Star Health And Allied Insurance Complaints & Reviews

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
_

We were very happy with icici's health insurance plan but then last month, before the renewal of the yearly plan, mr. Sumit sharma and mr. Farhan - from the star health insurance team approached my father asking to port from icici to star - assuring coverage of all existing diseases and medications. Thus, the same was ported on 3rd august'18 and unfortunately he got admitted on 16th august, in maharaja agarsen hospital - new delhi - and the tpa is now rejecting the claim saying that none of the diseases are covered and hence, the claim shall not be approved.
Now, the hospital bills are moutning to lakhs of rupeed and the patient is fighting for his life and these buggers are not answering my calls!

Its a team of cheats!
Never buy star health insurance.

I krishan kumar my policy number p/161111/01/2018/004398 i have taken a insurance policy in your insurance company star health and allied insurance company limited for my family. At time of taking insurance policy no terms and conditions are given to us and no policy details are given. We are using the insurance policy first time. On17/08/2018
My son praveen sharma whose i'd number[protected]. He had stomach pain on 17/08/2018 and in emergency zone in lotus hospital in gurgaon sec-12, near bus stand, then they admitted him in emergency ward and started the treatment and after all the treatments and diagnosis.in ultrasound and urine reports they said that the patient having 2 stones in intestine of 5.7mm and
Second one of 4.6mm. After sharing details by hospital department to insurance company then after 24 hours star health surveyer taken a survey and after some hours star health replied and rejected the claim approval. I don't know why they rejected.

I have to say that this is totally fraud for me that no claim approval done and before and after taking insurance policy no one told us the terms and conditions for time limits. I want to say this is totally fraud and the star health taken two or three amounts of rupees 15693.

My claim no is 0239862, following items is not reimburse to me and it should be payable as per your terms and conditions of payable and nonpayable list.


Meals by hospital to patient
Charges of ward doctors
And fees of sugar and blood group test of patient.

Kindly justify your reply with relevant documents of terms and conditions.

Atlast i must tell you, this type of inconvenience is not expected from star health.
Few months ago i made a claim on iffco tokiyo and fantastic service provided to me no such deductions made. I was very happy the way iffco tokiyo treat me.

I was admitted at non network hospital and had submitted my bills for reimbursement. I was shocked inspite of the treating doctor stating clearly that i was not having a pre-existing disease, star health rejected my appeal vide cr[protected] stating that it is a pre-existing disease. Please assist with complete reimbursement. I request the company to have an impartial view to my claim and let me know the reason for rejection.

I had applied for star health and allied insurance for hospitalisation policy on 24/07/18. Alongwith cheque for rs 13275
The amount was debited to my account on 25/07/18. They raised a query which i replied to eithin three days. Then they asked me to remove new x ray on my own expenses of rs 1400/- and submitted original x ray alongwith findings/reports
Which i submitted on 25/07/18. They then
Rejected my policy proposal...

I've already submitted my resignation to youon 29th june, 2018. After that i've received a call from star health asking me why i want to resign and they said that i'll receive a call from your head office (H. O.), chennai, but till date i've not received any call from your h. O.
On 18th july, 2018 when i meet the concerned lady at park street, kolkata office but she said that my branch office (I. E., from where i'm having my agency)...

Sir/mam,
My medical policy no P/111111/01/2017/009843 family Health optima Insurance policy in the name of D Ramkumar I have forwarded the Master Health Check Up claim on 27/04/18 amount of Rs.2180/- as per your instructions I have made the check up on 29/03/18 but so for not received any amount at your end. I have started in the year 2012. One fine morning your annanagar Branch staff call me and inform that this type of policy not eligible for this claim, same I have informed that your staff only inform me for which I have made the Health Check Up so for not give any reply at your end. Once I request you to kindly reimbursement of the claim amount which ever is eligible.

Regards
D.Ramkumar
[protected]

I am using star health family insurance policy since oct-2009 till date our policy number is p/181100/01/2018/007557. From the last three years i did not use my insurance card. Unfortunately, my spouse has been hospitalized on 16th of july 2018 in cosmopolitan hospital, trivandrum, kerala. My claim number is cli/2019/181100/0192056.

The total bill claimed is rs1, 21, 479.00, and only rs 60, 972.00 has been approved.
br...

Policyno. P/141137/01/2018/001375

This is my coorporate madiclaim (Corporate Identity Number U66010TN2005PLC056649) but still they haven't pay New Born Baby expenses. I am getting mail that - NO DETAILS FOR BABY
HENCE BABY BILL NOT
PAYABLE

1. They Rejjected by sayng : There is no detail for Baby like they said There is no Baby Name in Bill, Which is not possible logically and technically. So I feel this is very stupid reason to cancel the claim.

2. They asked me that we need discharge summary of baby, I also shared you the same with them and they said will clear your dues but after that they are saying that your baby is normal, so we can't pay for his room rent everything.
Every baby has to go monitoring and all process until unless they baby is ok or not but I am not getting singal amount of clain process by saying " Your baby was ok at that ".
So please help me on that.

Hi,

very horrible experience with star health i am a regular customer for star health last three year, but my experience with star health is very disappointed at the claim time customer care is not good my claim is 50000 and star health given me only 32000 alter operation and i will produce all bill of hospital my insurance is cashless but star health not given me full claim i left this insurance and my suggestion to all people no body go with star health.

Horrible and terrible experience