditures.
2. I had again put up a claim towards post hospitalization of rs. 19600/- out of which only 400/- has been approved. They did not give any specific reason for not settling this. Initially upon enquiring they told me that the documents are incomplete then i got the necessary papers from concerned doctor and finally they sent me an email stating "we have settled the claim as per reasonable clauses applicable under the terms and conditions for the nature of treatment incurred and we express our inability to settle any additional amount."

If this is what the insurance company's rules are, then nobody should take insurances. I am going to recommend my company not to opt for this insurance. If there would have been minor deductions i would not have bothered so much. I have been covered under this same policy since more than 3 years and have never ever claimed any amount. This is for the first time i am claiming and the first experience is really horrible experience.

I had applied for health insurance but got rejected as it did meet the company policy and got my cheque back. Now i keep getting multiple calls asking to apply for an insurance, i have politely told them the reason and not to trouble again. The agents keep calling and hassle stating that they will offer rs. 1000 off and will give silver coin. Then again and again i get hassling calls, i had warned them if i get another call in regards to...

Hospitalization claim no 0155887 dtd 6th july 18.
My wife was admitted at medihope hospitals in bangalore for treatment of a fracture in her right had wrist on 27-06-18 and the star health had approved the payment of rs 24000 to the hospitals. This hospital made us to buy few medicins and other items required during the hospitalization and the payment was made by us. They also did not entertain consultation fees, registration charges etc for this hospitalization.
Post hospitalization i submitted a claim to the insurance co for rs. 8924/- against the above mentioned charges and the insurance co approved an amount of rs 3279.00 only and sent a dd to me (Yet to be received) by post.
I asked them why the claim is not paid in full and they sent me a mail stating few medicins and items are adisallowed even though the same were purchased for the purpose of the treatment during the hospitalization.
Attached is a copy of the claim and the mail sent by the star helath insurance co.
Please clarify if this is correct or what i should do to get the balance payment.

Mail copy:
Cli/2019/161112/0155887 claim dated 18th jul 18-cr[protected]
Yahoo/inbox
• support
To:[protected]@yahoo.co.in
28 aug at 11:43 am
Dear sir/madam,
We refer to your representation regarding the review of your claim cli/2019/161112/0155887,

In this regards we wish to inform you that as per the claim documents received our medical panel has reviewed and the non payable item has been disallowed.
_
Volini spray, vasofix, cannula fixator, octocal not payable, service, mrd, admission charges not payable bonmed, xcral not payable.

No report for x-ray dated 16.7.18 hence not rs 300/- not payable
_