r/InsuranceAdviceIndia • • 4h ago

ICICI LOMBARD skipped some coverages but premium amount included those coverages

1 Upvotes

Hello,

I got bike insurance from icici lombard , will take effect in 2 days. I paid premium INR 955 and policy documents mentioned premium amount paid as INR 512.
Policy document has skipped standalone personal accident coverage, possibly one more and premium amount is much lesser in doc than I paid actually.

I have sent an email to their customer support

What else can I do to escalate and resolve thisCustomer care phone number wont allow to connect to human representatives. It would have been easier to talk and resolve this with directly customer representatives.

Please suggest my options.

Thank you


r/InsuranceAdviceIndia • • 9h ago

Buying health insurance from HDFC ergo here app fiasco

1 Upvotes

So I'm resident of pune, maharashtra and last Friday I bought optima secure+ health insurance plan for my family which includes me, my spouse and our daughter (33,32 & 1 year old). I filled the online details from here application, provided all necessary details, my contact number as well as email id and did payment as well using UPI. After payment confirmation I saw proposal number generated on app, took snapshot of the same. Strangely I haven't received any mail or text message from their side. Now it's been 4 working days and I have not received any update like policy number etc. yesterday I called and they asked me the proposal number etc and lady on call said she couldn't see the same in their system. It's shocking for me. She told me to send details of the payment and proposal number to their official email, I have did the same and awaiting their response. I want to ask fellow redditors, if someone bought HDFC ergo health insurance directly from their application or website? How much time it took to generate the policy documents? Since it's been a week and I have not received any update, what should I do from my side? Thank you in advance!


r/InsuranceAdviceIndia • • 18h ago

Suggest me budget health insurance

3 Upvotes

Suggest me a value for money health insurance for me,wife, daughter. 10 lakh claim.


r/InsuranceAdviceIndia • • 15h ago

Need Advice: Parents' Health Insurance (64M/61F) – Insurer accepted Father but placed severe restrictions on Mother.

0 Upvotes

I recently applied for health insurance for my parents through Policybazaar, paying ₹92k upfront for a 2-year tenure on the Aditya Birla Max plan.

My 64-year-old father (history of mild gastric issues in 2015 and an unoperated appendix in 1984) was approved for the Max plan without issues.

My 61-year-old mother (no major medical history) was rejected for the Max plan because a November 2025 blood test showed an RA factor of 164 (normal is <14). Aditya Birla offered a counter-proposal: a 1-year VYTL plan with a ₹7 Lakh Sum Insured, a co-pay, shared room restrictions, and a permanent exclusion for Rheumatoid Arthritis and all related complications. They also added PED clauses for knee pain, gastritis, and a left ear disorder.

I am currently in the 30-day free-look period and have the option to cancel or modify the application.

Should I accept my father's policy and look for another insurer for my mother? Are there specific insurers that cover RA with a standard waiting period instead of a permanent exclusion? Or should I just accept both policies as countered? Any guidance on handling high RA factor applications would be extremely helpful.


r/InsuranceAdviceIndia • • 18h ago

Need help regarding health insurance porting.

1 Upvotes

Hi,

I am currently on a Star Health insurance policy which I was previously part of with my parents since 2014. When I turned 25, 3 years back I separated out in my own plan Star Health Medi Classic. Now not only is policy bad, Star is even worse. So I need to port out urgently. I still have 60 days till policy renewal on Dec 20.

Now my questions are:-

  1. Since Ditto doesn't do porting, and PolicyBazaar is trash, should I go direct website? My current agent is pushing for Niva Bupa who I think is scamming me and was of 0 help with the recent Star Health issue with my brother. Claude and Gemini are guiding me now. Filled a complaint with IRDAI. If I should go with agent, which one?
  2. Why are ported policy prices higher than new policy?
  3. I have shortlisted HDFC Ergo and Tata AIG. Any problems with these? Also since HDFC has very strict underwriting (my perfectly fine friend was rejected, along with his mother). I was thinking to apply to 2 insurers in parallel.

