- My claim not settule by star health ^Open

Ranjanben s Hirpara filed this complaint against Star Health Allied Insurance Company on Jan 10, 2023

Resolution Demanded:
Apology

This is all details of my claim
I’m Ranjan hirpara I have medical insurance from **/**/**** in Star Health whose policy number is P/******/**/****/******. I had general pain in right leg since **-** days in the month of September so I went to see Dr. Piyush Sorthia sir on **/**/****.
Doctor Piyush Sorthia sir gave me medicine for ** days and told me that if there is no improvement with this medicine then get MRI report. He wrote a prescription for an MRI.
Despite taking the medicine given by sir, there was no significant difference in my pain so I got the MRI report done on **/**/****. It is the first MRI report of my life. I have never shown any orthopedic doctor before that I have never had any foot pain.
In the MRI report I found AVN disease after which I referred Dr. Rajesh Jani sir who is a specialist in this disease. He referred me for core decompressive surgery.
To know more about this surgery I consulted Dr. Ram Mohan Sir in TALK TO STAR facility of Star Health **/**/****. I was also told by Dr. Ram sir to undergo this surgery as per Dr. Jani sir.
I decided to get this surgery done by Doctor Jani Sir at Shiv Orthopedic Hospital. But there was no cashless facility here.
Before undergoing this surgery I called the helpline number of the company on **/**/**** at **:** and asked whether the cost of this surgery is eligible for reimbursement or not. I was informed by the company officer that the expenses for this surgery are eligible. Its recording is available with me. Thereafter I underwent this surgery on **/**/**** and lodged a claim with the company vide claim number CIR/ ****/******/*******.
I handed over the necessary proofs for this claim and the file given by Doctor Sahib to the company on **/**/**** through soft copy. Thereafter I produced the proofs required by the company from time to time. But the company wrongly kept extending my claim by repeatedly asking for the same evidence.
My claim was rejected by the company on **/**/**** as my illness was pre-existing.
I would like to ask the company on what evidence the company considers my illness as a pre-existing illness. For which I have repeatedly represented to the company but no proof has been given to me by the company. This means that the company has no proof.
Thus the company cannot reject my claim without any proof and if the company has any proof that my illness is pre-existing then it must be presented to me.
As per IRDA rules, a company cannot treat a claim as a pre-existing disease based on speculation. Also, for long-term illness, the policy provided by the company has a waiting period of * year. According to the company’s medical team, our disease is not curable.
I vouch for this disease ***% that I do not have this disease pre-existing and I have never had any kind of leg pain before the above mentioned date.
And yes the insurance company said that now you have to go to the claim department if you are looking for justice and they will check it. So we presented in Grievance department on **/**/**, they also kept saying that your insurance has been passed, now our medical team will get the money in *-* days. When called, same answer. On */*/** i.e. after ** days the billing department came to know that this is called plasma therapy so now you will not get insurance...
This disease comes under “ICD code **M**”. ***** claims have been paid by different companies in India since **/**/**** for this disease.
It is my right to get the amount of this claim and it is the duty of the company to give, so please kindly request the company to stop giving me (the patient) mental stress and pay this claim as appropriate.
this is the fact of star health take insurance.
if you want more information my mobile no is ***********.

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