r/InsuranceTroubleIndia

Hi everyone, I’m **M30 from Chennai**, working in corporate, and I need some genuine advice regarding **health insurance for my mother**.

About **11 months ago**, I purchased a **₹10 lakh policy from Star Health** for my mother (**56F**). Thankfully, she has been healthy so far. Recently, during a check-up, we found that she has an **endometrium thickness of 12 mm**. Since this condition likely existed before taking the policy, I understand it may be treated as a **pre-existing condition** and may not be claimable right now.

As a backup, I recently added my mother to my corporate insurance policy as well, mainly because claims there seem much smoother and cashless approvals are easier. I specifically enrolled her for this endometrium-related surgery, since it may not be claimable under my Star Health policy due to it being considered a pre-existing condition.

Now the confusing part:

While enquiring at the hospital, they told me that they generally don’t prefer **Star Health** because claim approvals are **not very reliable nowadays**. One staff member even said that for a surgery costing around **₹2 lakh**, sometimes only **₹80k gets approved** under Star Health. They also mentioned that some doctors hesitate to proceed when the insurance is Star Health due to approval issues.

They suggested insurers like **Aditya Birla** and **HDFC ERGO** instead (upon my request).

Later, I spoke with my insurance agent (who is experienced and has been handling policies for years). He said:

* I can **port the policy next year** while retaining continuity/seniority benefits.

* These kinds of **partial approvals can happen with any insurer** depending on hospital limits, package rates, and policy terms.

* The hospital I checked with is a **smaller hospital**, so I should also verify with **bigger reputed hospitals** before concluding that Star Health is bad overall.

## **Important Point**

**The hospital where I enquired is actually a smaller hospital where my consulting doctor practices.**

So now I’m confused.

People who have actually done claims for parents:

* Is this kind of issue **common across all insurance companies**?

* Is **Star Health** really problematic nowadays?

* Are **HDFC ERGO / Aditya Birla** genuinely better for claim settlement?

* Should I continue Star Health and rely on reputed hospitals instead?

* Which insurer has given you the **smoothest experience for parents/senior citizens**?

I genuinely don’t mind paying a **higher premium** if it means **fewer hassles during emergencies** in the future. My mother is healthy now, and I want to make the **right long-term decision** before any major health issue comes up.

Would really appreciate honest experiences and suggestions.

Thanks in advance.

Hi all. On 28th march i was hospitalized for 4 days due to severe gastritis. I’ve dealt with this since childhood, the pain was unbearable. I tried standard meds and even went to the OPD for injections, but nothing worked. Only when those failed did the doctors advise I be admitted for proper treatment.

Star Health rejected my claim (Rs.15,500), arguing that I was "stable" and didn't actually need to be hospitalized. They didn't even give me a reason until I followed up via email, and now they’ve been ignoring my responses for five days. I’m planning to file a complaint with the Insurance Ombudsman. Am I missing any crucial steps, and is it possible to claim interest on the refund amount due to the delay? Any advice would be crucial.

I have office life insurance but would like to take term life insurance of 2 crores.

I am fit with no ailments but was a light smoker(5-6 per day) till 2 years back.

I understand that they ask only if you have smoked in the last 12 months so I will tick the box as "No" for smoking.

Planning to go with HDFC, what are do's and don'ts that I should take care of before taking the life insurance?

Example - not to share bank statements for income proofs.

Add ons?

Hi everyone, I am seeking urgent advice regarding a severe health insurance nightmare my family is currently facing with Aditya Birla Health Insurance. I want to discuss my current strategy to get cashless approval reconsidered and clear their Fraud Investigation (FWA)

The Context:

Patient: My father (61Y, Senior Citizen).

Insurer: Aditya Birla Health Insurance (Activ One MAX+ plan). We ported to them from Niva Bupa in June 2025.

Policy Continuity: Maintained continuously since June 9, 2019 (82 months of unbroken coverage).

Diagnosis: Stage 5 CKD (End-stage renal failure)

The Systematic Harassment & "Bait-and-Switch" Tactics:

Aditya Birla is currently harassing us across two separate life-saving admissions using the exact same arbitrary excuse.

Incident 1: The First Admission (March 2026)

My father was admitted to Yashoda Super Speciality Hospital on March 29, 2026.

We applied for cashless. They denied it on March 30, stating: "Chronicity of Chronic kidney disease cannot be ascertained hence cashless claim denied".