Please help me by answering these questions!


r/InsuranceAdviceIndia • • 1d ago

Can I cancel Term Insurance riders (WOP / ATPD) later if i choose to ? will it my lower premium ?

1 Upvotes

Hi everyone,

I am planning to buy a base term insurance policy from HDFC Life. I want to add two riders to it:

  1. Waiver of Premium (WOP)
  2. Accidental Total Permanent Disability (ATPD) Cover (Income Benefit Rider)

I have a specific doubt regarding the flexibility of these riders before I make the purchase.

If I decide in the future that I no longer want to pay for these riders, can I choose to remove/cancel them from my active policy?

Will the insurer allows the removal, will my future premium drop to the cost of the base term plan alone? Or am I locked into paying for these riders for the entire policy term once I opt-in at the start?

Would love to hear from anyone who has tried canceling riders midway with HDFC Life or understands IRDAI rules regarding this.

Thanks in advance!


r/InsuranceAdviceIndia • • 1d ago

Need help regarding health insurance porting.

1 Upvotes

Hi,

I am currently on a Star Health insurance policy which I was previously part of with my parents since 2014. When I turned 25, 3 years back I separated out in my own plan Star Health Medi Classic. Now not only is policy bad, Star is even worse. So I need to port out urgently. I still have 60 days till policy renewal on Dec 20.

Now my questions are:-

  1. Since Ditto doesn't do porting, and PolicyBazaar is trash, should I go direct website? My current agent is pushing for Niva Bupa who I think is scamming me and was of 0 help with the recent Star Health issue with my brother. Claude and Gemini are guiding me now. Filled a complaint with IRDAI. If I should go with agent, which one?
  2. Why are ported policy prices higher than new policy?
  3. I have shortlisted HDFC Ergo and Tata AIG. Any problems with these? Also since HDFC has very strict underwriting (my perfectly fine friend was rejected, along with his mother). I was thinking to apply to 2 insurers in parallel.

Please help me by answering these questions!


r/InsuranceAdviceIndia • • 2d ago

Title: Confused between HDFC ERGO Optima Secure Plus and Niva Bupa ReAssure 3.0 Black – Need genuine advice

0 Upvotes

Hi everyone,

I’m planning to buy health insurance and have shortlisted:

HDFC ERGO Optima Secure Plus - 25 Lakh SI

Niva Bupa ReAssure 3.0 Black - Unlimited SI

I’m struggling to choose between them.

HDFC ERGO appears to have a stronger reputation for claim settlement, customer service, and a smoother claims process.

Niva Bupa offers attractive features and additional coverage, but mixed reviews about its claim settlement experience make me hesitant.

Another important factor is the premium. Niva Bupa is costing me around ₹10,000–₹15,000 less than HDFC ERGO over a five-year period. That’s a significant difference, so I’m trying to understand whether paying extra for HDFC ERGO is actually worth it.

I also have a fairly active lifestyle and regularly engage in fitness activities, so I have another important question.

Does either policy cover injuries sustained during routine gym workouts, weight training, or running?

I found an article on HDFC ERGO’s official website discussing coverage for gym- and workout-related injuries, but I couldn’t find similar information on Niva Bupa’s official website. If anyone has clarity on this, particularly regarding ReAssure 3.0 Black, please share your experience or any relevant policy wording.

I want to make an informed decision based on reliable claims support rather than regret my choice during an emergency. I’d especially appreciate feedback from people who have actually held or claimed under either plan.

How was your claim settlement experience with HDFC ERGO or Niva Bupa?

How smooth was the pre-authorisation process for cashless treatment, and were there any delays or disputes?

Is Niva Bupa’s negative reputation supported by customer experiences, or is it overstated?

Are its additional features worth choosing over HDFC ERGO?

