[Resolved] Star Health And Allied Insurance Co Ltd — Rejection of Cashless claims on unethical grounds

ajohnso2

Sep 25, 2011

Address: Pune, Maharashtra

I am in mid of an email battle with Star Health and Allied Insurance and thought it is time to go ahead and write a review to appraise the general public on how this insurer is fooling and fleecing customers by denying claims when there is no case of denial.

Background is I had bought a senior citizen red carpet policy for my mother aged 60 and renewed it over these years for a sum assured of 2 lakhs. The good thing stated in the policy document is that all pre-existing diseases are covered with caps for claim amount. As well there are first year and second year exclusions for certain procedures. My mother suffered fom Diabetes and BP which I had declared while buying a policy. Note I bought it via their tele-sales channel where the Chennai office directly deals with you, debits your credit card, and sends the policy to your home address. All seemed fine till August this year when we did a complete check for my mother and she was diagnosed with Gall Stones. The doctor suggested removal of the gall bladder. I checked the policy on the internet and the featues mentioned that gall stones are covered from the second year of the policy. Sounded good as this policy was in force for couple of years now. So I got my mother admitted and sent all the required documents to star health for cashless coverage. I was told that they do not have a third party administrator and hence claims are settled faster than any other insurer. Alas, it is a lie. My mother was admitted on 16 Sept and till evening the claims department was asking for various documents viz. first consultation prescription, USG copy, which was sent to them on the same day. The procedure was planned on the next day so I called and asked the customer service desk in Chennai of how much time will they take to pre-authorize the claim. Note the hospital will not operate in case of cash less claim till the insurance company approves the claim. Full day on saturday my mother was empty stomach ready for the operation and Star Health Insurance was not ready to provide any information at all of whether the claim is accepted or rejected. As there was very little time left I made a payment myself and asked the hospital to start the operation while I sort the matter with the insurer. In the meantime Star Health’s claims department came back with a query. My mother had a minor stroke like condition sometime ago and she was on medication for the same (apparently this was after the insurance premium was paid) and we had told the doctor about this (note this prescription was sent to Star Health as well. So clearly on my part I am not hiding any facts from the Insurance company). They came back with query that we send the duration of the CVA (Stroke) and the discharge summary for the last hospitalization. My doctor wrote back to start stating that the CVA was not a major one and that there was no hospitalization for the same. Complete set of reports were at Hyderabad (since I have a permanent residence there) and we were not in a position to send those details. The doctor also added that there was no connection between the current condition (gall stones) and CVA and hence the claim should be honoured for gall bladder removal. Post this Star Health took their own sweet time and we were shamelessly calling them to an extent that they started shouting on us. We were anxious at one end where my mother was being operated and at the same time had to bear with illeterate and ill mannered customer service reps at Star Health. Alas, around 5 PM the hospital called me and told me that our claim has been rejected stating "Misrepresentation of PED" (pre-existing disease). I was baffled and called the customer service and they again were not ready to appraise me what I had mis-represented. They asked me to speak to Pune office, who in turn told me that they are helpless as you have bought the policy from tele-sales. They straight forwardly rejected speaking to us stating this. We then had to bear with those goons in Chennai who don’t know how to speak to customers at all as well as were not ready to appraise us why the rejection was made.

Next day I wrote to the insurance ombudsman copying the grievence dept and I got a reply from someone called Rangamani. Now this person says that they are denying only cashless claim and we can send bills for claim later on. This is the first time someone is giving us an alternative. Till now our claim was rejected, now we have an option to send the bills. Wow. I was not convinced and I asked him why the cash less claim was rejected. First this person denied that Star Health has told that we "misrepresented PED" and then came back and kept telling me to file claim with them after settling the bill at the hospital. The next day I sent the fax Star Health sent to my hospial and then this person came back and said that they had doubt on the hospitalization and hence they denied the cashless claim. I again asked him what was the doubt, note a doctor from Star Health visited us at the hospital on Friday and noted down all details for the illness. So they have all the information they needed and there shouldn’t be a doubt to reject a claim. (In the meantime the hospital staff told me that Star is notorious for finding ways to reject the claim). Upon pestering and repeatedly asking questions to Rangamani I got a response from their doctor that the reason of denial of cashless is the CVA and the hospital has not sent a proper response to their query. This was a surprise as my doctor had clearly mentioned that the CVA has no relevance to the procedure which is due to be performed i.e.gall bladder removal. I asked the same question to rangamani and the person started accusing me back of concealing information. This was totally lie as I had already mentioned everything to the insurance and the procedure for which the claim was made. I had sent back an email asking them if CVA and gall stones are related disease and does it form a basis for denial of claim. Further more the policy itself states that all pre-existing diseases are covered. Note that the brochure and policy document doesn’t mention that we have to disclose everything. My point is there are known and unknown diseases which anyone at the age of 60 may suffer and if the policy requirement doesn’t require a pre-insurance hospital checkup this is due to happen. That is why we pay a huge premium for insurance.

Anyway I am still pursuing this case with the grievence cell and will not budge till they respond to all my queries. I also plan to write to the IRDA and also bloomberg UTV to publicise this issue so that the general public is warned against dealing with Star Health and Allied Insurance.

Now the big question, will my claim be honoured. Lets wait and watch. I will update this space when any development happens. As of now I am sending the bills to their Chennai office.

Before you buy any insurance from Star Health it might be worth speaking to me on [protected]

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Aug 13, 2020

Complaint marked as Resolved

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Comments

chahat nagpal

from Gurgaon, Haryana

Jun 2, 2009

Star Health & Allied Insurance — Policy Documents and Cash-less card not received

Dear Sir/Madam

I have bought their Family Health Optima policy(Sum Assured 2 Lakh) wide cheque No 729825 drawn on ICICI Bank, Faridabad dated 1 May 2009 having amt Rs 3188

Insured Members
Chahat Nagpal and Bindu Nagpal

the same cheque has been cleared but i have not received the policy neither the card (image of bank account is attached for your reference)

Regards
Chahat Nagpal
Faridabad (Haryana)

ajohnso2

Sep 25, 2011

--- On Wed, 21/9/11, Anupam Johnson <[protected]@yahoo.co.in> wrote:

> From: Anupam Johnson <[protected]@yahoo.co.in>
> Subject: RE: Re:: FW: Re:: FW: SR Number: SRV[protected]
> To: "[protected]@irda.gov.in" <[protected]@irda.gov.in>, "rangamani.mg" <rangamani.[protected]@starhealth.in>
> Cc: "vasudevan.v" <vasudevan.[protected]@starhealth.in>, "gurumoorthy.r" <gurumoorthy.[protected]@starhealth.in>, "padmapriya.c" <padmapriya.[protected]@starhealth.in>, "shahima.k" <shahima.[protected]@starhealth.in>
> Date: Wednesday, 21 September, 2011, 6:09 PM
> Rangamani,
>
> Please show me proof of denial by me for CVA, you
> re-iterating doesn't have any stand because it is a lie.
> Show me proof that I have denied and I will withdraw my
> claim. You don't have any proof because your intentions are
> unethical. I have mentioned to my doctor that my mother is
> on medication for CVA so where is the point of
> supressing/concealing facts? This same has been sent to you,
> where is the point of concealing. In fact you are concealing
> the incompetence of your doctors or concealing your lie by
> not answering till date if CVA and gall stones are linked.
> Should I rope in the Indian Medical Association for this? My
> doctor is a local representative for IMA and he is more than
> happy to pitch in if required. Stop accusing and accept the
> fact that you guys have goofed up. Aren't you lying here?
>
> The second option of reimbursement (which you call a
> universal process) is not on your website. You have not
> answered my question yet why it is missing in the claims
> process section on your website. Aren't you lying?
>
> Customer satisfaction - Check www.mouthshut.com and see how
> many people recommend you. You may reject the numbers there
> because you do not want to accept truth. Anyway, what
> customer service you have, people like sultan in your
> customer service department whom you employ shout at your
> customers. What have you done may I know to address this?
>
> Anyway, I am gathering all people you have fooled and we
> are going to approach IRDA/Consumer Court with our findings
> and sort it out legally. You cannot run a business of
> fooling people like this.
>
> Thanks,
>
> anupam
>
> --- On Wed, 21/9/11, rangamani.mg <rangamani.[protected]@starhealth.in>
> wrote:
>
> > From: rangamani.mg <rangamani.[protected]@starhealth.in>
> > Subject: RE: Re:: FW: Re:: FW: SR Number:
> SRV[protected]
> > To: "Anupam Johnson" <[protected]@yahoo.co.in>,
> "[protected]@irda.gov.in"
> <[protected]@irda.gov.in>
> > Cc: "vasudevan.v" <vasudevan.[protected]@starhealth.in>,
> "gurumoorthy.r" <gurumoorthy.[protected]@starhealth.in>,
> "padmapriya.c" <padmapriya.[protected]@starhealth.in>,
> "shahima.k" <shahima.[protected]@starhealth.in>
> > Date: Wednesday, 21 September, 2011, 5:29 PM
> > Dear sir
> >
> > We once again reiterate that you are only trying to
> escape
> > from the fact
> > of suppressing the material fact of CVA which came to
> light
> > only after you accepted
> > after the details came from our cashless team.
> Moreover,
> > there was no question of lying
> > as we already expressed that cashless rejection was
> done
> > with no malafide intention or negative
> > attitude and falls under our normal procedure wherein
> the
> > insured has the second
> > option of reimbursemen as well.
> >
> > You still stand on the same point of of the
> interconnection
> > between two diseases, which will be best judged only
> after
> > the final reimbursement procedure is over. Hence, we
> > appreciate that you are despatching the documents
> tomorrow
> > wherein our reimbursement department will examine the
> > records at length to provide you final status after
> review.
> > We once again state that cashless rejection
> > was done only with the available records and not with
> any
> > motive.
> >
> > Let us examine the relationship between the disease
> after
> > we get all the reimbursement papers
> > from your end and we do not have intention to wound
> the
> > sentiments by rejecting the claim
> > unnecessarily as opined by you and we do level best
> for
> > customer satisfaction.
> >
> > Expecting your documents.
> >
> >
> >
> >
> > MG RANGAMANI
> >
> > GRIEVANCE DEPARTMENT
> >
> > ________________________________________
> > From: Anupam Johnson [[protected]@yahoo.co.in]
> > Sent: Wednesday, September 21, 2011 4:24 PM
> > To: [protected]@irda.gov.in;
> > rangamani.mg
> > Cc: vasudevan.v; gurumoorthy.r; padmapriya.c;
> shahima.k
> > Subject: RE: Re:: FW: Re:: FW: SR Number:
> SRV[protected]
> >
> > Rangamani,
> >
> > The documents will be couriered to you tomorrow and I
> will
> > give you the courier tracking id.
> >
> > Now coming to your comments, why are you lying again
> and
> > again that I have denied CVA and that only after your
> doctor
> > clarified I am agreeing to it. I have never denied
> anything
> > (everything is in email and can be used as a legal
> document
> > when the right time comes). Secondly you have not yet
> > answered my question. When the claim is not for CVA,
> how can
> > CVA become an issue for cashless claim? The claim is
> for
> > gall stones and you have denied my right for cashless
> claim
> > stating mis-representation. You have lied twice
> before
> > this:
> >
> > First Lie: You said that your departments have never
> > mentioned mis-representation (It was only when I
> scanned the
> > fax and sent you, you have done a U-turn)
> >
> > Second Lie: Again and again pointing that I have
> denied
> > CVA. If I was to conceal information I would not have
> told
> > this to the doctor itself who noted down the problem
> with my
> > mother. Your statement is a lie and un-professional to
> the
> > core (Note: everything is in written in this email
> which can
> > be verified by external agencies whenever required).
> >
> > Over and above accusing your customer wheras till now
> you
> > have not clarified relation between CVA and Gall
> Stones. It
> > is quite clear that you are concealing the
> incompetence of
> > your doctors at Star Health or You are concealing your
> lie
> > which has been caught red-handed because both these
> medical
> > conditions are un-related. Further more I have not
> claimed
> > for CVA so your point of rejection has no ground.
> >
> > You are already aware that I have made a formal
