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Care Health Insurance - Inconsistent Claim Deductions for Post-Brain Surgery Physiotherapy under Reasonable & Customary Charges & Privacy Breach (Bima Bharosa Token #07-26-010954)

Care Health InsurancePC-2026-02829Insurance ClaimsAnonymous ·
Extremely disappointed and frustrated with Care Insurancen After undergoing brain surgery, I expected my health insurance to support my recovery. Instead, I have been forced to repeatedly chase the company for reimbursement of prescribed physiotherapy expenses. My physiotherapy has continued at the same clinic, with the same treatment course, yet similar claims are sometimes approved and sometimes rejected or substantially reduced under the vague explanation of "Reasonable & Customary Charges." Here are the numbers:nn• Claim ******: ₹1,28,146 claimed; ₹44,146 settled; approximately ₹84,000 deducted.n• Claim ******: ₹1,68,623 claimed; disputed over reimbursement deductions and inadequate explanation.n• Claim ******: ₹75,600 claimed; almost the entire amount approved.n• Claim ******: ₹1,14,023 claimed; just ₹1,971.47 paid; ₹1,12,051.96 deducted. How can similar physiotherapy expenses from the same clinic receive such drastically different treatment? I have repeatedly submitted the documents requested and asked Care to provide item-wise deductions, calculation sheets, applicable policy terms, and the geographical benchmarks used to determine "Reasonable & Customary Charges." I still need clear, evidence-based answers. I escalated my grievance through IRDAI's Bima Bharosa mechanism (Token No. 07-26-010954), yet these concerns remain unresolved. To make matters worse, Care previously sent me a settlement document containing another customer's personal and claim details instead of my own. This raised serious concerns about the handling of customer information. I am recovering from a serious medical condition. Spending my time repeatedly uploading documents, following up, and challenging unexplained deductions is the last thing I should have to deal with. Health insurance should provide peace of mind during a medical crisis—not become another battle. I am not asking for special treatment. I am asking for consistency, transparency, fair claim assessment, and accountability. Care Health Insurance, please answer these basic questions:nn- Why are comparable claims treated differently?n- What calculations and benchmarks justify these deductions?n- Why do repeated requests for a clear explanation remain unanswered? Enough of generic responses. Policyholders deserve answers, not just terminology. #CareHealthInsurance #HealthInsurance #InsuranceClaims #CustomerExperience #ConsumerRights #IRDAI #Accountability

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Reference details

Complainant
***************
Target Insurer
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IRDAI Bima Bharosa Token No.
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Disputed Claim Records
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History

  1. Case filed

    System · 23 Oct 2026, 5:39 pm

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