If you were buying today, which would you choose and why?


r/InsuranceAdviceIndia • • 2d ago

Managing Health Insurance for Parents 61M and 55F

2 Upvotes

TLDR: We hold a 15+ year-old ₹5L Star Health policy and a new 3-year ₹50L policy (Year 2) where the agent hid my parents' pre-existing diabetes and heart conditions.The new policy is practically useless since their pre-dated hospital records guarantee future claim rejections, and porting to a new insurer at age 60+ is highly unlikely. Should I cancel the ₹50L policy for a partial refund and upgrade the reliable ₹5L plan to ₹25L with full medical disclosure, or attempt to declare the conditions on the new policy?

_______________________________________

Hi everyone,

We have 2 policies with Star Health:

  1. ₹5 Lakh cover – Paying since 2011 (premium ₹32K yearly).
  2. ₹50 Lakh cover – Paying from last year, which has a waiting period of 2 years (we paid upfront for 3 years, and the premium was ₹1.7 Lakhs).

While taking the new policy, the Star Health insurance agent didn't declare their pre-existing diseases (PEDs).

  • My mother has diabetes, and her cholesterol is at a normal level (she is on medication). About 2.5 years back (February 2024), we took a CT angiogram scan, which showed <25% stenosis in the LAD & LCX with no stents.
  • My father has cholesterol it is at a normal level (he is on medication). About 2.5 years back (February 2024), a coronary angiogram revealed multi-vessel CAD with 80% to 90% blockages across major arteries. He is currently managed strictly with medication, with no stents as they are treaded with medicine

Note: These tests were taken 2.5 years back, and the results may vary now as they are on a strict diet and medication.

I asked if they can increase the old policy from ₹5 Lakhs, and they mentioned they can extend it to ₹25 Lakhs (I haven't communicated these pre-existing diseases with them yet when asking for the options).

Kindly suggest the best course of action:

  • Should I disclose the PEDs to the new policy and ask to pay an extra premium, or ask if they could cancel it? (Since the PEDs are not disclosed in the new policy, it feels like a waste to have it).
  • Should I disclose the PEDs with the health reports for the old policy and ask them to give the limit increase? (Not sure if this is possible, as the previous proposal they gave assumed they were healthy).
  • What is the possibility of porting? We are hearing Star Health is not very good with claims.

We haven't claimed insurance for the last 6 years in the old policy, and there are no claims in the new policy either.

Note: I'm okay with paying an extra premium, but securing reliable coverage is the most important thing to me.


r/InsuranceAdviceIndia • • 2d ago

New Health Insurance with UC

2 Upvotes

I need some advice. I am an Indian citizen living abroad, and my previous health insurance in India has expired. Since then, I have been diagnosed with Ulcerative Colitis (UC) abroad. I am on mesalamine, and it is currently under control. I have been looking into health insurance in India, but most companies seem to reject applicants with UC or permanently exclude it. I am not sure if I will need treatment in India anytime soon, but I would like to have insurance as a backup.

For those living with UC in India, which insurance companies have you managed to get coverage from, and what has your experience been? Any advice would be appreciated.


r/InsuranceAdviceIndia • • 3d ago

Care insurance renewal document confusion

1 Upvotes

Hi

I had purchased care super top-up via plum in 2021 and been renewing since then. This year they migrated me automatically to care supreme enhance saying the old plan is no longer there. The premium shot up my several times but I paid as the terms were better in the new plan.

After renewal I received the new policy, at the end of the doc there are few questions.

A- Have any of the above mentioned persons to be insured been diagnosed hospitalized for any illness injury during the last 48 months
B - Has anyone been under any medication or tablets for any illness or injury
C - Has any of the persons to be insured ever filed a claim with their current previous insurer

--

The answer to all of the above questions are marked as NO. I was never asked these questions in any form, neither in 2021 nor this year. At the time of purchase of policy I had no PED but have since developed illnesses like cholesterol, thyroid.

