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My star heallth insurance rejected

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20 May, 2021 by  rahul

Hi.

My mother got covid infected on 12.05.21. Her ct score is CORAD 5 and 5/20.

After consultation of doctor I got admitted in the hospital. Luckily I got bed in this pandemic scenario.

Her age is 58 years. Company decline my hospitalization charge saying that the lings got only 20 percent infected. And home isolation required not a hospitalization.

Please guide me what i will do.

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The rejection appears to be unreasonable. Whether a patient requires hospitalisation or not is a treating doctor’s call based on the presentation of clinical conditions of the patient. Insurance company cannot take a subjective call that hospital stay was not required, particularly considering your mother’s age and lung involvement.


You can represent the matter to the Chief Grievance Officer of the insurance company. If you do not get a response within 30 days or if you do not get a satisfactory response to your representation, you can approach Ombudsman. There is a high possibility that insurance company would be asked to pay the claim.

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20 May, 2021

Hey Rahul,

This needs closer look.

If you feel appropriate, send the claim rejection letter from star health as well as the discharge summary to my email anuj@sureclaim.in

I will evaluate the claim and suggest what options you have.

CT score does not indicate what care was advised for your mother. Let me look at it.

Anuj


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