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Cashless claim denied twice by HDFC ERGO for hospital admission with conflicting reasons

HDFC ERGO General InsurancePC-2026-02984Insurance ClaimsAnonymous ·
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When “cashless” fails: my experience with HDFC ERGO General Insurance My wife was admitted to Fortis Escorts Hospital, Faridabad, from 14 to 17 October 2026 with high-grade fever, vomiting and a complicated urinary tract infection (E. coli positive). She was treated with IV antibiotics and fluids. No stone surgery and no cyst treatment was done. HDFC ERGO denied cashless twice, with two different reasons: ❌ 15 Oct: “ovarian cyst, within the waiting period” ❌ 17 Oct: “calculus, within the waiting period” The facts: ✅ The treatment was for fever and infection. ✅ The CT scan shows no calculus. ✅ The cyst was an incidental imaging finding, with no treatment given for it. ✅ The denial came before the final urine culture report. I paid ₹93,965 out of pocket, even though I had renewed a ₹10 lakh family floater policy only months earlier. 📌 Policy No: ****** 00 📌 Claim (CCN): RC-HS26-16047068 IRDAI’s Master Circular requires cashless authorisation within 1 hour and final discharge authorisation within 3 hours. Changing the reason for denial within 48 hours suggests the medical scrutiny was not thorough. I have filed a detailed grievance and reimbursement request with HDFC ERGO. If it isn’t resolved, I will escalate to the Insurance Ombudsman and the Consumer Commission. A few lessons if you hold health insurance: Keep every report, scan and denial letter. A cashless denial is not a claim rejection. You can still claim reimbursement. Insurers must prove an exclusion applies. Incidental findings on a scan do not automatically trigger one. Escalate in writing: grievance cell, then CGO, then Ombudsman. Has anyone else faced a similar cashless denial? What worked for you? #HealthInsurance #HDFCERGO #IRDAI #InsuranceClaim #ConsumerRights #PolicyHolder

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  1. Case filed

    System · 26 Oct 2026, 6:36 am

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