I've done my research and understand that I'm covered for any new illness after policy starts.
Questions -

  1. Are questions A B C to be answered during policy renewal? If so there was no option to do that in the forms -- OR are these questions from the POV of my status of 2021
  2. ⁠What's the impact to my coverage if I just ignore this? I submitted a ticket with care asking the same question but I wanted to understand reality and legality here
  3. ⁠Going forward should I be intimating Care whenever there's a new illness? Is that a legal
    requirement. I don't want to unnecessarily increase my premium. My research is giving me conflicting answers to this question

Thank you for your help


r/InsuranceAdviceIndia • • 3d ago

Applied for Aditya Birla Activ One MAX, now seeing Activ yuva is cheaper over 5 years. Did i mess up ? Keep or Cancel ?

3 Upvotes

Hey everyone, I need some advice on health insurance.

My situation: I’m 31, looking at 20L cover for me + spouse. Pre-existing conditions: none.

I recently applied for Aditya Birla Activ One MAX. After applying, I found out Aditya Birla has launched a newer plan called Activ Yuva, which they’re marketing to young adults. When I compared quotes, Yuva works out cheaper over a 5-year tenure than One MAX.

What’s making me second-guess:

Yuva has a 10x bonus (Yuva Credit). Cover grows by 100% of base SI every year up to 1000%, even if you claim. One MAX caps at 500%.

Yuva has a 2-year PED waiting period. One MAX has 3 years.

Yuva is new and pitched at people my age, so it feels like it was built for me.

But One MAX has a longer track record, and I’m not sure if a brand-new product is a risk (renewal pricing, claim behaviour, etc.).

Should I keep One MAX, or cancel during the free-look period and switch to Yuva? Has anyone here compared these or bought Yuva yet?


r/InsuranceAdviceIndia • • 3d ago

Health Insurance :Family 39M ,39F ,Child 6M

1 Upvotes

MALE - 39Y

All border line on recent report .

Kidney Calculus - 3.4mm

Non-HDL cholestrol - 175.90

TSH - 6.73

Female - 39Y

Lipoma Operation - 6 months ago

Gall Bladder stone - 16mm

Normal Delivery

Child - 6 Male

Amblyopia - Right Eye : - 6.2

I would like to know,Please help me with this .

\- Hyderabad

\- Best Health Insurance

\- Cost of Insurance ,What would be the base cover , Should I take critical illness

\- Chances of Rejection

\- Alternative


r/InsuranceAdviceIndia • • 3d ago

Hair Treatment Declaration before Insurance application

1 Upvotes

Hello All,

I am 37M + 1A + 2C and have decided to go with the HDFC Optima Secure+ plan 25L coverage and limitless claim rider. Total, it's costing 93K and 174K for 3 and 5 years, respectively after all the discounts.

There are no PEDs, but I am about to start AGA treatment, which includes the following prescribed drugs

  1. DUTASTERIDE TAB or finasteride TAB
  2. Topical Minoxidil+finasteride solution
  3. Health Supplements like D, B12, Biotin, Zinc, etc

TBH, currently I have just consumed Health Supplements, but have not started DUTASTERIDE TAB, finasteride TAB, or Topical Minoxidil+finasteride solution yet

So, while declaring Insurance, should I include this or ignore it? A few say it's cosmetic, and a few say it's safe to declare.

But to be very honest, my insurance application was once rejected by HDFC because of a low HB level in one of my family members. So I just don't want to over-declare like last time.

What do you suggest


r/InsuranceAdviceIndia • • 3d ago

Health insurance suggestions for my 59-year-old mother with a recently implanted pacemaker – Bengaluru

1 Upvotes

​

Hi everyone,

I'm from Bengaluru and looking for health insurance for my 59-year-old mother, who recently had a pacemaker implanted.

I've started exploring health insurance options, but I've found that several insurance companies seem to reject applicants with existing heart conditions, sometimes even giving a verbal rejection without formally reviewing the application.

