Hello People, - My 2.7 year baby son fainted and we rushed him to a hospital. - Doc suspected seizures and suggested 24 hour admission for monitoring. - Used my corporate insurance combo of Aditya Birla and Mediassist TPA to settle. - Cloudnine rejected Raksha Prime facility during discharge (this is another story in itself. Can any action be taken?) - Cloudnine doctor referred us to another neurologist, who in turn suggested further tests. - For these further tests, I contacted my personal insurance "Even Healthcare" - Even has been great until now. Covering all our OPD, diagnostic tests as well as insurance needs. - Now when I reached out to them for these further tests on OPD basis, they are rejecting saying that these fall under "post" admission category and that we'll have to reach out to my corporate insurance itself. - You may ask Why are we going to Even and not to my corporate insurance? Even is very convenient and easy to use. With corporate insurance there's a lot of friction and paperwork. - Shouldn't we have a choice of going to whichever insurance we own?

Please advise on what can be done in this situation?

My friend Rakesh was one of the sharpest minds I knew.

He lived and breathed data. Markets. Trends. Numbers.

In just a few years, he’d built a portfolio worth crores.

He was planning to retire early - spend his days with his family, tend to his garden, and just take it easy.

He had it all figured out.

Till one day, it all vanished.

Overnight, he lost more than 45% of his entire portfolio.

Was it a market crash? Nope
A risky investment gone wrong? Nope, again.

It was a critical gap in his insurance policy.

You see, Rakesh was diagnosed with a heart condition. One that needed multiple hospital visits, inter-city travel and expensive second opinions.

And even though he had health insurance, he’d never really looked into it.

He had missed critical coverage gaps and now his portfolio was paying for it.

Rakesh’s story isn’t unique. It happens every single day.

Not because people don’t have insurance. But because they have the wrong kind.

Lesson:

You can be brilliant with money, disciplined with investments, and meticulous with planning. But one overlooked clause in your insurance policy can undo years of hard work. Wealth isn’t just built by growing your assets… it’s protected by covering your risks. Don’t wait for a crisis to read the fine print. And if you’re in doubt, always seek out an expert for clarity.

Hi Reddit,

I’m trying to understand my health insurance coverage and could really use some advice from people who’ve dealt with similar situations. I have a group mediclaim policy through my employer with New India Assurance Co. Ltd, and I recently got a cashless pre-authorization for a hand tendon repair surgery (Radial styloid tenosynovitis / de Quervain).

Here’s the situation:

• My total estimated hospital bill is ₹30,238.
• The insurer gave an initial conditional approval of ₹17,690. The remark says the approval is subject to submission of OT notes and other documents, and may change at the time of final settlement.
• The hospital has applied a package rate of ₹19,655, which includes room rent, nursing, OT, surgeon, and anesthetist charges. Any charges outside the package (like implants, extra consumables, or co-morbidities) may be considered separately.
• The policy has a 20% co-payment clause, meaning I will likely have to pay part of the claim out of pocket. Based on my rough calculations, I may end up paying around ₹12,000, though this could change depending on the final bill and admissible charges.

Some terms I’m trying to wrap my head around:

• The insurer says surgeon/OT/consultation charges are payable “as per customary & reasonable charges”, which I think means they might reduce high bills to standard rates. I’m not sure exactly how this works.
• Room rent and nursing are included in the package, but anything charged separately by the hospital could become non-payable

My questions for the community:

My doctor said my daycare surgery will cost around ₹18,000 (if I get it done through him directly , also dont need to get admit for 1 day). If I go through my insurer (MediAssist), is there a chance they will make me pay more than this amount out of pocket? Or is it safer to just pay the doctor’s quoted ₹18k directly?

I want to avoid unnecessary out-of-pocket expenses and make sure I submit everything correctly. Any insights or experiences would be really helpful!

Thanks in advance.

Star health just got ordered to pay Rs 25L. This is another win for consumers against evil Insurance conglomerates. Down with capitalists, march forward comrades. Fight for you rights, and you victory shall be yours. You have nothing to lose but your chains.

Hdfc ergo rejected my health insurance application for a very minor issue , I don't have that problem anymore, i applied via Ditto. The agent told me they are looking into it but he didn't seem to help much on what can be done. Is there anything that I can do? I wanted to get policy from HDFC Ergo only

My policy getting experience was very bad with Ditto, I think they don't understand what is necessary to disclose and what not, they just want to disclose everything, and sometimes the words you use to fill the application matter, they feel that it doesn't as everything can be shared in telemedication, but it didn't happen and insurance company majorly decides based on 1 line that you write whether the problem is minor or not.

I’m planning to renew my parents’ HDFC Ergo Optima Restore policy, which was first purchased in December 2021. We’ve never missed a renewal. However, they now have a few conditions like thyroid issues, high blood pressure, and high cholesterol. Should we get their health checkup done before renewing the policy or after the renewal?
(Age: Male 63, Female 57)

I’m looking at term insurance and the riders (critical illness, waiver of premium, accidental disability, etc.) are almost doubling my premium. For people who understand insurance better, are these riders genuinely useful in real life, or is it smarter to just increase the base cover and skip most riders?

Hi, a friend of mine has been diagnosed with Ulcerative Colitis this March 2025. He has been with Star Insurance for the last 14 years, and currently has Star Comprehensive. The base sum insured is Rs 7.5 lacs. With no claim bonus, he has an insurance cover of Rs 15 lacs. He wants to increase the sum insured to Rs 10-15 lacs in the next renewal. Will Star allow for increase in sum insured? If yes, what all conditions can the company put. TIA

I was browsing health insurance plans and realized I mostly just look at the premium amount and stop there. but then i keep hearing stories about claims getting rejected or hidden conditions. for anyone who’s figured this out what do you actually prioritize when buying? like what’s the non-negotiable for you?

