What is Your Experience on Ditto Handling Your Declined Health Insurance Claims?

[keneyhector]

Recently, I have come across a post about a journalist claim being declined by HDFC ERGO at https://www.reddit.com/r/personalfinanceindia/s/hl6mftbV68

On the journalist's Twitter thread, someone asked Ditto that why do they suggest HDFC ERGO in spite of being declining customers claim through unethical means. Ditto official handle and it's cofounder replied back saying that the customers who purchased the insurance through Ditto won't face such issues since Ditto fight back with the insurance company through various grievances portal.

As a customer of health insurance, we pay the premium to have piece of mind at money part when we are facing health difficulty. Most of the time, we don't have the mental strength to fight with this crony capitalist insurance companies. Can anyone confirm how much helpful the companies like Ditto when the customers are going through the hassle? If you have first hand experience please share it.

 

[jenlo]

@keneyhector Personal experience was that they were really helpful to fight back.
I had to undergo surgeries and they helped with challenging the decision

 

[keneyhector]

@jenlo What was the final outcome of the challenge? Did Ditto manage to get the claim for you?

 

[jenlo]

@keneyhector Yes, they got it sorted out. But it took few weeks

 

[brittnyest]

@jenlo Which insurance?

 

[jenlo]

@brittnyest HDFC ergo

 

[coahline]

@keneyhector They are really helpful ngl. However, when things reach a dead end, you'll be on your own.

It took me 6months to get my deposit back from a scummy hospital. Ditto guys helped with all the other things tho.

 

[sam2255]

@coahline @coahline What was the policy you claimed for?

 

[joed]

@keneyhector Ditto is a Corporate Agent IRDAI Licence. They are intermediaries that help connect customers.

As a Composite Agent, They can tie up with 9 Life Insurance, 9 General Insurance and Standalone Health insurance companies.
In the end, wherever the commission will be better, that will be pitched and a good brand name will help you offload many plans to people. Because Business bhi chalana hai.

Apart from this, related to claim settlement, the confidence of the intermediary/ Agent / Bancassurance Agent / employees / Any sales person doesn't matter because they are not paying a claim to you from their own pocket but the insurance company is the one who will pay the claim. In this case, the wierd reply that tension is the reason for claim rejection is a problem, as this needs to be justified by the insurance company.

So whenever anyone says that We will fight for the insurance customer to bring them justice and force the insurance company to pay the rejected claim is hammering their own foot while trying to sound Macho About it. Because you are walking on a rope with Insurance company having scissors handy just in case. Actuaries, Underwriters, MD Doctors, Analyst are a hell lot smarter and they know how to earn profit on every premium amt.

If you genuinely want 100% transparancy in the system, why not let all Intermediay / agent / Bancassurance/ Insurance Company list Their commission structure to the public ? Of how much they are earning on each sale and Additional perks / variable Payout structure that are provided by the same. They can't because this will be beneficial to the customers.

Make a process where If the Corporate Agent/ Bancassurance employee / agent / bank / Any sales person can be barred from selling insurance for 10 months in case of mis-selling and legal action can be taken where Commission for the equivalent months will be stopped. Do you think any Insurance Company via bank, agent, intermediary will try mis-selling if they know their license will be revoked for 10 months, where they can't do sales but have to provide servicing to all existing customer ?

There are 2 sides to this as The important, strength of an insurance company helps a nation grow and strengthen as well.

I have some ideas about it and am learning about the insurance sector as I am Studying for the Actuarial Science.

 

[winbuildsend]

@keneyhector I recently contacted Ditto and they advised me to go ahead with HDFC Ergo, seeing these comments I am a bit worried..any other good health insurance company any one of you can suggest me - for.myself and family?

 

[musician1975]

@winbuildsend Literally in the same boat. Few weeks back, searched online (including this sub) ultimate conclusion was HDFC ergo is best... But now this??

 

[kristenk89]

@musician1975 Mee too

 

[apostoliclife]

@winbuildsend Ergo is the best of the lot.

My guess is that in some of these declined cases there could be things like pre-existing diseases not disclosed correctly.

 

[kellya]

@apostoliclife Do yourself a favor don't waste money on this, just build a medical fund

 

[kellya]

@keneyhector I think I'm in a good position to answer this.

At the moment I'm fighting a claim, and ditto has helped to the extent they can.

But HDFC has rejected my claim and cancelled the policy and kept the entire premium paid upfront.

Ditto has now handed my case over to "Insurance Samadhan" and they did all the work for me and gave me stuff to mail the Insurance Ombudsman in the city.

Now the thing is, Ditto apparently is doing whatever they can. I took all the provided paperwork and just signed it and sent it to the Insurance Ombudsman, but I heard nothing back.

I am losing hope of getting my claim / refund or any money for that matter and from now on building a medical fund instead of wasting money on this Insurance scam.

Edit:

My experience with HDFC has been really bad and won't recommend it. At this point I think they've spent a lot of money to craft their image via marketing but in reality all of them are the same. Don't waste your money.

Edit 2:

They rejected on the basis of PED, and I submitted doctors certificate with specific timelines of illness and they just ignored it and denied the claim anyway. Also cancelled the policy and kept the entire premium amount 32k

Edit 3:

Ombudsman is not even replying been a whole month

 

[sunsable]

@kellya I have had experience with the rejections from star health insurance, I shamelessly kept bothering the star health Twitter handle and tagged their CEO in all other insurance portals handles and tagged national consumer helpline, NSR, RBI, Income tax department and who so ever I felt like and made a mockery of star health for few months and then they budged and released some more amount. Just try doing it, they might listen to your issues as it will affect their marketing

In the mail, I kept mailing the insurance ombudsman, IRDAI, but I think this didn't help much as I didn't get replies.

In short, everybody wants your money in India, but no one does the job for which they take your money for, the biggest culprit in the system is the government itself.

 

[kellya]

@sunsable I tagged them on Twitter and they're just copy pasting old response...

 

[sunsable]

@kellya Yeah they keep doing that. They test our perseverance, it took almost two months for me to get my issue resolved.

 

[andreaibaya]

@sunsable

In short, everybody wants your money in India, but no one does the job for which they take your money for, the biggest culprit in the system is the government itself.

Not if you are rich. If you have a large deposit in HDFC or is an HNI customer with HDFC Bank (or any other bancassuarance), they will try everything from their end to get you your money. The reason being, they are in need of deposits and the future business with you. But if you are nobody who took health insurance with ditto or through any other means, you are just one among a thousand donors to their pooling account from which will pay their lawyers or handlers to fight you. It all depends on what brings them profit.

Now with a rich customer of theirs , it's a totally different ballgame. These HNIs will be having crores sitting with their accounts in HDFC. They won't lose their business to some other banks because of a health insurance claim.So HDFC will dance to the customer's tune.

Now again, think about it. A needy person who might be living paycheck to paycheck or might be having a six month salary as an emergency fund will probably lose his money due to this behaviour by the insurer. For the other person , who can pay off the bill from his pocket, who is having crores sitting in their account, will get the whole insurance benefit and most of the money he gave to the hospital. All of this from the pooling account to which we the fucking commoners paid for. Thus the rich didn't lose their money and can invest or keep their money in their pocket while the middle class who are in actual need of the reimbursement/ cashless calim will lose their savings and will drop back in their financial position.

This is the reality of India.

 

[sunsable]

@andreaibaya Yeah agreed, but those HNI ppl will have a network in such a way that they don't even get into such trouble.

India was , is and will be a place that supports Paisa phek tamasha dekh.