Anil Sharma filed complaint against STAR Health Allied Insurance Company on Oct 3, 2022
I would like to bring to your kind notice the fraudulent practices followed by STAR Health and Allied Insurance Company Ltd. The following part narrates my complaint against STAR Health:
In fact, my son Aradhya Sharma was admitted in the emergency conditions at Fortis Hospital at Mohali, Punjab on September **, **** due to the serious illness. In fact, he fell sick on September ** afternoon and initially, we tried to cure him at home and consulted local doctors but his fever was not getting under control. In the evening of September **, ****, his fever reached up to **** F and he started getting unconscious. In that situation, we rushed to the nearby Fortis hospital at Mohali, Punjab and took him to the emergency ward of the hospital. Doctors there examined him and decided to admit as his fever was too high. Further, he hadn’t taken any meals orally for the past about ** days and it was becoming difficult for him to ¬eat anything. As a result of emergency situation, doctors at Fortis Hospital admitted him and kept in the hospital for ** days (September **-**, ****) and discharged in the morning of September**, ****.
Since I have purchased a STAR GROUP HEALTH INSURANCE POLICY - GOLD [FOR PUNJAB NATIONAL BANK CUSTOMERS] thus, gave the reference of this policy to the hospital as Fortis is a network hospital and on the panel of Star Health for cashless settlements of hospital bills. After completion of treatment of my son, hospital submitted the bills for cashless settlement to the STAR Health but the company (STAR Health) rejected the claim on the flimsy grounds. On the verification and testimonials of the treating doctor, the hospital re-submitted the bills to the insurance company but Star Health again rejected the claim for the second time as well. Finally, I had to pay a sum of Rs **,*** from my pocket and got the patient discharged from the hospital.
On the rejection of cashless claim by Star Health, I was surprised to experience the behavior of this Insurance company. The rejection of a genuine claim by the STAR Health has put me in the state of deep mental shock and I felt betrayed and deceived by STAR. It is a clear case of breach of contract on the part of insurance company.
After the rejection of cashless settlement by the Star Health to Fortis hospital, I have submitted the original bills to Star Health for reimbursement on September **, ****, but I am not sure whether the insurance company would honor its legal obligation and reimburse me the hospital expenses of Rs ***** that I have paid to the Fortis hospital.
The particulars of the claim are as follows:
Name of the Patient: Aradhya Sharma, S/o of Anil Kumar Sharma, Age ** Years
Star Health Insurance Policy No.: P/ I *****/*l/****/******
Customer ld No.: *****************
Date of Birth: l*/l*/****
Sex: Male
Claim No.: *******.
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