[Resolved]  Star Health And Allied Insurance — mere 20% allowed as claimable for the hospital bill

Address:

No. 05 Perumal Koil Garden Street, Sowcarpet,, Chennai, Tamil Nadu, 600079

It is really disappointing to know that your company (M/s. Star health and allied insurance company limited) have approved an amount of mere rs. 7, 792/- against the total bill amount of rs. 21, 398/-.

Few of the points which were observed in claim sanction document were (Attached):
1. Though the room rent charge was within a limit of rs. 3, 000/- the amount (Actual rate being 2, 800) - please refer to document named "kamala interim bill" your company has disallowed the same to the tune of rs. 1, 100/-
2.in connection with professional fees (Surgeon, anastheist, consultation charges etc.,) & investigation and diagnostics it is observed that a proportional rate is only granted whereas the amount paid towards the same is within the limit. Due to which rs. 928 is further reduced from the claim amount.
3. Under the medicine column a sum of rs. 2, 971/- is denied against the actual claim of rs. 3, 419/-. On our followup with one of your executives (On [protected]) we were informed that accu chck, gloves, venflon and disposables are not claimable. Does it mean that apollo have used this products/medicines for no reasons, there was no need for using such medicine? & if the same was required there is no need to disallow the amount.
In other words, if there is a reason for usage this definitely falls under a valid claim and denial of the same is not accepted.
4. The most important claim under the "others" tab the whole amount of rs. 6, 000/- has been completely denied and there has been no proper justification for the same. On our followup with executive (On the same call on your toll free no. [protected]) we were informed that charges for "equipment, medical records. Hospital service and monitoring, other charges" are not payable. On further questioning on the breakup of the amounts and other basic information, we were informed to put a formal mail on the same for addressing this issue.

Considering the above facts of the case we want the following queries to be addressed specifically from your side:
1. Does it mean that apollo hospitals have used the equipment without any reason i. E., there were no need for the equipements and the treatment would be taken up without any real time observation or may be the patients are expected to have a knowledge of the same and carry the required equipments from their place while getting admitted to the hospital?
2. Does it mean that medical records were of no use and were generated for no reason i. E., the records are generated mere to create a big file and not to observe the patient's health condition?
3. Does it mean that hospital service is not at all required for the patients i. E., the patients can manage the affiars themselves?
4. We need to know the breakup of other charges which are not approved as a claim and the reason for the denial.

Ps: this might sound a little informal, however would like to inform that we are not fools here to pay you around rs. 40, 000 per annum (For the whole family) as insurance premium to star health and when it comes to delivery the company shall grant us mere 20%-25% of the claim amount.