We self-funded, filed for reimbursement, and this claim has been completely stalled ever since.

Incident 2: The Bait-and-Switch (May 2026)

My father was admitted again to Pushpanjali Medical Centre on May 5, 2026, to begin ongoing dialysis.

May 5 (9:25 AM): Aditya Birla officially APPROVED our initial cashless pre-authorization for clearly mentioned issue as CKD.

May 7 (6:09 PM): Two days later, in an act of extreme bad faith, they completely reversed their decision and revoked the cashless facility, giving the exact same reason: "Chronicity of Chronic kidney disease cannot be ascertained at this juncture..."

Because the hospital bills for maintenance dialysis at the end of the month, we are not yet asked for payments.

The FWA (Fraud Investigation) Trap:

Instead of processing the stalled March reimbursement, Aditya Birla sent a 3rd party Field Investigator to our home. The agent is now verbally demanding that we produce old OPD prescriptions from 2022–2023 specifically for his Diabetes and BP.

Here is the problem: We simply do not have those old physical prescriptions anymore. However, we did declare these conditions. Our Niva Bupa Policy Schedule from June 2022 explicitly lists "Diabetes mellitus/and its complications" and "Hypertensive diseases/and its complications" as declared and accepted Pre-Existing Diseases. Aditya Birla accepted this verified history when we ported in 2025.

Steps I’ve taken so far:

Verbal Pushback: On the call, I told the investigator to go ahead and submit his report with the medical documents we already shared. I did not agree to hunt for missing 4-year-old papers.

Escalation: I have emailed the CEO's desk (Mayank Bathwal) and posted on LinkedIn tagging the leadership about the mental harassment of a senior citizen and the bad-faith cancellation of an already-approved treatment.

My Planned Defense (If they formally email asking for the old papers):

The 60-Month Moratorium Rule: Since the policy is 82 months old, it falls under the IRDAI 5-year Moratorium (Clause 8.9), making the claim incontestable for non-disclosure.

The "Verified Record" Stance: I will reply stating that the 2022 Niva Bupa Policy Schedule is the definitive legal record of disclosure. We are not liable to act as a medical archive for 4-year-old papers for a risk the insurance industry has already accepted.

My Questions for the Community:

Approved then Denied: Has anyone experienced an insurer approving cashless and then reversing it days later without any new medical evidence? Is this strong grounds for a "Deficiency in Service" penalty at the Ombudsman?

The "Missing Prescription" Trap: Has anyone successfully got a reimbursement claim approved when you explicitly told the FWA team you do not have the 3-4 year old past prescriptions?

Moratorium Rule in Reality: Does the Ombudsman actually enforce the 60-month Moratorium strictly? Can Birla legally demand old papers despite the Moratorium?

Next Escalation Step: It has been over 48 hours with zero reply to my emails to their Care Head. Should I immediately log a grievance on the IRDAI Bima Bharosa portal for "Delay in Processing," or wait to see what the FWA investigator puts in his formal report?

Any guidance from folks who have dealt with Aditya Birla’s claims team or navigated a similar FWA investigation would be incredibly helpful. This is mentally exhausting for my family.

Thank you.

#HealthInsurance #AdityaBirlaHealth #InsuranceOmbudsman #IndiaInvestments #IRDAI #BimaBharosa

​

Need suggestions based on real claim experience for my mom’s health insurance. We’re confused between:

1. HDFC ERGO Optima Secure

2. ICICI Lombard Elevate

3. Care Supreme

Main priorities:

- smooth cashless claims

- fewer hidden charges

- good hospital network across India

- room rent flexibility

- claim approval experience

- premium stability during renewal

- support for pre-existing diseases in future

Would really appreciate honest personal experiences — especially regarding claim settlement, hidden clauses, premium hikes, and customer support during hospitalization.

Applied for health insurance with HDFC ERGO. Declared all PED honestly.

They rejected my application citing Gilbert syndrome and posterior pharyngeal wall congestion.

I’m confused because these aren’t really serious diseases, more like mild conditions.

They suggested I apply for Arogya Sanjeevani (₹5L cover), but I was aiming for a regular comprehensive plan.

Has anyone faced something similar? What are my options now - try other insurers or just go with Arogya Sanjeevani?

My mother went through a surgery and we claimed a cashless facility. Now we incurred certain expenses post hospitalisation and ICICI Lombard has denied a partial claim of ~25k INR. Can someone pls assist as to what I can do here. Sharing timelines and details below.