> complaint
> > to IRDA regarding this. (this mail is a record of all
> our
> > communication and when time comes it will clarify
> easily who
> > is lying or concealing information).
> >
> > As well I have taken my experience to the public on
> > www.mouthshut.com. I will also publish my email
> > communication to the public at large. My review can be
> found
> > here http://mouthshut.com/review/Star-Health-Insurance-review-uuostrrrnn
> >
> > Interesting fact is I am being contacted by other
> customers
> > who have been fleeced by Star Health and Allied
> insurance. I
> > am in touch with all of them and we are forming a
> group to
> > formally complain to IRDA about your lies and fleecing
> of
> > customers. I will also approach the press very soon so
> that
> > what I have faced should not be faced by others in
> future.
> > You are accountable to the customers who give you
> business
> > and not fleece them by giving incorrect
> representations or
> > accusing them of lying/concealing information. Between
> all
> > this the aspect of customer service is also null at
> Star
> > Health. I will build a case and present to IRDA as to
> why
> > Star Health should continue to run business given so
> many
> > ill practices.
> >
> > I as well thank you for maintaining all communication
> in
> > email so that I have written proof.
> >
> > Thanks,
> >
> > Anupam
> >
> > --- On Wed, 21/9/11, rangamani.mg <rangamani.[protected]@starhealth.in>
> > wrote:
> >
> > > From: rangamani.mg <rangamani.[protected]@starhealth.in>
> > > Subject: RE: Re:: FW: Re:: FW: SR Number:
> > SRV[protected]
> > > To: "Anupam Johnson" <[protected]@yahoo.co.in>,
> > "[protected]@irda.gov.in"
> > <[protected]@irda.gov.in>
> > > Cc: "vasudevan.v" <vasudevan.[protected]@starhealth.in>,
> > "gurumoorthy.r" <gurumoorthy.[protected]@starhealth.in>,
> > "padmapriya.c" <padmapriya.[protected]@starhealth.in>,
> > "shahima.k" <shahima.[protected]@starhealth.in>
> > > Date: Wednesday, 21 September, 2011, 10:28 AM
> > > Dear Sir,
> > >
> > > We have already requested you to submit all the
> > original
> > > discharge summary, bills, investigation reports,
> > > to the address which we have already mailed.
> Hence, we
> > will
> > > be expecting your documents at the
> > > earliest for further processing. While going
> through
> > your
> > > previous mail, we understand that you are
> > > quite specific only about the link between two
> > diseases and
> > > you have not accepted the fact
> > > that the patient had a symptomatic disease of
> CVA
> > which you
> > > have accepted only after the
> > > mail came from our Sr.doctor explaining the
> reason of
> > > rejection. Hence, it is clear
> > > that the cashless was rejected on the grounds of
> > benefit of
> > > doubt and without prejudice
> > >
> > > Kindly note that we will be in a position to
> provide
> > you
> > > elaborative explanation only when we receive the
> > documents
> > > from your side and it is too early for us to
> provide
> > > exhaustive explanation.
> > >
> > > Expecting your documents at the earliest.
> > >
> > > MG RANGAMANI
> > >
> > > GRIEVANCE DEPARTMENT
> > >
> > > ________________________________________
> > > From: Anupam Johnson [[protected]@yahoo.co.in]
> > > Sent: Tuesday, September 20, 2011 5:31 PM
> > > To: rangamani.mg; [protected]@irda.gov.in
> > > Cc: vasudevan.v; gurumoorthy.r; padmapriya.c;
> > shahima.k;
> > > umameenakshi.v; [protected]@gmail.com
> > > Subject: RE: Re:: FW: Re:: FW: SR Number:
> > SRV[protected]
> > >
> > > Rangamani,
> > >
> > > I have received the claim forms. Just to confirm
> I
> > need to
> > > send the hospital bills and discharge summary in
> > original to
> > > you guys and nothing else. Can you please
> confirm
> > asap.
> > >
> > > As well am not convinced that you want to put my
> > questions
> > > on the backburner till you get the above
> documents
> > from me.
> > > I want answers to my questions asap. Can't your
> > experienced
> > > doctors answer a simple query which I have asked
> > whether CVA
> > > is linked to Gall stones. If they are not linked
> what
> > valid
> > > reason will you state for rejecting my cashless
> > claim.
> > >
> > > In addition I have sent the brochure to you as
> well
> > which
> > > states all pre-existing diseases are covered.
> Nowhere
> > in the
> > > brochure or the policy document it states that
> non
> > > disclosure will lead to claims not honoured. That
> is
> > the
> > > reason you guys have formulated caps for various
> > procedures
> > > and exclusions. Quote from the brochure or
> policy
> > document
> > > if my above statement is wrong.
> > >
> > > Hello IRDA - I would like to raise a formal
> complaint
> > > against Star Health and allied insurance for
> cheating
> > a
> > > policy holder and not disclosing accurate
> information
> > for
> > > rejection of cashless claim. Please read through
> the
> > mail
> > > chain below. The reason for rejection of my
> cashless
> > medical
> > > claim has been cited as CVA whereas the procedure
> was
> > gall
> > > stone removal. Till now the insurer has not
> clarified
> > if
> > > these two conditions are linked and form basis
> of
> > rejection
> > > of claim. Please also guide me how I can claim
> for
> > mental
> > > harassment (which is evident from the mail chain
> > below)
> > > which has been meted out to me by this insurer.
> > >
> > > Thanks,
> > >
> > > Anupam
> > >
> > > --- On Tue, 20/9/11, Anupam Johnson <[protected]@yahoo.co.in>
> > > wrote:
> > >
> > > > From: Anupam Johnson <[protected]@yahoo.co.in>
> > > > Subject: RE: Re:: FW: Re:: FW: SR Number:
> > > SRV[protected]
> > > > To: "rangamani.mg" <rangamani.[protected]@starhealth.in>
> > > > Cc: "vasudevan.v" <vasudevan.[protected]@starhealth.in>,
> > > "gurumoorthy.r" <gurumoorthy.[protected]@starhealth.in>,
> > > "padmapriya.c" <padmapriya.[protected]@starhealth.in>,
> > > "shahima.k" <shahima.[protected]@starhealth.in>,
> > > "umameenakshi.v" <umameenakshi.[protected]@starhealth.in>,
> > > [protected]@gmail.com
> > > > Date: Tuesday, 20 September, 2011, 3:06 PM
> > > > Rangamani,
> > > >
> > > > My response to your comments:
> > > >
> > > > 1. I have never denied anything what you
> have
> > > mentioned (If
