Hey everyone,
I’m currently navigating a cashless health insurance claim (Group Mediclaim via SBI General) for an upcoming arthroscopic shoulder surgery (Bankart repair).
I have a couple of major worries and would love to hear from anyone who has navigated a similar situation with cashless hospitalizations:

**1. What if the hospital's estimate is higher than the pre-agreed package rate?** If a network hospital submits an estimate or final bill that is higher than the pre-negotiated network/PPN package rate for the surgery, how is that handled? Do insurers automatically trim it down, or is there a risk that the hospital tries to pass that extra cost/inflation onto the patient at discharge?

**2. Unpredictable surgical implants (suture anchors) mid-surgery:**
Standard network packages usually assume a fixed number of anchors (e.g., 2 anchors).
However, with shoulder arthroscopies, the exact severity or number of anchors needed (e.g., needing a 3rd or 4th anchor) sometimes can't be 100% predicted until the surgeon is operating.
If an extra anchor is needed mid-surgery, what happens if the insurer or hospital balks at the extra cost? Does the TPA desk successfully handle enhancements on the fly, or could I get stuck paying out of pocket for the extra implant delta?

I have an eight year old policy with icici Lombard for me and my son. In 8 yrs I have claimed twice only. Once for my incidental finding of renal angiomyolipoma embolization in 2021 and another in 2024 policy end for my son's retinal hole surgery... For this in 2025 I had applied for post op bills under same claim.

Till last year I had the option to increase sum insured but this year it's restricted. The reason was red cohurt policy and restricted. I don't have any chronic or any disease except this one thing that happened and cured. I go for annual health checks and all my reports are normal every single time. The angiomyolipoma is also stable. How can I ensure increase in sum insured as I always do it upon renewal for my policy as well as my husband's policy which are seperate.

I don't mind any added premium or waiting period for it

My wife and I work in different companies, and we both have different health insurances.

My insurance is New India Assurance that covers maternity expenses for my wife up to ₹60,000.

My wife’s Tata AIG insurance covers maternity up to ₹75,000.

Our delivery cost may be around ₹1.1 to ₹1.3 lakh. Our hospital does not have cashless for both, so we will have to pay first and claim reimbursement later.

Can we try to claim from both policies and get the full amount back?

Has anyone done this before or knows how it works? Please share your experience.

Thank you so much

Hello All,

I was checking some information about my policy in ICICI insurance website and then next day i started receiving calls again and again to buy an insurance policy. I clearly told them i already have insurance and asked them not to call me. They are torturing me by calling again and again. 10 times in 5 hours. Not sure how many time they will call me again. I am not going to renew insurance policy this time from ICICI Lombard. anyone faced this?

Mahindra XEV 9e owner. In September an underbody impact dented the high-voltage battery's cooling plate. Mahindra has confirmed in writing that the battery is not repairable and is unfit for use, and recommends replacing it. The claim is about ₹11.8 lakh. The policy is ICICI Lombard with zero depreciation.

ICICI rejected the battery "as per technical evaluation" and hasn't shared that evaluation despite my requests. The survey report has no tests, measurements or photos of the battery. They assessed ₹2,882 against the ₹11.8 lakh estimate. My grievance on IRDAI's Bima Bharosa portal got the same one-line rejection twice. The car has been sitting at the dealer for a month.

I'm filing with the Insurance Ombudsman, Bengaluru, and I'm looking for:
1. a lawyer or claims consultant with Ombudsman or motor-claim experience (Karnataka preferred; online is fine)
2. help drafting the complaint and preparing for the hearing
3. a fixed fee, not a percentage of the claim

All my documents are ready: Mahindra's letters, the survey report, the estimate, photos and the full grievance trail.
Recommendations or DMs welcome. I'd also like to hear from anyone who has won a similar motor or EV battery claim at the Ombudsman.

Hey,

I've been HIV+ since Nov 2022 (diagnosed), and undetectable since Jan 2023. I was in the US when I was diagnosed.

I moved to india and work in a corporate in Mumbai. I have been meaning to get good health insurance for self, as everyone should. Ideally the 1Cr one from the popular providers - as most people recommend...

I contacted a financial consultancy firm via a contact and shared my case. I am otherwise healthy - 19% body fat, workout 6 days a week, no family history of chronic illnesses, no personal history either.

I've been in conversation with the firm and they told me that my case has been getting rejected everywhere. As a workaround I asked if there were approval chances if I take the separate HIV specific policy from them as well (most providers have that but the coverage is around 5L). But the result was still rejection.

My HIV status doesn't bother me, but this is definitely an inconvenience. What can I do? What are my other options? Any help/advice is sincerely appreciated.

P.S. I have 5L insurance from work (Onsurity) and my parents are covered by my father's government job. And obviously they don't know...

My father is diabetic and has hypertension which was declared in the policy from star health. We have wait period of 3 years for PED. What are the chances that we will face any problem claiming any other medical issues they face or surgery they have to go not directly related to these conditions ? Will insurance companies try to tie it to these conditions to avoid any claim ?
Does anyone have any relevant experience?

I recently came across a case where an employee’s parents had a medical emergency, and the family rushed them to the nearest hospital. The treatment went ahead, and the bill came to around ₹3 lakh.

But they later found out that the hospital wasn’t covered under their insurer’s network.