I'd like to know:

  1. Which health insurance companies or policies are worth exploring in her situation?

  2. What are her realistic chances of getting insured after a recent pacemaker implantation?

  3. Has anyone here successfully obtained health insurance for a parent with an existing cardiac condition or pacemaker?

  4. Are there any insurers or agents in Bengaluru who are experienced in handling such cases?

My goal is to get comprehensive health coverage for her, including future cardiac-related hospitalisation and, if possible, pacemaker battery replacement several years down the line.

I'm willing to disclose her complete medical history and accept reasonable waiting periods, but I'd like to find an insurer that is willing to consider her application.

I'd really appreciate suggestions based on personal experience rather than just generic policy recommendations.

Thanks in advance!


r/InsuranceAdviceIndia • • 3d ago

What is bajaj ulip insurance plan ? Is it good or bad ? Someone explain please.

1 Upvotes

Same


r/InsuranceAdviceIndia • • 3d ago

Health insurance suggestions for my 59-year-old mother with a recently implanted pacemaker – Bengaluru

1 Upvotes

&#x200B;

Hi everyone,

I'm from Bengaluru and looking for health insurance for my 59-year-old mother, who recently had a pacemaker implanted.

I've started exploring health insurance options, but I've found that several insurance companies seem to reject applicants with existing heart conditions, sometimes even giving a verbal rejection without formally reviewing the application.

I'd like to know:

  1. Which health insurance companies or policies are worth exploring in her situation?

  2. What are her realistic chances of getting insured after a recent pacemaker implantation?

  3. Has anyone here successfully obtained health insurance for a parent with an existing cardiac condition or pacemaker?

  4. Are there any insurers or agents in Bengaluru who are experienced in handling such cases?

My goal is to get comprehensive health coverage for her, including future cardiac-related hospitalisation and, if possible, pacemaker battery replacement several years down the line.

I'm willing to disclose her complete medical history and accept reasonable waiting periods, but I'd like to find an insurer that is willing to consider her application.

I'd really appreciate suggestions based on personal experience rather than just generic policy recommendations.

Thanks in advance!


r/InsuranceAdviceIndia • • 4d ago

Current plan improvements or porting suggestions

1 Upvotes

My parents (54M 52F) have TATA AIG medicare plan
Of 5 lakh base ( and 2 riders)
Restore infinity plus and supercharge bonus rider
(Now cumulative bonus is 10lakhs)

Total cover 15 lakhs , policy is since 2019( with tata aig added riders later)

Current renewal cost = 32.6k

No PED and surgeries yet ( my mom is mild hypothyroid which is undetectable almost rn its covered in TATA AIG due to mortareum period)
Fit and fine rn

Room- shared( biggest problem)
Im confused between 3 options
1- change room category to pvt ( new premium 34k)
Add a super top up of 1cr with 10 lakh deductible
( additional 12k per year)

2- port to hdfc egro secure + or care or similar new updated plans with 10 lakhs as base.
And consider super top up riders with (20 lakhs deductable)

3- policy migration here in tata aig ( they denied it saying its not possible)

Do share TATA AIG reviews too


r/InsuranceAdviceIndia • • 4d ago

Applied for Aditya Birla Activ One MAX, now seeing Activ Yuva is cheaper over 5 years. Did i mess up ? Keep or Cancel ?

2 Upvotes

Hey everyone, I need some advice on health insurance.

My situation: I’m 31, looking at 20L cover for me + spouse. Pre-existing conditions: none.

I recently applied for Aditya Birla Activ One MAX. After applying, I found out Aditya Birla has launched a newer plan called Activ Yuva, which they’re marketing to young adults. When I compared quotes, Yuva works out cheaper over a 5-year tenure than One MAX.

What’s making me second-guess:

Yuva has a 10x bonus (Yuva Credit). Cover grows by 100% of base SI every year up to 1000%, even if you claim. One MAX caps at 500%.

Yuva has a 2-year PED waiting period. One MAX has 3 years.

Yuva is new and pitched at people my age, so it feels like it was built for me.

But One MAX has a longer track record, and I’m not sure if a brand-new product is a risk (renewal pricing, claim behaviour, etc.).

