STAR Health Insurance

Intimation No.:CLI/2014/131214/0238828.

The claim relating to the reimbursement of hospitalization expenses for treatment of epiretinal membrane with macular edema - left eye- Diabetes Safe Insurance policy- Star Health and Allied Insurance Co. Ltd.

The insured person is a long time patient of diabetic. The insured person has been covered by medical insurance of Star Health and Allied Insurance, under the Diabetes Safe Insurance policy.

The insured person has undergone surgery, an Epiretinal membrane with macular edema-left eye, at L V Prasad Eye Institute, Vijayawada, for the purpose of regulating the vision as suggested by  the consultant surgeon who is a specialist in retinopathy.

The retinopathy surgery was done to improve the vision, which was badly affected as a result of long time diabetic. The surgery, an Epiretinal membrane with macular edema-left eye, conducted on the insured person is covered under diabetic retinopathy.

This was confirmed by the consultant surgeon and accordingly mentioned the same in the Medical certificate.

It is clearly stated and covered by the Policy Definitions “ Diagnosis Retinopathy means progressive damage to the retina of the eye caused by Diabetes Mellitus Type II.

This includes Macular edema, Non-Proliferative Diabetic Retinopathy and Proliferative Diabetic Retinopathy, requiring restoration through laser procedure”.

Non-Proliferative Diabetic Retinopathy [NPDR] can cause changes in the eye, including,  Macular edema.  Macular edema is the most common cause of vision loss in diabetes.

Trans pars plana vitrectomy [TPPV] is used to treat many retinal disorders such as Non-Proliferative Diabetic Retinopathy[NPDR], Epiretinal membrane with macular edema.

Therefore, this surgery undergone by the insured person covered under Non-Proliferative Diabetic Retinopathy.

Finally star health insurance company rejected without mention the conditions on what basis the claim was rejected.

Never opt for star health insurance.