> > > > I have please show it in this mail chain for
> a
> > > record).
> > > > Please read (re-read if you have to) the
> whole
> > mail
> > > chain
> > > > again. I am asking for reason of denial
> which you
> > have
> > > sent
> > > > now. I asked what is the "misrepresentation
> of
> > PED"
> > > which
> > > > first you denied (you lied, please read the
> > email
> > > chain) and
> > > > then when I scanned and sent the message you
> sent
> > to
> > > > Jehangir you have come back with the below
> > response
> > > from
> > > > your doctor. There is no merit in your
> statement
> > as
> > > the
> > > > claim is not for CVA whether known or
> unknown.
> > You
> > > have not
> > > > answered my question if CVA and Gall stone
> is
> > linked.
> > > > Clearly you are avoiding valid questions
> which I
> > am
> > > entitled
> > > > to receive answers and which clearly shows
> your
> > > malafide
> > > > intentions to reject my cashless claim.
> Don't
> > your
> > > > "Experienced Doctors" know about this
> whether
> > these
> > > two
> > > > conditions are linked. My doctor from
> Jehangir
> > has
> > > sent a
> > > > response clearly stating that these two
> > conditions
> > > > are not linked and the procedure sought
> is
> > for
> > > gall
> > > > bladder removal. A second question I ask you
> (I
> > had
> > > asked
> > > > this before as well), If a patient suffers
> from
> > > diabetes
> > > > (which I have declared) and there is renal
> > disorder
> > > due to
> > > > diabetes, will you reject the claim stating
> it is
> > not
> > > > declared? Please answer yes or no.
> > > >
> > > > 2. I will appreciate only if you pass my
> claim.
> > By my
> > > > experience till now, you guys are only
> making up
> > a
> > > case to
> > > > reject a claim citing irrelevant scenarios.
> If
> > not
> > > please
> > > > re-affirm my faith in star health by
> answering
> > the
> > > question
> > > > I have been asking viz. Is CVA or gall
> stones
> > linked?
> > > >
> > > > 3. (point mentioned as 2, i see it is a
> typo):
> > The
> > > > universal practice is not mentioned in your
> > website.
> > > If it
> > > > is a universal practice why is it missing
> from
> > the
> > > claims
> > > > procedure. (please go to http://starhealth.in/intimate-claim and see for
> > > > yourself if I am lying).
> > > >
> > > > 4. (point mentioned as 3, guess a typo): I
> am
> > > contacting
> > > > the policy issuing office only. This shows
> you
> > have
> > > not at
> > > > all studied my case. I have bought my
> policy
> > from
> > > > tele-sales. For the record I have contacted
> pune
> > > office as
> > > > well and they clearly mentioned that since
> this
> > policy
> > > is
> > > > bought online they cannot service me. Now
> this
> > is
> > > your
> > > > internal matter, sort it out yourself
> (please
> > read the
> > > mail
> > > > clearly I have mentioned this as well before
> that
> > the
> > > Pune
> > > > office did not service me). Would you now
> agree
> > that
> > > you do
> > > > not have Customer Focus at all. Please
> answer yes
> > or
> > > no.
> > > > Also, your people have never asked me to
> send
> > the
> > > documents
> > > > to your chennai office (again I have spoken
> to
> > > sultan,
> > > > ayisha, and subramaniam). I also see that
> the Dr
> > has
> > > > responded today (the mail you forwarded me)
> that
> > the
> > > patient
> > > > can send the documents for a claim later.
> So
> > clearly
> > > there
> > > > is a disconnect between your various
> > departments.
> > > >
> > > > 5. I will wait for you to send me the forms
> for
> > > claims.
> > > > Please send at the earliest.
> > > >
> > > > Thanks,
> > > >
> > > > Anupam
> > > >
> > > > --- On Tue, 20/9/11, rangamani.mg <rangamani.[protected]@starhealth.in>
> > > > wrote:
> > > >
> > > > > From: rangamani.mg <rangamani.[protected]@starhealth.in>
> > > > > Subject: RE: Re:: FW: Re:: FW: SR
> Number:
> > > > SRV[protected]
> > > > > To: "Anupam Johnson" <[protected]@yahoo.co.in>
> > > > > Cc: "vasudevan.v" <vasudevan.[protected]@starhealth.in>,
> > > > "gurumoorthy.r" <gurumoorthy.[protected]@starhealth.in>,
> > > > "padmapriya.c" <padmapriya.[protected]@starhealth.in>,
> > > > "shahima.k" <shahima.[protected]@starhealth.in>,
> > > > "umameenakshi.v" <umameenakshi.[protected]@starhealth.in>
> > > > > Date: Tuesday, 20 September, 2011, 2:28
> PM
> > > > > Dear Anupam
> > > > >
> > > > > From the reply mail sent by you, we
> note
> > the
> > > > following
> > > > > points
> > > > >
> > > > > 1. Now you accept the fact that the
> patient
> > had
> > > a
> > > > > symptomatic disease of CVA the fact
> > > > > that you have not accepted till the
> > previous
> > > mails
> > > > sent by
> > > > > you to us and you have accepted only
> > > > > after we provided the complete details
> of
> > > rejection.
> > > > From
> > > > > this you will understand the reason
> > > > > which prompted our cashless team to
> reject
> > the
> > > > cashless
> > > > > with no malafide intention.
> > > > >
> > > > > 2. You will appreciate, only at the
> time of
> > > > reimbursement
> > > > > after complete scrutiny/examination of
> > > > > of document our claims team will
> come
> > to
> > > know the
> > > > > exact cause of disease and any
> > interconnection
> > > > > between the disease at the time of
> admission
> > and
> > > PED.
> > > > >
> > > > > 2. Infact, it is a universal
> practice
> > that
> > > whenever
> > > > > denail of of cashless is made, the
> insured
> > > > > is expected to send the claim documents
> for
> > > further
> > > > action
> > > > >
> > > > > 3. Moreover, you had the option of
> > contacting
> > > the
> > > > Policy
> > > > > issuing office who would have provided
> > > > > the details of claims procedure after
> > rejection
> > > of
> > > > cashless
> > > > > and provided you the claim form.
> > > > >
> > > > > 4. Anyhow, since it is too early for us
> to
> > decide
> > > the
> > > > > course of action, we would appreciate
> > > > > if you submit all the related documents
> for
> > > further
> > > > > processing.
> > > > >
> > > > > We will help you by sending the
> claim
> > form
> > > to your
> > > > > mail id in the next mail for your
> further
> > > action.
> > > > > Kindly duly fill up all the particulars
> and
> > send
