Star Health And Allied Insurance Co. Ltd. — Medical claim denial

Address:	New Delhi, Delhi
Website:	.

This is regarding medical claim denial by Star Health and Allied Insurance Company Ltd.

I have taken their star FAMILY HEALTH OPTIMA INSURANCE POLICY (medical) from star health insurance for my parents in the month of Jun-2015 after doing all the Medical checkups confirmed by the Star Health at their assigned Laboratory at Punjabi Bagh new delhi-110063.

As per Star Health and Allied Insurance Company Ltd hierarchy medical tests are required after age of 50 for all and I admitted also their requirements just to confirm that my Parents are well or not, but once all the required tests get done by their procedure and Star Health intimated me that after doing scrutiny of the medical reports all the reports are normal and they will be in position to provide me the medical policy for my parents and I opted the same.


But accidently my father got admitted in Maharaja Agrasen Hospital (New Delhi).

He was not feeling well due to cough, Cold, Temperature issue, headache and breathing issue from last 6 days from the date he hospitalized but after investigation of doctor found that my father is having LRTI with COPD diagnose and after getting reports doctors found that patient has symptoms of COPD but not the exact diagnose, in the meanwhile patient blood platelets was going down and it was symptoms of dengue but all the reports were Negative and after doing CT Scan doctor stated that my father had tuberculosis in past and he stated that it was the diagnosed that happened in the body and recovered by itself and patient would not have been taken any medicine for this cause.

Final Diagnose at the time of discharge by the doctors was “Viral fever with Thrombocytopenia with chest infection respiratory distress”.

We requested for a cashless claim from the company, but it was refused as the policy tenure was not more than 4 years.
As per company policy diagnose can only be covered after the policy holder has completed four years with the company because it is Pre Existing Disease as per their policy.

Now, I am wondering about this Pre Existing Disease because when all the medical tests has been done by the medical company and reports were quite normal then why they are stating that this is Pre Existing Disease in the body and why they did not identify all these diagnose earlier at time of tests occurred and Star Health assured me to buy a policy for my parents.

I called to the customer care and Agreeing to which we were informed by the STAR insurance customer care and the agent that,
we can opt for reimbursement for various tests, doctor fees, hospitalization charges etc. We submitted all the documents and claim amount is 65704 (Sixty Five Thousands Seven Hundred Four rupees) in Indian rupees.

Would request you to please clear this issue as soon as possible and do not give any unnecessary problem to their customer when they want a happy relationship with the company.

Following are the details of the policy & claim : Policy No. (attached for reference in the mail) - P/700002/01/2016/013784 Claim No. - 0166242
Insured Name - Nand Kishore

Regards
Satish Kumar ([protected])