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₹1,15,000 OUT OF POCKET FOR JUST 6 DAYS IN THE HOSPITAL. THEN WHAT’S THE POINT OF HAVING HEALTH INSURANCE?

Aditya Birla Health InsurancePC-2026-02912Insurance ClaimsSanjeev ·
₹1,15,374 PAID FOR MY WIFE’S 6-DAY HOSPITALIZATION. ₹44,000 STILL UNREIMBURSED. WHAT IS THE POINT OF HEALTH INSURANCE? I am raising a serious concern about Aditya Birla Health Insurance and Policybazaar.com over my wife’s hospitalization claim and the lack of meaningful support in resolving it. My wife was hospitalized for six days at Yatharth Super Speciality Hospitals after suffering from persistent fever, mouth ulcers and stomach pain. Despite submitting medical records, our cashless claim was repeatedly rejected on the grounds that hospitalization was “not justified” and treatment could have been managed through OPD. I paid ₹1,15,374 out of pocket. After repeated follow-ups and a complaint through Bima Bharosa, the insurer approved only ₹71,374, leaving ₹44,000 unreimbursed. Shockingly, deductions have also been made from my pre- and post-hospitalization reimbursement claims, adding to my concerns about how these claims are being assessed. My questions to Aditya Birla Health Insurance: Why was ₹44,000 deducted without a clear, itemized explanation linked to the exact policy clauses? Why were ₹17,000 deducted for medicines and consumables? How were ₹12,500 in room and nursing charges calculated? Why have eligible pre- and post-hospitalization expenses also been deducted? If hospitalization was not justified, why was ₹71,374 eventually approved? My policy provides for 0% co-payment. What contractual provisions justify these deductions? I demand a fresh review, a transparent breakdown of all deductions—including pre- and post-hospitalization claims—and reimbursement of all amounts payable under my policy. My questions to Policybazaar.com: I purchased this policy through your platform, trusting you to help me choose insurance that would protect my family. Despite repeated follow-ups and reconsideration requests, I keep receiving the same response: “Your claim is under review.” If your role ends after selling the policy, what value does your post-sale support provide? If you cannot control the insurer’s decision, why not actively escalate the dispute and help obtain clear answers instead of repeating updates already available in the app? I expect Policybazaar to take meaningful action and help resolve this matter. Both companies: I request a substantive written response within 7 calendar days. If unresolved, I reserve my right to pursue the applicable grievance-redressal and legal remedies. Health insurance is purchased for financial protection during medical emergencies—not to spend weeks chasing explanations and fighting unclear deductions. I am not asking for special treatment. I am asking for transparency, accountability and a fair settlement of my family’s claims. #HealthInsurance #InsuranceClaim #ConsumerRights #AdityaBirlaHealthInsurance #Policybazaar #BimaBharosa #IRDAI

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  1. Case filed

    Filer · 25 Oct 2026, 3:31 am

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