Star Health And Allied Insurance — family health optima insurance policy

Address:

Hyderabad, Telangana, 500044

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