> > > the
> > > > same
> > > > > along with relevant documents
> > > > >
> > > > > MG RANGAMANI
> > > > >
> > > > > GRIEVANCE DEPARTMENT
> > > > >
> > > > >
> ________________________________________
> > > > > From: Anupam Johnson [[protected]@yahoo.co.in]
> > > > > Sent: Tuesday, September 20, 2011 2:00
> PM
> > > > > To: rangamani.mg
> > > > > Cc: [protected]@gmail.com;
> > > > > vasudevan.v; gurumoorthy.r;
> padmapriya.c;
> > > shahima.k;
> > > > > umameenakshi.v
> > > > > Subject: Re:: FW: Re:: FW: SR Number:
> > > SRV[protected]
> > > > >
> > > > > rangamani,
> > > > >
> > > > > thanks for clarifying. with due respect
> to
> > the
> > > doctor
> > > > is
> > > > > the claim made for stroke or gall
> stone
> > removal?
> > > > couldn't
> > > > > the doctor decipher the difference
> between
> > two
> > > > different
> > > > > medical conditions. the doctor
> (Dr.Kiranjit
> > > Siingh)
> > > > at
> > > > > jehangir had responded the same stating
> no
> > > connection
> > > > > between these two conditions. further
> the
> > cva was
> > > a
> > > > minor
> > > > > incedent and not hospitalized which
> was
> > also
> > > mentioned
> > > > in
> > > > > the response. now i question what else
> is
> > unclear
> > > from
> > > > this
> > > > > response. do your esteemed doctors do
> not
> > > understand
> > > > the
> > > > > difference? i take this response as a
> > > straightforward
> > > > > attempt to reject a claim. please can
> dr.
> > asiya
> > > > exemplify
> > > > > the connection between cva and gall
> stones.
> > i
> > > will ask
> > > > my
> > > > > doctor to pitch in as well if there is
> any
> > > confusion.
> > > > >
> > > > > secondly why doesn't the denial letter
> > mention
> > > the
> > > > next
> > > > > steps to be taken for claim. why your
> > customer
> > > > service
> > > > > representatives neither the pune office
> told
> > us
> > > the
> > > > > procedure to file a claim. in addition
> there
> > are
> > > no
> > > > claim
> > > > > forms under the download section of
> > > starhealth.in
> > > > >
> > > > > please send me the claim form along
> with
> > answers
> > > to
> > > > the
> > > > > above questions.
> > > > >
> > > > > thanks
> > > > > anupam
> > > > >
> > > > > On Tue, 20 Sep 2011 13:23 IST
> rangamani.mg
> > > wrote:
> > > > >
> > > > > >Dear Sir,
> > > > > >
> > > > > >We are forwarding the mail received
> from
> > our
> > > > Sr.Doctor
> > > > > which is self-explanatory. From the
> > trailing
> > > mail
> > > > > >it is evident that the patient was
> > suffering
> > > from
> > > > CVA
> > > > > which compelled us to reject the
> cashless.
> > > Hence,
> > > > > >we request you to provide us the
> > discharge
> > > summary
> > > > and
> > > > > other records for arriving final
> decision
> > > > > >in your claim.
> > > > > >
> > > > > >MG RANGAMANI
> > > > > >
> > > > > >GRIEVANCE DEPARTMENT
> > > > > >
> > > > >
> > >________________________________________
> > > > > >From: shahima.k
> > > > > >Sent: Tuesday, September 20, 2011
> 1:07
> > PM
> > > > > >To: rangamani.mg
> > > > > >Cc: gurumoorthy.r; padmapriya.c;
> > > umameenakshi.v;
> > > > > vasudevan.v
> > > > > >Subject: RE: Re:: FW: SR Number:
> > > SRV[protected]
> > > > > >
> > > > > >Dear rangamani Sir
> > > > > >
> > > > > >Am replying to said claim.kindly
> ensure
> > that
> > > > > communication is forwarded to insured
> from
> > > GRIEVANCE
> > > > DEPT.
> > > > > >Policy No;P/700001/01/2011/004988
> > > > > >Name : Grace Johnson
> > > > > >DOA:16.9.2011
> > > > > >diagnosis: cholelithiasis
> > > > > >Reason for Denial of cashless
> > > > DOC:misrepresentation of
> > > > > PED
> > > > > >
> > > > > >During the cashless processing it
> was
> > > evident
> > > > from
> > > > > hospital papers sent from Jehangir
> hospital
> > that
> > > pt
> > > > was
> > > > > having past history of
> CVA(cerebrovascular
> > > accident
> > > > )ie
> > > > > stroke.In this regard query has been
> raised
> > from
> > > > cashless
> > > > > dept on 17.9.2011 regarding duration
> of
> > stroke
> > > and
> > > > other
> > > > > relevant medical/surgical history: the
> reply
> > sent
> > > from
> > > > the
> > > > > hospital in this regard was inadequate
> and
> > > incomplete
> > > > and
> > > > > thus star Health was compelled to send
> a
> > denial
> > > of
> > > > cashless
> > > > > letter.however the insured is having
> the
> > option
> > > of
> > > > > reimbursment in which the claism will
> be
> > viewed
> > > in
> > > > entirety
> > > > > and if needed specialist opinion may
> be
> > utilised
> > > > > >Regards
> > > > > >Dr asiya
> > > > >
> > >________________________________________
> > > > > >From: rangamani.mg
> > > > > >Sent: Tuesday, September 20, 2011
> 12:08
> > PM
> > > > > >To: Anupam Johnson
> > > > > >Cc: gurumoorthy.r; padmapriya.c;
> > > umameenakshi.v;
> > > > > vasudevan.v; shahima.k
> > > > > >Subject: RE: Re:: FW: SR Number:
> > > SRV[protected]
> > > > > >
> > > > > >Dear Anupam,
> > > > > >
> > > > > >
> > > > > >Further, we would like to reiterate
> our
> > > earlier
> > > > stand
> > > > > that rejection of cashless does not
> mean
> > > rejection of
> > > > claim.
> > > > > Since you have specifically asked for
> the
> > details
> > > of
> > > > > rejection of cashless, we are marking
> the
> > copy to
> > > our
> > > > Senior
> > > > > doctor who will provide with the
> information
> > of
> > > > rejection.
> > > > > >
> > > > > >Kindly send all the documents to
> us
> > without
> > > > further
> > > > > delay inorder to arrive at final
> decision
> > of
> > > your
> > > > > claim. Your cashless denial was not
> > done
> > > anyway
> > > > with
> > > > > any negative intention and it is only
> a
> > process
> > > flow.
> > > > We
> > > > > would
> > > > > >appreciate if your send us the
> final
> > bills
> > > > immediately
> > > > > for further action. Field visit is one
> of
> > the
> > > claims
> > > > > procedure
> > > > > >and it is not the final decision
> and
> > final
> > > > decision
> > > > > will be taken only by our claims
> processing
> > > team.
> > > > > >
> > > > > >Dear Dr.Asiya
> > > > > >
> > > > > >Kindly provide the details of
> rejection
> > of
> > > > cashless
> > > > > since the insured has specifically
> asked us
> > to
> > > write
