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Cashless Claim Rejected and ₹44,000 Unreimbursed After Six-Day Hospitalization

Aditya Birla Health InsurancePC-2026-02909Insurance ClaimsAnonymous · 1h ago

₹1,15,000 PAID OUT OF POCKET AFTER MY WIFE’S 6-DAY HOSPITALIZATION. IS THIS WHAT HEALTH INSURANCE IS SUPPOSED TO DO? I am raising a serious concern about our experience with Aditya Birla Health Insurance Company Limited and Policybazaar.com My wife suffered from persistent fever, mouth ulcers, and stomach pain. As her condition did not improve despite initial treatment by another doctor, the doctors at Yatharth Super Speciality Hospitals assessed her condition and recommended hospitalization. Despite submitting medical records, the cashless claim was repeatedly rejected, stating that hospitalization was “not justified” and treatment could be managed through OPD. On discharge day, we were advised to pay the bill and seek reimbursement. I paid ₹1,15,374 out of pocket for six days of hospitalization. After repeated rejections, follow-ups and a complaint through Bima Bharosa, the insurer approved ₹71,374, leaving ₹44,000 unreimbursed. The deduction breakdown: Investigation charges: ₹11,000 Medicines and consumables: ₹17,000 Miscellaneous charges: ₹3,500 Room and nursing charges: ₹12,500 The insurer’s deduction statement repeatedly mentions room-rent restrictions, excess pharmacy charges and syringes, but does not clearly map these reasons to each deduction or explain the calculations. Questions for Aditya Birla Health Insurance - Why was ₹44,000 deducted, and what exact policy clauses justify each deduction? - Why were ₹17,000 deducted from medicines and consumables? Which specific items were disallowed? - How were the room-rent restriction and ₹12,500 deduction calculated? Were proportionate deductions applied? - If hospitalization was not justified, why was ₹71,000 eventually approved? - My policy provides for 0% co-payment. Please clarify the contractual basis for these deductions and confirm that no expense was deducted twice. Aditya Birla Health Insurance Company Limited: Conduct a fresh medical review, provide an itemized deduction statement with exact policy clauses, and reconsider the outstanding ₹44,000 wherever the deductions are unsupported. Policybazaar.com: Review the assistance provided during the claim process and actively escalate this unresolved matter to the insurer. I request a substantive written response within 7 calendar days. If unresolved, I reserve the right to pursue the applicable grievance-redressal and legal remedies. This is not just about ₹44,000. It is about trust, transparency and accountability. Families buy health insurance for financial protection during medical emergencies—not to spend weeks fighting unclear deductions. I am asking for a fair assessment of my wife’s claim under the policy we purchased. We deserve clear answers and a fair resolution. #HealthInsurance #InsuranceClaim #ConsumerRights #Policybazaar #AdityaBirlaHealthInsurance #IRDAI #BimaBharosa

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System · 24 Oct 2026, 7:42 pm

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