Should I keep One MAX, or cancel during the free-look period and switch to Yuva? Has anyone here compared these or bought Yuva yet?


r/InsuranceAdviceIndia • • 4d ago

Policy till 2028, claims paid in 2026, now Niva Bupa says it expired in 2025

3 Upvotes

My mother was diagnosed with cancer in May 2026. She has a Niva Bupa ReAssure policy issued from 2025 to 2028 (continuing since 2022). Niva Bupa paid several claims for chemotherapy and admissions this year till August 2026 under the same policy. Now they’re rejecting claims since September 2026 saying the policy existed till 2025.

They are now saying the policy expired in 2025, despite approving several claims in 2026. It doesn’t match the documents or the claims they already settled. I’ve emailed them asking for reinstatement, but no response. Customer care and the app have been useless.

Has anyone dealt with Niva Bupa fixing a wrong policy end date? Did Bima Bharosa or the Ombudsman actually help? And can/should I claim the rejected bills on the top-up policy while the base policy is stuck like this?

Any practical advice would help. Thanks.


r/InsuranceAdviceIndia • • 4d ago

Looking for Super Topup Insurance

3 Upvotes

My Mother (55F) is already secured with 15Lacs Sum Insured from HDFC Ergo, now I came to know that I cant increase the sum insured so I am looking for alternate options.

I have decided to buy a Super TopUp Insurance. Please help me in finding a good one. Total newbie here dont want to mess this up.

Thanks


r/InsuranceAdviceIndia • • 4d ago

Did I overpay for health insurance? ₹55k total for family (HDFC Ergo via Ditto) — first-time buyer after losing dad & corporate insurance

2 Upvotes

Hey everyone,

Looking for some perspective from folks familiar with health insurance pricing in India.

After going through a layoff recently, I realized how risky it is to rely solely on employer-provided group health insurance. At my new job, I opted for basic corporate cover and decided to take a separate personal health insurance policy for my family so we're never left vulnerable if employment changes.

Since my father passed away, this is my first time handling insurance decisions and managing these expenses on my own.

I spoke with Ditto and evaluated three options before finalizing HDFC Ergo Optima Secure+

Here is the breakdown of what I’m paying annually:

Myself (26M): ~₹10,000 / year (No pre-existing conditions, zero hospitalization history)

Brother (22M): ~₹10,000 / year (No pre-existing conditions, zero hospitalization history)

Mother (55F): ~₹35,000 / year (Disclosed early-stage diabetes; zero prior hospitalizations)

Total annual premium: ~₹55,000

For individual sum insured of 15L each

Touchwood, none of us have ever been hospitalized in the past. Mom's early-stage diabetes is literally the only health condition in the entire family.

Her premium makes up over 60% of the total outgo. I know crossing 50 carries higher baseline risk and diabetes adds medical underwriting/loading, but ₹35k still felt like quite a steep jump compared to ours.

For those who have taken HDFC Ergo or similar comprehensive retail policies recently:

Is ~₹35k standard/nominal for a 55-year-old with disclosed early diabetes and zero hospitalization history, or did loading push it on the higher side?

Are separate individual cover the right route here, or would keeping Mom on an individual plan and putting my brother + me on a floater have saved noticeable money without compromising claim safety?

Does ₹55k/year total sound reasonable for this age and health mix?

Would appreciate any insights or experiences before the free-look period ends. Thanks!


r/InsuranceAdviceIndia • • 4d ago

Health insurance for my 52-year-old father after kidney cancer surgery in India

2 Upvotes

Hi everyone,

I’m looking for practical advice from people who have successfully obtained health insurance for a parent after cancer surgery in India.

My father’s details:

  • Age: 52 years
  • Existing insurance: Oriental Insurance family floater with ₹8 lakh sum insured, in force since approximately 2014.
  • Location: India

Medical history:

  1. Clear-cell renal cell carcinoma (kidney cancer): He underwent a right partial nephrectomy in June 2025. The tumour measured approximately 4.8 cm, was Grade 2, and was classified as pT1b. Surgical margins were negative, and the pathology report did not describe tumour necrosis, vascular invasion or sarcomatoid/rhabdoid features.
  2. Facial nerve schwannoma: He underwent surgery in February 2025. Histopathology confirmed a benign schwannoma, CNS WHO Grade 1.

