\

Not making full payment as hospital bill

Complain ID : CCN033877   43  

Insurance Complaint Complaint Date: January 27, 2020
  • State :  Meghalaya
  • City :  Jawai
  • Address: Dalmia Cement Thangskai Village
My Wife Sheela Chandravanshi was admitted to Apollo Chennai for the treatment of her severe back pain on 11.11.2020 & after medical examinations , it has been decided to carry out surgery of the disc as treatment.
I am working in Dalmia cement Meghalaya & have group medical insurance coverage of Rs 6 lacs , so I started the treatment using cashless facility by duly providing information to insurance company.
The surgery of fusion was taken place in her 2 discs L3-L4 & L4 & L5 & also IVC filter done. Hospital informed me regarding expenses around Rs. 7 lacs & I was assured that Rs 6 lacs will be paid by Insurance company & remaining one lac I will manage on my own.
On day of discharge, Star health insurance refused to pay Rs 6 lacs as coverage instead they reimburse only Rs 3 lacs, saying that One disc extrusion will be paid only 3 lacs. I was shocked & in deep trouble to pay the bills, but any how I manage to pay rest of the money by the help of my friend`s support.
Later I requested Star Insurance to reimburse remaining Rs 3 Lacs by justification that surgery has been carried out for 2 discs. On their requirements I sent all the required original documents for validation. After sending all the documents & followups finally they rejected my request on 21st Jan 2020, saying that As per sub-limit incorporated for major surgery (Extruded Disc) the maximum amount payable for treatment is Rs.3,00,000/- and we have settled the same towards hospitalization expenses in cashless facility for the above claim.
Above logic is not applicable if not applicable as Rs 3 lacs shall be paid for 1 Disc operation, whereas surgery of my wife was for 2 disc & also for IVC filter , which cost nearly 1 lacs Rs.

Sir, medical insurance is matter of trust & customers are assured that at-least insurance coverage money will be paid in case of any medical emergency, but by harassing the clients, they are creating atmosphere of mistrust & betrayal .
Sir, I request to kindly do the justice, so I can get at-least the coverage amount which is justified & my rights, at the earliest.
I am submitting all the desired documents for perusal please. I am confident that you will consider my case & resolve this with empathy.

Thanking you Sir,

Rajesh Chandravanshi
DCBL Meghalaya
claim no. CLI/2020/161200/0635363
Policy no.:P/161200/01/2019/012323
Complaint Against : Star Health insurance Ltd

Share Now Ask Question Reply Now Contact Submit Complaint

Related complaints

Complaints

    Service issue | Complaint | Query | Feedback | Suggestion | Reply

    Write your Consumer Complaints at forum, talk to members having similar complaints. Consumer Court, Consumer Complaint, Help to file Consumer Complaint Court, Address of Consumer Courts, Complaint against mobile phone service Online Consumer Complaint, Complaint against government department How to trap a bribe seeker Complaint.