Urgent: Star Health Insurance Reduced Cashless Claim from ₹2.4L to ₹78K – Decision Due by 12 PM Tomorrow

Hi Reddit community,

I’m in a critical situation and need urgent advice regarding a health insurance claim with Star Health Insurance. Here’s the situation:

Key Details:

Pre-Approved Amount: ₹2,40,000 (during estimation).

Final Approved Amount: ₹78,000 (after treatment).

Difference to Pay: ₹1,62,000 (out of pocket).

Decision Deadline: Tomorrow by 12 PM.

What Happened:

The hospital applied for a cashless claim, and Star Health Insurance pre-approved ₹2,40,000.

After treatment, the final bill was submitted, and the insurer approved only ₹78,000, citing policy terms and conditions.

I now have to pay the difference of ₹1,62,000, which is a huge financial burden.

What I’ve Done So Far:

Contacted Star Health Insurance for a breakdown of deductions.

Reviewed my policy document but still unclear about the massive reduction.

Spoke to the hospital, but they said the issue lies with the insurer.

Questions for the Community:

Is it normal for insurers to reduce the approved amount so drastically?

What can I do to appeal or negotiate with Star Health Insurance in such a short time?

Should I escalate this to IRDAI or seek legal advice immediately?

Any tips on negotiating with the hospital to reduce the out-of-pocket amount?

Next Steps I’m Considering:

Filing a formal grievance with Star Health Insurance.

Escalating to IRDAI if the insurer doesn’t resolve it.

Negotiating with the hospital for a discount or payment plan.

TL;DR:
Star Health Insurance reduced my cashless claim from ₹2.4L to ₹78K, leaving me to pay ₹1.62L. Decision due by 12 PM tomorrow. Need urgent advice!