- Claimed 80K (I have 20% Co-pay so expected 64K refund). ICICI eventually paid only 42K.

- Out of disallowed expense, they deducted 21K for physiotherapy stating "pls share cost wise breakup".. I've already submitted Dr's prescription and invoice for this 21K (availing physiotherapy is covered in the policy).

- I've also raised a query with the support but they closed the query stating the same reason. They're not even stating the query and closing the ticket directly without any resolution.

Is there anything that I can do here. The support team seems to be of no help altogether.

​

Hi everyone, I am seeking urgent advice regarding a severe health insurance nightmare my family is currently facing with Aditya Birla Health Insurance. I want to discuss strategy for cashless approval and clear their Fraud Investigation (FWA).

The Context:

Patient: My father (61Y, Senior Citizen).

Insurer: Aditya Birla Health Insurance (Activ One MAX+ plan). We ported to them from Niva Bupa in June 2025.

Policy Continuity: Maintained continuously since June 9, 2019 (82 months of unbroken coverage).

Diagnosis: Stage 5 CKD (End-stage renal failure) discovered incidentally on Jan 30, 2026.

The Systematic Harassment & "Bait-and-Switch" Tactics:

Aditya Birla is currently harassing us across two separate life-saving admissions using the exact same arbitrary excuse.

Incident 1: The First Admission (March 2026)

My father was admitted to Yashoda Super Speciality Hospital on March 29, 2026.

We applied for cashless. They denied it on March 30, stating: "Chronicity of Chronic kidney disease cannot be ascertained hence cashless claim denied".

We self-funded, filed for reimbursement, and this claim has been completely stalled ever since.

Incident 2: The Bait-and-Switch (May 2026)

My father was admitted again to Pushpanjali Medical Centre on May 5, 2026, to begin ongoing dialysis.

May 5 (9:25 AM): Aditya Birla officially APPROVED our initial cashless pre-authorization .Here also CKD was clearly mentioned for which this admission was made.

May 7 (6:09 PM): Two days later, in an act of extreme bad faith, they completely reversed their decision and revoked the cashless facility, giving the exact same reason: "Chronicity of Chronic kidney disease cannot be ascertained at this juncture..."

Because the hospital bills for maintenance dialysis at the end of the month, we haven't even been able to file the reimbursement for this yet. We are now forced to arrange out-of-pocket funds for an entire month of life-sustaining sessions for a senior citizen.

The FWA (Fraud Investigation) Trap:

Instead of processing the stalled March reimbursement, Aditya Birla sent a 3rd party Field Investigator to our home. The agent is now verbally demanding that we produce old OPD prescriptions from 2022–2023 specifically for his Diabetes and BP.

Here is the problem: We simply do not have those old physical prescriptions anymore. However, we did declare these conditions. Our Niva Bupa Policy Schedule from June 2022 explicitly lists "Diabetes mellitus/and its complications" and "Hypertensive diseases/and its complications" as declared and accepted Pre-Existing Diseases. Aditya Birla accepted this verified history when we ported in 2025.

Steps I’ve taken so far:

Verbal Pushback: On the call, I told the investigator to go ahead and submit his report with the medical documents we already shared. I did not agree to hunt for missing 4-year-old papers.

Escalation: I have emailed the CEO's desk (Mayank Bathwal) and posted on LinkedIn tagging the leadership about the mental harassment of a senior citizen and the bad-faith cancellation of an already-approved treatment.

My Planned Defense (If they formally email asking for the old papers):

The 60-Month Moratorium Rule: Since the policy is 82 months old, it falls under the IRDAI 5-year Moratorium (Clause 8.9), making the claim incontestable for non-disclosure except for proven fraud.

The "Verified Record" Stance: I will reply stating that the 2022 Niva Bupa Policy Schedule is the definitive legal record of disclosure. We are not liable to act as a medical archive for 4-year-old papers for a risk the insurance industry has already accepted.

My Questions for the Community:

Approved then Denied: Has anyone experienced an insurer approving cashless and then reversing it days later without any new medical evidence? Is this strong grounds for a "Deficiency in Service" penalty at the Ombudsman?

The "Missing Prescription" Trap: Has anyone successfully got a reimbursement claim approved when you explicitly told the FWA team you do not have the 3-4 year old past prescriptions?

Moratorium Rule in Reality: Does the Ombudsman actually enforce the 60-month Moratorium strictly? Can Birla legally demand old papers despite the Moratorium?

