What to do if company rejects the claim?
A few months ago, I was admitted to ASTER MIMS Kottakkal due to frequent vomiting, which turned out to be caused by a UTI (Urinary Tract Infection). The doctor recommended admission, and we stayed for 2 or 3 days. However, the insurance company declined our cashless claim request. We contacted our agent, and he advised that we could file a claim later by showing all the expenses. This request was also rejected, stating that UTI doesn’t require admission for treatment. As a result, we had to bear the charges despite having active health insurance. A representative from the insurance company came for inspection but did not provide any clarification. My health condition at the time was indeed serious enough to warrant admission, as per the doctor’s advice. Can Star Health reject the claim by stating it's only an outpatient case? Is it possible to get the claim amount by filing a case?
Dear Client, yes, the insurer can reject the claims if they believe hospitalization was not medically necessary. However, you can challenge it by submitting the doctor’s records proving need for the admission and file a written complaint with the insurer. If it's still not resolved, then approach the Insurance Ombudsman or consumer court. I hope this answers your query, for further queries contact us.
If Star Health rejects your claim stating that UTI does not require admission, you can appeal their decision through the Insurance Ombudsman or file a complaint with the Consumer Court for unfair rejection. If your doctor’s recommendation for admission is valid, you can argue that it was medically necessary and seek compensation. For further legal assistance contact us on our helpline number.
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