[Resolved]  Star Health And Allied Insurance — paid less claim amount

Address:

Nagpur, Maharashtra, 440024

This is in regards to the claim number cli/2019/700016/0733522 raised for a knee repair surgery done at dr mahajan hospital nagpur which is a tied up with star health.
The policy is on 3rd year running and is a senior citizen red carpet policy.
I was repeatedly told by the customer care officer that maximum 70% amount will be considered as the claim amount as it is a not existing disease, however, i was only provided with 50% of the approved amount.
On inquiring about the reason as to why the amount was given less than 70%, the crc officer sara said that the expert team investigated and concluded that as the knee issue cannot be a sudden issue this means that it was existing from 4 - 5 years.
However, the doctors report submitted by the hospital clearly states the below : "difficulty in walking since 1.5 years
Pain n swelling in kneww with limitation of moment
".
If the reports says that the issue is from last 1.5 years, how can the company say that the issue is existing from last 5 years?
I was even told (By mr rahul ppa for nagpur region) that due to the age of the patient being more than 60 years, the claim is reduced to 50 %.in this case can you please explain me that what is the meaning of senior citizen policy? When the name itself says senior citizen it means that the patients age is more than 60 years.
The disappointment aslo comes from the crc officer sara who clearly say "do whatever you can, the company will not pay anything"? Is this the way star health is treating its customers?
The crc officer sara also says that all the disease shows symptoms from long time and we should get operated as soon as we get any one symptom of the disease.
If so then i must say all doctors should only concentrate on doing surgery.
I want to know the exact reason as to why my claim was not processed under 70 percent?