Next Escalation Step: It has been over 48 hours with zero reply to my emails to their Care Head. Should I immediately log a grievance on the IRDAI Bima Bharosa portal for "Delay in Processing," or wait to see what the FWA investigator puts in his formal report?

Any guidance from folks who have dealt with Aditya Birla’s claims team or navigated a similar FWA investigation would be incredibly helpful. This is mentally exhausting for my family.

Thank you.

#HealthInsurance #AdityaBirlaHealth #InsuranceOmbudsman #IndiaInvestments #IRDAI #BimaBharosa

I’m planning to take a personal health insurance policy and I’m confused about the best way to buy it.

Should I:

\- buy through Policybazaar,

\- buy directly from the insurance company website, or

\- buy through a personal insurance adviser/agent?

Which option is better in terms of:

\- claim support,

\- transparency,

\- premium,

\- customer service, and

\- avoiding future issues?

Would like to hear real experiences and suggestions from people who already purchased health insurance in India.

I started my porting request with HDFC ERGO almost 4 weeks before my renewal date, but the entire experience has been painful and quite unprofessional. There has been no consistency in the information provided by different sales representatives, and communication has been very confusing.

I have been continuously insured with Care Health Insurance (previously Religare) for the last 7 years without any claims. When I originally purchased the policy, the sales agent verbally assured me that maternity expenses would be covered after 2–3 years. However, when we finally applied for a maternity claim after 7 years, it was rejected saying maternity was not covered under the policy.

That experience seriously affected my trust in Care Health Insurance. If they reject a maternity claim after such a long waiting period, it naturally makes me wonder how reliable they would be for larger medical claims in the future.

Because of that, I researched alternatives and found many people recommending HDFC ERGO. But honestly, my experience with their sales process has also been frustrating. Even after starting the porting process well in advance, they kept delaying things until the last moment before my renewal deadline, leaving me with very little time to properly evaluate my options or make a calm decision.

At this point, I genuinely want suggestions from people who have dealt with either insurer. Is it worth continuing with Care despite this experience, or is porting to HDFC ERGO still the better option despite the poor onboarding experience?

Need advice regarding Star Health Super Star policy claim rejection.

My father was hospitalized from Jan 20 to Jan 23. Our policy has 180 days post-hospitalisation coverage (up to around July 23).

We submitted around ₹54k worth of post-hospitalisation expenses including:

CT scan

Blood tests

Medicines

Follow-up consultations

Star Health approved only around ₹10.5k and rejected many items saying “exceeded dates”.

But all major expenses were actually within the 180-day period.

Some details:

Only ₹453 worth of medicines were mistakenly billed in my name (understandable rejection)

Psychotherapy OPD ₹800 was rejected

One ₹6500 diagnostic bill was rejected because it was submitted as a Xerox/WhatsApp tax invoice copy, but now I have obtained the original bill

Most other medicines/tests were in the patient’s name and within the policy period

I emailed them explaining the 180-day coverage, but they sent a generic reply saying:

“maximum eligible amount already settled” and “non-payable/non-medical expenses deducted.”

They did not specifically explain why “exceeded dates” was applied despite the 180-day cover.

I also spoke with the agent, and he said they would reconsider the claim within 1 week (1 day remaining now).

One more concern:

My policy is ending/renewal is due this month, but I still have around 2 months remaining under the 180-day post-hospitalisation period. Can they reject future valid post-hospitalisation claims because the policy expires before the 180 days end?

Has anyone faced something similar with Star Health?

Especially regarding:

Wrong “exceeded dates” rejection

Post-hospitalisation claim disputes

Claims after policy expiry but within post-hospitalisation period

Should I be ready to escalate to grievance/IRDAI/Insurance Ombudsman if they don’t properly respond?

Any advice would help.

Edit: used Ai

I have a health policy from HDFC Ergo since 2015 and had no PED at that time.5 months ago I started taking medication for BP.How do i declare this now after I have already renewed the policy for current year? Will any claims from now be rejected due to non declaration?

Hi,

Recently i’ve been looking at getting an HDFC insurance policy for my family, particularly the “ Hdfc Ergo Optima Secure + “ as a family floater policy with a sum insured of 50L

I’ve Previously had a family floater policy from my local bank, had 6 years with them and absolutely 0 claims..

