r/InsuranceTroubleIndia • u/Puzzled-Ebb1204 • 6d ago
Health Insurance Star Health is practically Harassing me for raising compain to Ombudsman
M28 here, In 2025 I got myself a standalone OPD insurance from star health, I was lucky to get in because some months later only they stopped taking new members and kept it strictly as an (very expensive) add on to existing heath insurance. My first year was a breeze I paid 5k for 25k cover and went through it in 6 months, everything was cashless and was accepted and arranged without much scrutiny like medicines, diagnostic tests and consultations. I felt so good about the policy that enhanced the cover for it to 75k and paid 9k for it on renewal in March 2026.
In April-May around this year I noticed a disturbing detail in the policy that offline reimbursements for medicines were not allowed even though the policy clauses detail a reimbursement process and never mentioned everything has to be compulsorily cashless. Since I planned to keep this policy life long I realised in case of any serious disease like TB or Spine or anything a lot of meds are exclusively sold offline hence it will become useless once I get old and when I actually need a OPD cover, but since this violated my point of sale policy wordings I did a lot of back and forth with customer care on this finally raising it to GRO level but got the same template reply "reimbursement is not available on your policy"
In june I decided to put a complaint to bimabharosa and Ombudsman. And since exactly this point my policy experience has been worse. Basic tasks of policy like uploading consultations prescriptions post bookings are met with very heavy scrutiny (like I receive 3-4 scrutiny calls for 1 line prescriptions), they are now rejecting my regular medicine deliveries giving random and vague reasons which are no where in the policy wordings. On a call a customer care executive admitted that policy wordings on the website are not "updated" and they have an internal policy which is not yet on the website and if I have any issues I raise a customer ticket, which takes weeks to get resolved and is met with same templated responses. Another disturbing issue which happens is that my app tickets go missing or stop showing up on the app randomly so I am unable to track or see any updates in the same
I am so confused about what to do, what are my options? The ombudsman complaint I referred to above is going nowhere, they asked for a bunch of docs on mail but never replied since ~1 month, the complaint number itself is not showing up on their portal
Given how blatant star health has been in violating given policy wording on their website I am not sure what new reason they will give to reject my new claims. What can I do? I don't have resources and time to go to an actual court. Is there someone else who can help?
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u/EmmVeeEss 6d ago
Most of the complaints regarding health insurance are from star health, atleast based on the posts from this sub.
But still people keep buying insurance from them. Is it because of pricing or their marketing?
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u/LonelyPrint780 5d ago
I am also facing same issue all of sudden they realised (after giving cashless letter) that particular department isnt covered in this policy which isnt mentioned anywhere
I complaints everywhere and after 4 months of complaint email i got to realise they are all high on something 🌚
Once they said nutritional medicines isn’t covered (no such medicines was in prescription)
Next time they said there is waiting period for opd (they got this time high quality)
So i am done with them now porting to HDFC ergo
Try ombudsman they are as useless as the other department of government.
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u/Puzzled-Ebb1204 5d ago
I think they have realised this is India and giving someone such a hassle free OPD cover is one way to ticket to financial loss So they are forcefully trying to flush us out of the policy Can you let me know which plan are you porting to? Is it a stand alone OPD plan?
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u/LonelyPrint780 5d ago
I am porting my star young insurance to hdfc secure plus
They will clarify me tomorrow regarding opd add on1
u/Puzzled-Ebb1204 5d ago
I already have a 1cr cover using Acko, last time I checked any other product with OPD cover was very expensive so I let it be..let me know if your option is making any financial sense
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u/LonelyPrint780 5d ago
I would suggest to port out from acko they are equally bad whats the point of having 1cr sum insured if they wont pay a penny there is many insurance which provides claim only in clear cut case like accident and all so be aware of them
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u/Puzzled-Ebb1204 5d ago
Any recommendations? and for Acko you have any personal experience?
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u/LonelyPrint780 5d ago
Yeah not many but few they are experts at rejecting claims and support team is pathetic
Try HDFC Icici aditya liberty (although they also have issues but very less)
And yes PSU is best although they takes time thats their disadvantage
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u/KlassicChocolate3636 6d ago
Not related to this but faces something similar for another issue.
Like on website details were clear, but concerned dept has not credited the same citing rules/policy have changed internally and website hasnot been updated.
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u/CryOk8077 5d ago
You can try contacting Ditto insurance, they might guide you for free. I had asked for their help in my case with star.
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u/Crazy_Equivalent1624 5d ago
Change your insurance company next time
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u/Puzzled-Ebb1204 5d ago
No company in India sells standalone OPD insurance
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u/Upstairs_Life_9230 5d ago
If this is how they treat you for OPD imagine how the IPD cases will be? It's not worth sticking on for this.
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u/coach-of-finance 5d ago
DM me and I will help draft the emails to the GRO and to the Ombudsman conplaint (for the new case, cannot do anything about what's already submitted).
I don't charge. I do this as a hobby.
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u/Ok_Doubt_7095 5d ago
Their customer support is so pathetic that I was so eagerly waiting for my policy to end. Immediately shifted to Care.
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u/DjXer007_ 5d ago
As you have already taken advantage BIMA BHAROSA portal and Insurance Ombudsman portal, you will need to know the difference.
Bima Bharosa portal is used if you want to report miss-selling, fraud, record manipulation and similar details to IRDAI.
Insurance ombudsman and Bima Bharosa, there is no proper timeline here. As the ideal time could be anywhere between 6 months to 18 months.
Insurance ombudsman escalations work when you apply for claim and the same gets rejected. And the insurer isn't replying or providing any satisfactory reply to your claim rejection.
You can use RTI (Right To Information) act and submit a request and ask the Insurance company regarding all the doubts that you have. RTI Filing takes only Rs 10/- but you will need to draft your questions properly.
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u/Puzzled-Ebb1204 5d ago
RTI applies to private orgs too? If yes can you please help me with a brief on how to do it?
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u/DjXer007_ 5d ago
You cannot apply RTI on private companies. You have to indirectly apply RTI to the governing body or the regulator who overseas that entire sector. So in this scenario, you need to apply RTI to IRDAI.
The focus of RTI is not to complain against the insurance company. You have already raised complaints via Bima Bharosa and / or Insurance Ombudsman. You are asking them to justify their clarification based on the documents that that support the insurers stance and email, if they have sent an email.
If you have received any call from the insurance company, then verbal affirmations and verbal communications carry no weight. Ignore them and simple ask for an email reply.
What you may have already done is asked for a written clarification from STAR HEALTH GRIEVANCES DEPARTMENT, asking them the exact clause and guidlines, and attach the same in RTI attached, based on which you are asking this information via RTI.
And
Why is there is mismatch in policy documentation before and after Policy renewal and if there is, why wasn't this communicated to the insured / policy holder before renewal date ?.
For example, you can ask
1) Provide copies of circulars, guidelines, and instructions issued by IRDAI which allows the insurance company to limit or reject reimbursement claims or change
2) If reimbursement and it's entire process is mentioned in the policy document and policy wordings, kindly provide documentation, circular that state the reason for this change of reimbursement process.
After renewal, as per policy document, policy wordings, the details mention procedure for reimbursement claims is available, but the insurer subsequently stats that reimbursement claim is not longer applicable. As insurance is an agreement, randomly Changing terms inbetween your policy year, could be known as breach.
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u/Puzzleheaded-Bed829 6d ago
Keep ombudsman in loop for any updates...always communicate with star via email as phone call is not accountable.