> > > > to
> > > > > him.
> > > > > >
> > > > > >MG RANGAMANI
> > > > > >GRIEVANCE DEPARTMENT
> > > > > >
> > > > >
> > >________________________________________
> > > > > >From: Anupam Johnson [[protected]@yahoo.co.in]
> > > > > >Sent: Tuesday, September 20, 2011
> 11:48
> > AM
> > > > > >To: rangamani.mg
> > > > > >Cc: gurumoorthy.r; padmapriya.c;
> > > umameenakshi.v;
> > > > > vasudevan.v; [protected]@gmail.com
> > > > > >Subject: RE: Re:: FW: SR Number:
> > > SRV[protected]
> > > > > >
> > > > > >Mr Rangamani,
> > > > > >
> > > > > >You are not re-iterating. This is
> the
> > first
> > > time
> > > > you
> > > > > are giving me a reason and that too
> doubt of
> > PED
> > > > (please
> > > > > read the complete mail chain below,
> you
> > have
> > > even
> > > > denied in
> > > > > email below that your department
> mentioned
> > > anything
> > > > about
> > > > > PED, are you not lying????). Now I
> have
> > attached
> > > proof
> > > > that
> > > > > you guys mentioned "misrepresentation
> of
> > PED"
> > > (please
> > > > refer
> > > > > attached document you sent to Jehangir
> > > Hospital).
> > > > Please
> > > > > give me a full explanation what "doubt"
> or
> > > > > "misrepresentation" has happened on my
> part
> > when
> > > > taking the
> > > > > policy. Note it is a customers right to
> know
> > in
> > > > complete why
> > > > > a denial has been made. I am not
> convinced
> > why I
> > > > should
> > > > > claim it separately when I am entitled
> to
> > > cashless
> > > > benefit.
> > > > > If at all there is a denial please
> provide
> > > complete
> > > > crystal
> > > > > clear details and don't beat round the
> bush
> > > stating
> > > > "doubt".
> > > > > How can you guys be in doubt when Dr.
> > Juneja
> > > (the
> > > > doctor
> > > > > appointed by star health insurance for
> Pune)
> > has
> > > > visited me
> > > > > and my mother at Jehangir Hospital,
> noted
> > all
> > > > > > the history, spoke to the patient
> about
> > the
> > > > problem,
> > > > > spoke to the doctor at Jehangir
> Hospital,
> > noted
> > > > everything
> > > > > in a standard performa document (of
> star
> > health
> > > > insurance)
> > > > > and taken signature from my mother as
> well.
> > > Please
> > > > explain
> > > > > clearly is my humble request.
> > > > > >
> > > > > >I will be forced to approach IRDA
> for
> > the
> > > fact
> > > > that you
> > > > > have not clarified the denial when
> according
> > to
> > > me
> > > > there is
> > > > > no basis of you being in "doubt". As
> well I
> > am
> > > in
> > > > touch with
> > > > > the press and very soon I will make a
> > formal
> > > complaint
> > > > to
> > > > > them to make the public at large aware
> of
> > your
> > > > mis-selling
> > > > > prepositions and ridiculous attempts
> to
> > deny
> > > claim.
> > > > > >
> > > > > >Thanks,
> > > > > >
> > > > > >Anupam
> > > > > >
> > > > > >--- On Tue, 20/9/11, rangamani.mg
> <rangamani.[protected]@starhealth.in>
> > > > > wrote:
> > > > > >
> > > > > >> From: rangamani.mg <rangamani.[protected]@starhealth.in>
> > > > > >> Subject: RE: Re:: FW: SR
> Number:
> > > > SRV[protected]
> > > > > >> To: "Anupam Johnson" <[protected]@yahoo.co.in>
> > > > > >> Cc: "gurumoorthy.r" <gurumoorthy.[protected]@starhealth.in>,
> > > > > "padmapriya.c" <padmapriya.[protected]@starhealth.in>,
> > > > > "umameenakshi.v" <umameenakshi.[protected]@starhealth.in>,
> > > > > "vasudevan.v" <vasudevan.[protected]@starhealth.in>
> > > > > >> Date: Tuesday, 20 September,
> 2011,
> > 10:19
> > > AM
> > > > > >> Dear Sir,
> > > > > >>
> > > > > >> Further, we would like to
> reiterate
> > > that,
> > > > cashless
> > > > > was
> > > > > >> denied since there was a doubt
> of
> > > > > >> PED and will provide you the
> final
> > > status
> > > > only
> > > > > after you
> > > > > >> submit all the original bills
> etc
> > > > > >> for further processing. Hence,
> we
> > > expect
> > > > your
> > > > > cooperation
> > > > > >> and request you to send
> > > > > >> all the bills for final
> resolution.
> > We
> > > regret
> > > > for
> > > > > any in
> > > > > >> convenience in this respect.
> > > > > >> MG RANGAMANI
> > > > > >>
> > > > > >> GRIEVANCE DEPARTMENT
> > > > > >>
> > > > > >>
> > > ________________________________________
> > > > > >> From: Anupam Johnson [[protected]@yahoo.co.in]
> > > > > >> Sent: Monday, September 19,
> 2011
> > 6:09
> > > PM
> > > > > >> To: rangamani.mg
> > > > > >> Cc: [protected]@gmail.com;
> > > > > >> vasudevan.v; gurumoorthy.r;
> > > padmapriya.c;
> > > > > umameenakshi.v
> > > > > >> Subject: RE: Re:: FW: SR
> Number:
> > > > SRV[protected]
> > > > > >>
> > > > > >> the "misrepresentation of ped"
> was
> > the
> > > > reason
> > > > > quoted in the
> > > > > >> denial of cashless claim (i
> will
> > scan
> > > and
> > > > send as
> > > > > soon as
> > > > > >> possible). if you're telling
> me you
> > are
> > > not
> > > > aware
> > > > > of any
> > > > > >> such communication please
> check
> > with
> > > your
> > > > claims
> > > > > >> department.
> > > > > >>
> > > > > >> let me re-iterate i am
> agitated
> > because
> > > of
> > > > the
> > > > > reason
> > > > > >> quoted for denial of cashless
> claim
> > and
> > > till
> > > > now
> > > > > no one from
> > > > > >> star insurance has clarified
> about
> > this
> > > > reason.
> > > > > appreciate
> > > > > >> if you can clarify this
> before
> > anything
> > > > else.
> > > > > >>
> > > > > >> also, i will keep the
> ombundsman
> > in
> > > loop
> > > > because
> > > > > you guys
> > > > > >> have not clarified yet the
> reason
> > for
> > > denial
> > > > of
> > > > > cashless
> > > > > >> claim.
> > > > > >>
> > > > > >> thanks,
> > > > > >>
> > > > > >> anupam
> > > > > >>
> > > > > >> On Mon, 19 Sep 2011 17:59 IST
> > > rangamani.mg
> > > > wrote:
> > > > > >>
> > > > > >> >Dear Anupam
> > > > > >> >
> > > > > >> >We are in receipt of your
> mail
> > and
> > > noted
> > > > the
> > > > > contents.
> > > > > >> In the mail which we have
> sent
> > > > > >> >we have not mentioned
> anything
> > about
> > > the
> > > > word
> > > > > >> "misrepresentation of PED".
> Our
> > > > > >> >cashless department has
> only
> > denied
> > > the
> > > > > cashless. You
> > > > > >> may forward the documents