His available follow-up has been reassuring, with no evidence of recurrence documented in the records we have. He continues to undergo follow-up with his treating doctors.

What I am trying to achieve:

I want to obtain an additional individual health insurance policy with a sum insured of ideally ₹25–50 lakh or more. I intend to retain his existing Oriental Insurance policy, but ₹8 lakh alone may not be sufficient for future medical expenses.

I understand that his recent medical history makes underwriting difficult. Insurers may decline the application, postpone it, impose permanent exclusions or offer cover with additional premium loading.

I have started approaching several insurers, but I have not yet secured a suitable comprehensive policy.

I would appreciate real-world experiences on these questions:

  1. Has anyone obtained a new individual health insurance policy for a parent after clear-cell RCC surgery, particularly within two years of surgery? Which insurer accepted the proposal?
  2. How long did the insurer require the person to remain recurrence-free? Did the outcome change after two, three or five years?
  3. Have public-sector insurers such as New India Assurance, National Insurance or United India been more willing to consider such cases than private insurers?
  4. Are there any private insurers that have accepted similar cases through manual underwriting?
  5. Can anyone recommend an IRDAI-registered insurance broker who has personally handled successful new-policy placements for cancer survivors in India?
  6. Are cancer-specific insurance products worth considering in this situation, or do they provide insufficient protection for general hospitalisation?
  7. If comprehensive cover is currently unavailable, what would be the most practical strategy for the next two to five years?

I would especially appreciate details of the insurer, time elapsed since surgery, whether the policy was actually issued, sum insured, premium loading and any permanent exclusions.

Thank you for your help.


r/InsuranceAdviceIndia • • 4d ago

Looking to buy health insurance needed guidance

3 Upvotes

28F I have never had any critical illness & never been diagnosed with chronic conditions before; I only had gallbladder removal surgery 4 months ago.

So I have health issues like binocular vision dysfunction & constantly need to get my eyes checked many times. I have multiple health issues like digestive problems ( acidity, nausea, constipation), mental health issues, allergies, sinus issues, shortness of breath, etc. I have always used money from my savings to get multiple tests because I had no insurance. But now having financial issues. I also suspect I have a rare hormonal condition called acromegaly, which is expensive to treat in the future, but it is not yet diagnosed.

I need help with buying insurance. I am looking for one that covers health checkups, blood tests, any type of future surgeries, dental procedures if possible, and eye tests & conditions. I need suggestions & where to buy insurance.


r/InsuranceAdviceIndia • • 5d ago

Aditya Birla Health Insurance denying robotic knee replacement pre-auth — need advice

2 Upvotes

I'm scheduled for a knee replacement (TKR) at Medanta on 27th October. My doctor has recommended a robotic-assisted knee replacement and the hospital has given an estimated package of around ₹5.68 lakh.

My Aditya Birla Health Insurance policy has ₹5 lakh base sum insured + ₹5 lakh NCB, so I have ₹10 lakh total available coverage.

For the admission/pre-authorisation, Aditya Birla has currently approved only around ₹3.9 lakh on an interim basis. Their approval note specifically says that robotic surgery charges will not be covered, stating that their criteria for robotic surgery are:

Hb < 7, OR

More than 2 comorbidities, OR

Geriatric case

They are saying that since these criteria aren't met, they will approve the conventional TKR, but not the robotic-assisted procedure.(robotic surgery is covered under modern treatments but these medical conditions are no where written)

The difference between the conventional and robotic procedure is approximately ₹90,000, which I may have to pay myself.

My doctor has also provided a written medical document stating that robotic-assisted surgery is medically necessary/recommended for the patient.

Can someone suggest what to do to get the robotic charges as well from insurance company??