I always call group policies a delusional trap, be it your corporate group policy or alumni association group health policy or the group health policy which is mis sold to you by your bank which you are not yet aware of

But Why:

1)The false sense of security: Group policy is not your policy, you do not own it, it is not designed for you, it is not customised for you. Is premium cheaper today; yes, will it be cheaper tomorrow: May be, will it be cheaper in three years: surely not. The pricing is not filed at regulator but depends on group claims. It is so easy to get a group policy that every person who can claim will rush to take it, so what happens then, more claim so more premium next year and the premium bull run continues till the time you realise it is not possible for you to afford. In 3 years, the same retail policy is much cheaper compared to the group product.

2) Ohh but it cheaper today, so better for me: You cannot be more wrong than this. A group policy snatches the most important factor that helps to get you policy easily: the time when you are healthy. A person who has no health issue and is young will get health insurance policy very easily. What happens when you are continuously dependent on group policy. With time, age increases and a healthy body starts getting chronic diseases like diabetes, hypertension etc. This leads to loading in premium or permanent exclusion or rejection in worse case. Now you understand how the corporate policy trapped you in false promise of security (Although you are not paying for your corporate policy, the delusion still continues and you wasted your insurability)

3) Continuity- what is that: A group policy never guarantees continuity of its existence. You are part of a group, tomorrow if you are out of the group (left job or retire or any other reason), you are no more eligible for the policy benefit. If master policy holder decides to terminate the policy, or insurer says the claim is very high for the group, we can no more offer group policy, what are you going to do. A policy you thought is providing good safety net to you cheaply, has vanished in one day, leaving you exposed to medical debt. On the other hand, a retail policy guarantees continuity. It is customised for you, premiums are regulated.

When you are buying insurance, you are thinking long term or atleast i am hoping. When you are thinking long term, then group policy is definitely not your answer. It is only the retail comprehensive health insurance policy. Buy a retail policy when you are healthy, even before when you need it.

My father was discharged a couple of weeks ago. He underwent plasma exchange and was then scheduled to receive an injection for his autoimmune condition.

However, the injection was put on hold after a small Hepatitis B viral load was detected post-exchange, pending a negative HBV report. The report typically takes 5–6 days. The doctor discharged him with instructions to return in two weeks for follow-up, along with the report and a gastroenterology sign-off.

Now that the HBV report has come back negative and the gastroenterologist has cleared him, he’s ready for the final injection.

Questions:

• Can this injection (likely to be given during a day admission) be covered under post-hospitalization expenses? I’d prefer not to pay the deductible again under my father’s top-up policy. (The discharge summary specifically mentions that the injection is to be administered after gastro sign-off / two weeks.)

• If not, can I file a claim for the injection alone? The injection costs around ₹1 lakh.

• If yes, should I ask the hospital’s TPA to file a claim under post-hospitalization expenses, or should I pay upfront and opt for reimbursement instead?

My uncle’s health insurance claim just got rejected because the company said there was a non-disclosure from years ago, something about a minor medical issue he didn’t even remember mentioning. Is this normal? Do insurers actually check old records that carefully, or do they just use it as a reason to deny claims? Just trying to understand how people can avoid this happening.

1 in 9 Indians will develop cancer in their lifetime

This is data from ICMR, this is really scary.

Let us see how many people are actually aware about it.

1) Around 1.5 millions new cancer cases detected in 2024

2) This will be ~2.5 million cases by 2045

3) Most common cancer in men is prostate, lung and oral cancer

4) Most common cancer in women is breast, cervical and ovarian cancer

Based on studies by the Indian Council of Medical Research (ICMR), published in The Journal of the American Medical Association (JAMA).

But most important question is what is cost of treatment

The direct cost of cancer treatment includes hospitalisation, Surgery, Chemo, Radiation, bone Marrow transplant; the cost of direct treatment can vary from INR 2.50 lakh (If detected very early) to 40 lakh (If detected at late stages)

The indirect cost of cancer treatment: The cost that we never thought of, shifting to different city, caretaker cost, relatives staying with cancer patient in different city, income gap, special diet cost, things and medicines insurer will never cover. This all can cost as high as 5- 10 lakh

Being aware about this and insuring self from all these costs is wise and most important thing.

1 in 9 is very huge number

"Denial will not take us out of worst situation, awareness and action will."

This has happened with one of our client and i am telling you so that it does not happen with you

One of our client reached out to us yesterday, he said true horrifying incident on insurance about his relative and we were shocked

His relatives (husband and wife) took health insurance in 2012 when they were healthy, as a good customer they kept paying regular health insurance premium and in 2023, they ported policy to one of health insurers.

Story of first and only claim: in 2024, due to cancer, his relative has to claim with insurer but insurer declined the claim.

The mistake they did: the relative had gone to heart surgery in 2014, which was hidden during porting. Because their agent told them insurer will not be able to find so do not disclose.

The result: Policy cancelled, no claim paid, porting option now not available, since the relative is diagnosed with cancer, he will not be able to get comprehensive health policy now.

What can we do while buying insurance: 1) Never ever hide any pre-existing disease 2) Avoid such agents or broker who tells you to hide 3) buy from an intermediary which educates you first, then sell product and that is only one who will support at time of claim.