> directly
> > to
> > > > > >> >following address along
> with
> > duly
> > > filled
> > > > in
> > > > > claim
> > > > > >> form.kindly download the claim
> form
> > from
> > > our
> > > > > starhealth
> > > > > >> webste(www.starhealth.in)
> wherein
> > we
> > > have
> > > > also
> > > > > provided the
> > > > > >> claims procedure steps.
> > > > > >> >
> > > > > >> >
> > > > > >> >Star Health and Allied
> > Insurance
> > > Co.
> > > > > >> >Claims reimbursement
> Section
> > > > > >> >KRM Centre,
> > > > > >> >6th Floor,
> > > > > >> >Harrington road
> > > > > >> >Chepauk,
> > > > > >> >Chennai
> > > > > >> >
> > > > > >> >Kindly note that, we will
> not
> > be in
> > > a
> > > > position
> > > > > to mark
> > > > > >> cc to ombudsman till the
> > > > > >> >time we receive official
> letter
> > or
> > > > > correspondence from
> > > > > >> them.
> > > > > >> >
> > > > > >> >We request you to provide
> all
> > the
> > > > documents to
> > > > > the
> > > > > >> above address for further
> > processing
> > > > > >> >
> > > > > >> >
> > > > > >> >MG RANGAMANI
> > > > > >> >
> > > > > >> >GRIEVANCE DEPARTMENT
> > > > > >> >
> > > > > >>
> > > >________________________________________
> > > > > >> >From: Anupam Johnson [[protected]@yahoo.co.in]
> > > > > >> >Sent: Monday, September
> 19,
> > 2011
> > > 5:17 PM
> > > > > >> >To: rangamani.mg
> > > > > >> >Cc: vasudevan.v;
> > gurumoorthy.r;
> > > > padmapriya.c;
> > > > > >> umameenakshi.v; [protected]@gmail.com
> > > > > >> >Subject: Re:: FW: SR
> Number:
> > > > SRV[protected]
> > > > > >> >
> > > > > >> >hi,
> > > > > >> >
> > > > > >> >thanks for your email.
> > > > > >> >
> > > > > >> >again, your reply is
> unclear
> > and you
> > > have
> > > > not
> > > > > clarified
> > > > > >> what you mean by
> "misrepresentation
> > of
> > > ped".
> > > > this
> > > > > displays
> > > > > >> lack of customer focus and
> > commitment.
> > > this
> > > > is the
> > > > > same
> > > > > >> response i received from your
> > customer
> > > > service, no
> > > > > one has
> > > > > >> told me to send bills which
> you
> > are
> > > telling
> > > > me
> > > > > only now. in
> > > > > >> addition you have not
> mentioned
> > how
> > > these
> > > > > documents need to
> > > > > >> be sent. another example of
> poor
> > > customer
> > > > > service.
> > > > > >> >
> > > > > >> >thanks,
> > > > > >> >
> > > > > >> >anupam
> > > > > >> >
> > > > > >> >p.s. please include the
> > insurance
> > > > ombundsman
> > > > > in all
> > > > > >> your responses. they should
> also
> > be
> > > aware on
> > > > what
> > > > > measures
> > > > > >> you guys are taking to solve
> my
> > issue
> > > > > >> >
> > > > > >> >On Mon, 19 Sep 2011 15:33
> IST
> > > > rangamani.mg
> > > > > wrote:
> > > > > >> >
> > > > > >> >>Dear Sir,
> > > > > >> >>
> > > > > >> >>We have only denied
> your
> > > cashless
> > > > and
> > > > > deniying
> > > > > >> cashless does not mean denying
> the
> > > claim
> > > > > altogether.
> > > > > >> >>In this respect, we
> would
> > > request you
> > > > to
> > > > > submit all
> > > > > >> the original bills, discharge
> > summary to
> > > > claims
> > > > > department
> > > > > >> >>for arriving final
> > decision.
> > > > > >> >>
> > > > > >> >>MG RANGAMANI
> > > > > >> >>
> > > > > >> >>GRIEVANCE DEPARTMENT
> > > > > >> >>
> > > > > >>
> > > >
> >>________________________________________
> > > > > >> >>From: grievances
> > > > > >> >>Sent: Monday,
> September 19,
> > 2011
> > > 3:19
> > > > PM
> > > > > >> >>To: claims.helpdesk
> > > > > >> >>Cc: rangamani.mg;
> harish.k
> > > > > >> >>Subject: SR Number:
> > > SRV[protected]
> > > > > >> >>
> > > > > >> >>Dear Sir,
> > > > > >> >>
> > > > > >> >>Kindly see the mail
> below.
> > > > > >> >>
> > > > > >> >>Regards,
> > > > > >> >>Vinoth.R
> > > > > >>
> > > >
> >>________________________________________
> > > > > >> >>From: Anupam Johnson
> [[protected]@yahoo.co.in]
> > > > > >> >>Sent: Monday,
> September
> > 19,
> > > 2011
> > > > 11:08 AM
> > > > > >> >>To: [protected]@gmail.com
> > > > > >> >>Cc: support;
> grievances; abigale.[protected]@yahoo.com
> > > > > >> >>Subject: Denial of
> claim
> > no
> > > 0067526
> > > > by
> > > > > Star Health
> > > > > >> insurance
> > > > > >> >>
> > > > > >> >>Dear Insurance
> Ombudsman,
> > > > > >> >>
> > > > > >> >>I write to you to
> highlight
> > the
> > > > torture
> > > > > and ill
> > > > > >> treatment meted out to me and
> my
> > family
> > > by
> > > > Star
> > > > > Health and
> > > > > >> Allied Insurance.
> > > > > >> >>
> > > > > >> >>I had bought a Senior
> > Citizen
> > > Red
> > > > Carpet
> > > > > policy
> > > > > >> from Star Health Insurance
> (Policy
> > no
> > > > > >> P/700001/01/2011/004988) which
> was
> > sold
> > > to me
> > > > by
> > > > > their
> > > > > >> tele-sales department over
> the
> > phone. I
> > > was
> > > > told
> > > > > (and the
> > > > > >> policy document states this
> as
> > well)
> > > that
> > > > all
> > > > > pre-existing
> > > > > >> illness are covered on this
> policy
> > and
> > > there
> > > > is no
> > > > > need of a
> > > > > >> pre-insurance check up
> required for
> > the
> > > > insured
> > > > > person. I
> > > > > >> had stated in my application
> in
> > good
> > > faith
> > > > that my
> > > > > mother
> > > > > >> suffered from Diabetes and BP
> for
> > the
> > > last
> > > > 15
> > > > > years and the
> > > > > >> tablets she was on for the
> same.
> > The
> > > policy
> > > > also
> > > > > mentions
> > > > > >> some exclusions for first and
> > second
> > > year ( I
> > > > have
> > > > > attached
> > > > > >> the latest brochure which I
> > procured
> > > from
> > > > > starhealth.in
> > > > > >> which is the official website
> of
> > the
> > > > insurer).
> > > > > >> >>
> > > > > >> >>On August 31 this year
> my
> > mother
> > > went
> > > > for
> > > > > a full
> > > > > >> health checkup and was
> diagnosed
> > with
> > > gall
> > > > stones
> > > > > >> (cholelithiasis) and the
> doctor
> > had
> > > suggested
> > > > to
> > > > > undertake a
> > > > > >> surgery for the removal of
> gall
> > > bladder.
> > > > Please
> > > > > refer the
> > > > > >> brochure and note that the
> gall
> > stones
> > > are
> > > > > excluded only

