I am writing to raise a grievance against Star Health and Allied Insurance Company Ltd. for rejecting my genuine health insurance claim despite fulfilling all required conditions.
My wife had to be hospitalized under the supervision of a senior and experienced medical doctor, who clearly advised inpatient care due to the nature of her health condition. I submitted:
The treating doctor’s letter recommending hospitalization
Hospital admission and discharge summary
All bills and treatment details
Diagnostic reports and prescriptions
However, Star Health rejected the claim citing that “the treatment could have been done on an outpatient basis.” This decision was taken in contradiction to the attending doctor’s recommendation and without any medical evaluation by the insurance team.
Even after escalating the matter to the Grievance Redressal Cell of Star Health, the claim was again rejected without giving due consideration to the medical necessity and evidence provided.
This not only undermines the expertise of medical professionals but also puts unnecessary mental, emotional, and financial stress on patients and families who act in good faith based on a doctor’s advice.
Request for Intervention:
I kindly request the respected authority to:
Direct Star Health Insurance to review and approve the claim based on the medical justification already submitted
Issue a warning to prevent such non-transparent and arbitrary practices
Ensure that insurers do not overrule certified medical advice purely for cost avoidance
I trust that the forum will take appropriate action to safeguard consumer rights and promote ethical insurance practices.
Thank you for your time and consideration.
Nitin
Jabalpur 482001, Madhya Pradesh
Email: nxxxxxxxxxr@gmail.com
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