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Care Health Insurance - Unjustified Cashless Pre-Authorisation Rejection for Emergency Angiography Based on Mere Suspicion of PED Non-Disclosure Due to Early Claim Post-Porting

Care Health InsurancePC-2026-02841Insurance ClaimsAnonymous ·
🚨 WHEN PAYING FOR COVERAGE STILL LEAVES YOU UNPROTECTED: SUSPICION VS. POLICY TERMSn Is an early claim valid grounds for rejection, or should health insurance claims be judged strictly on policy terms and evidence? Sharing a deeply concerning experience regarding my mother's cashless pre-authorisation rejection by Care Health Insurance.n📌 The Background:n• Sept 2025: Purchased my parents' first health insurance policy from Niva Bupa, fully disclosing all pre-existing medical conditions (Father: Diabetes & Hypertension | Mother: Hypertension).n• Sept 2026: Ported the policy to Care Health Insurance with full disclosures and continuity of benefits.n• Rider: Opted for Instant Cover paying an additional ₹14,000 premium.n📌 The Incident: On 19 October 2026, my mother experienced severe breathing difficulties and dangerously high blood pressure. She was evaluated at Medanta by Dr. Sudhanshu Kumar Dwivedi (DM, Cardiology), who advised urgent coronary angiography and further necessary procedures. We submitted the cashless pre-authorisation request immediately.n📌 The Outcome: Cashless pre-authorisation REJECTED. The verbal clarification received? Because the policy was ported ~20 days ago, the timing raises "suspicion of pre-existing disease (PED) non-disclosure."n📌 Questions for Care Health Insurance & IRDAI: 1 Since when did an early claim become legal proof of non-disclosure? 2 Why charge ₹14,000 extra for Instant Cover if early claims are viewed with inherent bias instead of policy terms? 3 Where is the concrete medical evidence proving non-disclosure of a specific condition prior to policy issuance? Suspicion is not evidence. Porting a policy with continuous coverage is a right governed by IRDAI regulations. Penalising a policyholder simply because a medical emergency occurred shortly after porting undermines the very purpose of health insurance. For an insurer, this is a file number. For me, it is my mother's health and our family's financial security. I request Care Health Insurance to conduct a fair, objective, and evidence-based review of this claim without hiding behind timing-based assumptions. They have the baseless ground like suspicion PED and 20 days after the renewal to reject the claim and they unable to show any written clause that violated just denied the approval within 01 hours it shows there melafide intension. Health Insurance Caren #CareHealthInsurance #HealthInsurance #InstantCover #PreExistingDisease #PED #InsuranceClaims

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  1. Case filed

    System · 23 Oct 2026, 6:04 pm

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