AVTARLDH

from Bengaluru, Karnataka

Nov 23, 2011

Start Health Insurance & Allied Policy — Denied to Give Claim

Dear Sir,
I have insured policy No. P/700001/01/2012/004383 and Clam No. 0095535. This is to Inform you that I took Family Health Floter Plan from Start Health & Allied Insurance Company Limited, In Which My Wife & My Three Doughter were Enrolled.
On Dated 17/11/2011 I admitted in CMC Ludhiana - Punjab Hospital due to Skin Problem.
During admission to Hospital, I showed my cashless Mediclaim Card & Get Approval No. 0095535. From Star Health and Allied Insurance Co. Ltd. and started the treatment. In the Next Day their TPA Representative visited the CMC Hospital.
On Dated : 21/11/2011 I was discharged from hospital in the morning. In Evening CMC Hospital told me that bill was denied to pay by Star Health Insurance Co Ltd. So, I called to their Ludhiana Branch Manager and other mentioned numbers but no satisfactory answer was come from their side.
Due to Pressure of Hospital I have Paid Hospital Bill by Myself,
You are requested to please help me Refund my money back from Star Health Insurance
I am feeling helpfull, Please Help me.
Thanks & Regards
Avtar Singh
#10400, St. No.9,
Chander Lok Colony,
Rahon Road,Ludhiana (Pb.)
Mobile Number : [protected]

ncstshaan

Feb 27, 2013

That is sad. What an awful service from Star.
What was the final outcome ? Eager to know ...

patelmehul26

from Mumbai, Maharashtra

Mar 8, 2013

I have the same problem star health has rejected saying pre existing disease which has i have mentioned and that disease is before 22 years with has no relation with current disease. I would like to know your outcome and i would also like to registered complain i need your help for this my mobile no is [protected] please contact to me with your current mobile no.

Mehul Patel
Gujarat

Ramakrishnan Krishnamurthy

from Nashik, Maharashtra

May 15, 2016

My brother is 24 years old and was diagnosed with kidney failure. When star health insurance cash less claim was claimed, it was rejected stating the following reasons

AS PER SUBMITTED DOCUMENT PATIENT HAD SR. CREATINE VALUE OF 8 AND SHRUKKEN KIDNEY WITH POOR FUNCTIONING, INDICATES LONG STANDING KIDNEY DISEASE EXACT ONSET AND ETIOLOGY CANNOT BE ASCERTAINED WITH AVAILABLE DOCUMENTS, HENCE CASH LESS DENIED.

when policy said all preexisting diseases covered and we had provided all the medical documents but insurance has denied cash less and asking for us to go for reimbursement.

sai Krishna1

from Shegaon, Maharashtra

Jun 6, 2016

My sister had epilepsy before taking insurance from star health and alliance insurance which is called pre-existing disease.my sister had a pre-existing disease and period of 4years will be completed on October 2016.will my sister get insurance after October if i undergo surgery in Kims hospital

sai Krishna1

from Shegaon, Maharashtra

Jun 16, 2016

Insurance regarding pre-existing disease

I had a pre-existing disease and period of 4years will be completed on October 2016.will i get insurance after October if i undergo surgery in Kims hospital

Ch Shivam

Sep 8, 2016

Star health insurance the name is related to star but friends don't believe this company I am fealing bad ... . don't go for this company

Abhsihek Singh

Jun 28, 2019

Worst Company, Please avoid Star Health at any cost please spend few bucks and get a genuine policy, I will say HDFC and Apollo Munich are honest company and they will not bother you to settle the claim. Star health is NO 1 Fraud company on this planet earth.