In July 2024, I took a health insurance policy from Care Health Insurance. The policy was taken from Policy Bazaar.
On 29th of December 2024, we went out to watch a movie with family. As we waited in the lobby of the theatre, my mother started sweating profusely and complained that she is feeling unwell. She asked to leave but she needed help to stand as she felt very dizzy. Please note that it was Sunday late evening, so we had no option for an OPD. With assistance we transported my mother to the emergency of the nearest hospital, i.e. Manipal Hospital(Salt Lake Branch).
The doctors examined and recommended admitting my mother. I am no medical expert and hence I followed the recommendation of the Doctor. She was discharged after two days(31-12-2024).
The hospital supplied the documents necessary for the cashless claim. In the first instance, the claim was denied stating similar exclusion Code 04(Admission primarily for investigation and evaluation). Even though the admission records noted the admission for Medical Management and NOT for Investigation. Further justification for hospitalisation was also provided by the doctor. With this the claim process moved forward only to be impeded with endless query. While we did not want to stay any longer in the hospital than strictly necessary, this felt frustrating to wait and keep responding to the never ending queries from the insurer. We cleared the bill ourselves and filed for a claim under reimbursement. On the claim reimbursement portal of Care Health Insurance, we uploaded all relevant documents to satisfy the query.
As of today, the claim stands denied stating the first reason, exclusion Code 04(Admission primarily for investigation and evaluation). It feels to me like we are going in circles, finding reasons to deny the claim anyhow.
We reached out to Policybazaar for assistance and guess what? Horrible experience. 99% of the time the Relationship Manager was not available to help. Never ever take online policies from Policybazaar.
As common man, I believe hospitals are ready with beds to admit people and charge whopping amount and insurance companies like Care Health Insurance and intermediaries like Policybazaar is present to deny your claims and say sorry.