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Hospital Visit Turns Into an Unexpected Battle

Sumit Kumar, a business consultant living in Pune, was faced with every family’s nightmare: his wife had a persistent fever, and local clinics weren’t able to help. After several attempts at getting her better, he took her to Manipal Hospital on July 15. He called his health insurer, Star Health Insurance, before heading there—and was told they would approve a cashless treatment.

A Doctor’s Advice, But Insurer Says "No"

Since the hospital’s outpatient department was closed that day, they went straight to the emergency ward. The emergency doctor quickly started IV treatment and recommended hospitalisation, worried the symptoms might be linked to dengue or that the fever could return. Sumit’s wife was admitted for observation, staying over 48 hours in the hospital.

Sumit even double-checked with Star Health. A representative assured him, “If she is admitted for more than 24 hours, your claim will be approved.” But things did not go as promised.

Three Claim Rejections, No Clear Explanation

Despite following the doctor’s advice and the lengthy hospital stay, Star Health rejected the claim three times. Each time, they responded that “hospitalisation was not medically necessary.” Sumit was left confused and frustrated. “Who are they to decide that over the doctor?” he said.

Trying to resolve things, he submitted three separate letters from the treating doctor explaining the need for his wife’s admission. But Star Health dismissed all the letters with generic, copy-paste explanations.

Emotional Stress and Financial Burden

While dealing with his insurance company, Sumit also spotted a billing error at Manipal Hospital and negotiated the bill down to ₹41,000, which he paid himself for the time being. The financial impact was tough, but dealing with the repeated claim rejections made things even worse. Sumit described the experience as “emotionally exhausting.”

The Turning Point: Going Public on LinkedIn

After being ignored one too many times, Sumit shared his ordeal publicly through a LinkedIn post on July 26. The post quickly got attention, racking up thousands of views and comments, including similar stories from other people. The sudden public scrutiny changed everything. The next day, Star Health called Sumit, apologised, and approved his claim—not for the full amount, but at least ₹36,000.

Sumit didn’t provide any new documents; all that changed was that his complaint went viral. As he said, “We pay premiums for peace of mind, not for mental harassment.”

What the Insurance Company Said

Star Health Insurance explained that their team of medical professionals reviews each claim based on medical evidence. They stated that the paperwork initially submitted didn’t prove the hospitalisation was necessary and that there were also billing discrepancies. The company claimed to have communicated with Sumit during the process and said that once a revised bill and complete case papers were given, the claim was finally processed and paid out.

Final Thoughts

Sumit’s story highlights how insurance claims can be an uphill battle—and sometimes, it takes public attention to get a resolution. For many, it’s a reminder that standing up and speaking out can make a difference, but it shouldn’t take going viral to be treated fairly.