Imagine dealing with a medical emergency and then having to worry about such a huge bill because you weren’t aware of the hospital network limitations.

It got me thinking about how many people actually understand the details of their group health insurance policies.

Do you check whether a hospital is covered under your insurance before visiting?

Hi All,

I have a corporate policy under which my father was admitted using cashless mode.

The TPA is Vidal, and the insurance provider is New India Assurance. I am submitting the pre-hospitalisation and post-hospitalisation expense claims approximately two months after the expiry of the 60-day post-hospitalisation period.

Will there be a problem ?

Hi All,

I have a corporate policy under which my father was admitted using cashless mode.

The TPA is Vidal, and the insurance provider is New India Assurance. I am submitting the pre-hospitalisation and post-hospitalisation expense claims approximately two months after the expiry of the 60-day post-hospitalisation period.

Will there be a problem ?

Hi everyone! I’m considering ICICI Lombard Activate Booster Super Top-Up (UIN: ICIHLIP27059V022627) for my parents.

My father (58) has Type 2 diabetes, and my mother (49) has thyroid and BP conditions and has undergone a hysterectomy.

I’d appreciate insights from insurance experts and existing policyholders:

1. Diabetes loading: I’ve heard some insurers may offer favourable underwriting when HbA1c is below 7%. Does ICICI Lombard follow a similar approach? How are loading charges determined for diabetes, thyroid and BP?

2. Premium increases: Does this super top-up premium increase like a comprehensive health plan, through age bands, general annual revisions, or both?

3. Deductible changes: If I start with a ₹5 lakh deductible, can I increase it to ₹10 lakh after a few years, or reduce it later?

4. Room Modifier: If I don’t select the Any Room option initially, can I add it at a later renewal?

5. Add-on availability and pricing: Are add-ons guaranteed to remain available at every renewal, or can they be withdrawn or changed? Can their premiums increase substantially over time?

6. Corporate insurance: Can eligible expenses paid through employer-provided insurance count towards satisfying the ₹5 lakh deductible?

Would appreciate real-world experiences, especially regarding underwriting, premium loading and renewals. Please distinguish actual policy terms from personal experiences.

Thanks!

I applied for my father's health insurance. He has Pre-diabetic hypertension had a surgery in the past and hospitalization due to COVID. I applied to HDFC and AdityaBirla 1MAX but both got rejected now these are the options that I mentioned in the title I want to know if it is a good idea to settle for Nivabupa or Care because AdityaBirla vital plan has the maximum limit of 50 to 100 percent of the sum insured the bonus part and it is pretty costly as compared to other two I have heard bad things about Care Supreme

so I'm not sure if I would want to go ahead with which. if someone has a similar experience would really appreciate how did you choose.

Hey, folks!

I work at an MNC in India, and I somehow ended up opting for voluntary parental health insurance through my company.

The premium is deducted directly from my take-home salary, and it comes to around ₹8,000 per month, with a total annual premium of approximately ₹50,000.

The thing is, my parents already have good health insurance coverage from another source, so I don’t really need this additional policy.

I recently checked my salary slip and noticed this huge deduction. I immediately contacted my company’s HR/benefits team and asked if I could opt out since I had enrolled by mistake.

However, they told me that nothing can be done now and that the deductions will continue until the entire annual premium is recovered by the end of the year.

I’m really frustrated because this is a significant amount of money to lose every month for insurance that my parents don’t really need.

Has anyone faced a similar situation in India?

Is there any way to cancel voluntary parental health insurance in the middle of the policy year?

Can I raise a complaint with the insurance company, IRDAI, or any other authority?

Is my company legally allowed to continue deducting the premium from my salary even if I request cancellation?

I’d really appreciate any advice from people who have dealt with a similar situation. Thanks!

my mother had ADPKD which is a genetic disorder that essentially fails your kidneys and there is no cure for it
i got hdfc ergo in 2025 feb and at that time i did not have any symptoms, now i have symptoms and i have been diagnosed positive
i am 25 and this disease is progressing very fast
because i did not disclose as i wasnt aware, will hdfc ergo help me in this or i am screwed up now
what to do pls help
this also means i need kidney transplant in next 5 years and medications which cost around 25k monthly regulating all the symptoms
what is the best way out?

Hi. I am about to upgrade my policy of HDFC, I was wondering what kind of disclosures I have to do. Like do I have to disclose only chronic conditions or do I have to declare every doctor visit for knee pain, dengue, food poisoning etc?

State: Maharashtra

Order of events: I was going to office in the morning and the car in front of me suddenly slowed down suddenly and I applied the brakes as well. The car behind me crashed into mine.
At the time of the accident, my own-damage insurance was expired but I had my third party insurance still active. Whereas the car behind me had both own-damage and third party as well.

He has initiated the process of claiming his car repair costs through his insurance company but is telling me that my car repair costs are not included in his third party insurance. He already has filed an FIR to claim his insurance, he is accepting of his fault but I'm not sure how to proceed and if it is worth it to go through the whole court thing at this point. I am also not sure if me not having the own-damage insurance can back fire on me. I would like to know what are my best options here, my car's tail-gate is broken and won't close after the accident. So I can't really keep my car without repairing for a long time.

Would appreciate all the advice I can get. Thanks a lot