Pune Man's Health Claim Rejected Repeatedly, Approved Only After Social Media Outcry

Sumit Kumar didn't expect his wife's illness to spiral into a battle with his health insurer. But that's exactly what happened when a routine hospitalisation turned into a drawn-out dispute with Star Health Insurance, resolved only after he shared his ordeal on social media, according to a recent news report by India Today.

Kumar, a consultant based in Pune, had taken his wife to Manipal Hospital on July 15 after her fever showed no signs of subsiding. Before heading to the hospital, he contacted Star Health, which confirmed that the treatment would be covered under their cashless network, provided the admission lasted over 24 hours.

Reassured, the couple proceeded. Since the outpatient department was closed when they arrived, they were directed to the emergency ward. There, doctors advised immediate hospitalisation due to suspected dengue symptoms. His wife was admitted that evening and remained under observation for over two days.

But the claim didn't go through. Despite the duration of stay and medical recommendation, Star Health rejected it, not once, but three times. The reason? The insurer came to the conclusion that the treatment did not require hospitalisation.

Frustrated, Kumar submitted letters from the treating physician explaining why inpatient care was necessary. Each time, the response was the same. "They kept sending the same copy-pasted messages," he recalled. "Who decides what's necessary—the doctor or the insurance company?"

With no relief in sight, Kumar paid the Rs 41,000 bill himself after negotiating down some discrepancies. But the experience left him emotionally and mentally drained. "You're already worried about your loved one, and then you're chasing paperwork, emails, and calls that go nowhere," he said.

Unable to break through the red tape, Kumar took to LinkedIn on July 26 to share his experience. The post quickly caught on and resonated with those who faced similar troubles. Within 24 hours, the insurer got in touch and reversed its decision, offering to settle Rs 36,000 of the claim. No additional documents were asked for.

Kumar says the only thing that changed was public attention. In a brief response, Star Health said that their claims are reviewed by medical professionals and decisions are made based on documentation and treatment protocols. The company added that discrepancies in the hospital bill required clarification, and that the claim was re-evaluated after revised records were submitted.

While Kumar eventually received partial reimbursement, the incident raises a troubling concern: What happens to those who don't post online, or whose stories don't go viral?