Why you should avoid Star Health Insurance. Review on STAR Health Insurance

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 9011057655

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