Insurance not claimed

[Priya_G]

Hello everyone,

Here I am Posting regarding my parents health insurance, they are paying premiums every year since long but they never claimed anything. There is a huge gap, they seem not to understand their own insurance.

Recently my dad had some heart related issues so we rushed to hospital, he was admitted there for 3 days and is back now.. recovering.

So initially we submitted for cashless claim by company start health alliance insurance and we got rejection mail on 2nd day with reason that in 2012 there was a valve replacement happened which was not informed to insurance company that is why they are rejecting the claim.

In 2012 it really happened. Valve was replaced and that time as well it was rejected, as max health insurance company said. We don't reimburse for heart related issues for someone who is younger then age 45.

I am not even sure if there is a miss on our part.

Anyone who can help out here?


Also my dad is govt employee still not having any medical insurance from his office end. That's what he says. But I am not believing it.. I am only guessing that it must be there and he is unaware. Well I can't fight with him. I just can't believe him as isn't it compulsory.

I feel frustrated thinking of all this.
We had to pay everytime.
We paid for premiums everytime
Although my dad is fine so that's the relief. But I can't see the same thing again n again

What can we do ?.

 

[zacobite]

Hello everyone,

Here I am Posting regarding my parents health insurance, they are paying premiums every year since long but they never claimed anything. There is a huge gap, they seem not to understand their own insurance.

Recently my dad had some heart related issues so we rushed to hospital, he was admitted there for 3 days and is back now.. recovering.

So initially we submitted for cashless claim by company start health alliance insurance and we got rejection mail on 2nd day with reason that in 2012 there was a valve replacement happened which was not informed to insurance company that is why they are rejecting the claim.

In 2012 it really happened. Valve was replaced and that time as well it was rejected, as max health insurance company said. We don't reimburse for heart related issues for someone who is younger then age 45.

I am not even sure if there is a miss on our part.

Anyone who can help out here?


Also my dad is govt employee still not having any medical insurance from his office end. That's what he says. But I am not believing it.. I am only guessing that it must be there and he is unaware. Well I can't fight with him. I just can't believe him as isn't it compulsory.

I feel frustrated thinking of all this.
We had to pay everytime.
We paid for premiums everytime
Although my dad is fine so that's the relief. But I can't see the same thing again n again

What can we do ?.

declare all past conditions clearly at time of taking policy.. They can reject on Pre existing if not declared... Did he have a medical chk up when u bought star health policy.. did u declare his heart condition.. fight with star as it is more than 6 yrs so some hope is there PLUS even if it was there the PED clause is fulfilled as it has been long.. when did u buy star

 

[Priya_G]

It was bought by my dad in year 2022. Under some group policy by bank boi.
It was not intentional from our end to hide. But the policy agent did some cleverness here I am assuming .. as now when we are trying to reach him. He is avoiding conversation or not picking or when picked told same thing.

You mentioned fight with star. Well how do I do that. I have no contact details of company and toll free number seems useless