Ref: Claim under policy number: HJ00004857000104 Claim number : HR00076385
I am a physician myself and have helped numerous patients get their medical claims reimbursed. But my personal experience with Royal Sundaram Health Insurance was shocking, to put it mildly. My wife was admitted in a reputed medical college (not in a fancy corporate hospital) with severe backpain and spasm and required IM injections and physiotherapy. When I forwarded the claim to the company (for around 10, 000/- rupees), they turned it down, saying for this kind of stuff take outpatient treatment. I asked for a review of the case. But the decision remained the same. This is after 5 years of continuous claim free policy renewal for the whole family. Nowhere in the policy document it is mentioned that the insurance company and not the doctor will decide which patient should be admitted.
Not only that, they have asked me to pay a premium of 16, 000/- instead of the 9, 000/- that I usually pay for the whole family.
The moral of the story is:
Royal Sundaram will not reimburse for most regular claims in spite of hospitalization in good hospitals (they may pay you for some major surgeries)
You will not have the time to go to consumer court as most of the medical claims are for smaller amounts and the litigation process is long drawn in India
Dont fall for the initial low premium as the company may hike this up by almost 60% suddenly
Stick to good old public sector insurers or companies having in house claim settlement process rather than those using TPAs
If you have a existing policy with this company would suggest looking for better options once the health insurance portability is fully operational
Please contact me for any clarifications,
Dr Mathew.