I was told that i can’t port my policy since it’s a bank issued policy, but the insurance agent told me that they can get the waiting period waived off on the basis of 6 years and no claims. I spoke to hdfc ergo care directly and they told me it’s highly unlikely that they would be able to get the waiting period to get waived off

Not to mention but the quotations from the insurance agents are 7–10K INR higher than the website..

Where do you guys buy insurance policies from that are actually trustworthy and not scammy..

Hi all,

I have Star health comprehensive policy for my parents. My mother (62F) was hospitalised due to flare of auto immune disease she is having and we have availed cashless option. But star health processed 90k from 1.14l claim (approx 21%). Should I mail them for a challenge and clarification on why they deducted so much amount. They have deducted under following heads : -

1. 4.3k under Consumables

2. 5.9k under RMO General Physician fee + Dietician charge

3. 8.675k under Care hygiene and infection control charge + diet charge + medical history assessment

4. 5.140k under Vitamin B12, Folate serum, blood sugar, CRP test

Total 24.027k

I feel this is very unfair of them. I have been paying premiums since last 6 years. Kindly guide me on how to contest these charges and which heads have maximum probability of reimbursement by them.

Need some help understanding whether these corporate health insurance premiums for parents are actually justified as per market standards.

In my company, parental insurance is not included by default , employees have to voluntarily opt in and pay the premium themselves.

The premium trend over the last 3 years has been ( Provider - Care Health) :
- Year 1: ~₹28K
- Year 2: ~₹46K
- Year 3: ~₹92K

This is for:
- 2 parents covered
- Family floater policy
- Sum insured: ₹5 Lakhs total
- Effective premium per member: ~₹3,833/month

What is concerning is that despite such a steep increase:
- There is no increase in coverage amount
- No OPD or additional benefits added
- No major enhancement in the policy features

I completely understand medical inflation, claim ratios, and age-related risk factors. But a jump from ₹28K to ₹92K in just 3 years for the same ₹5L coverage feels extremely high, and I’m trying to understand whether this is genuinely the market reality or something specific to certain insurers/corporate setups.

Would really appreciate if people could share:
- Your corporate premium for parents
- Coverage amount
- Insurer name (optional)
- Whether premiums are company subsidized or fully employee paid
- Approximate YoY increase you’ve observed

I also wanted to understand one more thing:
- If an employee made a claim in the previous year, can the company/insurer mandate renewal for the next year without giving an opt-out option?
- And for employees who made no claims at all, is it normal to still bear such a massive increase uniformly?

Trying to understand how common this is across companies before escalating this internally.

Hi everyone,

Here’s my situation:

Hospitalisation date: 25 March

During hospital stay, my sum insured got exhausted

Policy renewal date: 29 March

I submitted post-hospitalisation bills in April (medicines, follow-ups, tests etc.)

Insurer has now rejected the claim, saying the hospitalisation belongs to the previous policy period

I’m confused because the expenses happened after renewal, when a fresh sum insured had started.

Is this rejection correct as per policy rules?

Hi everyone,

I’m seeking some guidance regarding the portability of a health insurance policy.

Back in 2017, I purchased a health insurance policy for my parents ( M - 62, F - 56 ) from Oriental Bank with a sum insured of ₹5 lakh. Recently, I wanted to port this policy to another insurer and increase the sum insured to ₹10 lakh.

I approached Care Health Insurance and received a reasonable premium quote, so I proceeded with the purchase. However, the policy was later rejected by their underwriting team on the grounds that it is a group policy and therefore not eligible for portability. I’ve since requested a refund and am currently still waiting for it.

In the meantime, I contacted another agent from Care Health who is now claiming that porting is possible and is asking me to pay the premium again. I have not proceeded, as I am still awaiting my initial refund.

I also reached out to Niva Bupa, and they have indicated that they can port the policy. On the other hand, some agents have clearly stated that such policies cannot be ported at all and that I would need to purchase a fresh policy.

This conflicting information has left me quite confused.

Could anyone here clarify:

Is it actually possible to port a group health insurance policy to an individual policy with another insurer?

Are there any common issues faced during claim settlements after porting?

Has anyone had a similar experience?

Any insights or advice would be greatly appreciated.

Thank you!

I took a 3cr term policy from tata aia from policy bazaar and had my medical done. After the medical Tata AiA came back with a counter offer because of hypertension and lipid levels. When i asked them to share the medical reports they said it will be shared only after the policy issuance and they can only arrange a call from a doctor before the issuance.

How should I proceed since both policy bazaar and tata aia have declined to share the medical reports?