A Comprehensive Analysis of HDFC Ergo Health Insurance Claims Experience

Introduction

Have you ever made any claims against HDFC Ergo Health Insurance? If so, was it a good experience? In this article, we delve into my personal experiences and share insights on the overall claims process with HDFC Ergo. While there have been some challenges, the overall experience has been positive.

A Positive Claims Experience with HDFC Ergo

Throughout my interactions with HDFC Ergo, I have had multiple experiences with their health insurance claims. It is important to note that, barring a few instances, the experience has overwhelmingly been positive.

Claim #1 - 2020 Cashless Claim for Client A

In December 2020, one of my clients required a cashless claim. The hospital bill was approximately Rs. 110,000. After submission, HDFC Ergo deducted only Rs. 1,680, with the remaining amount being promptly paid by the insurance company. This exemplifies the efficiency and reliability of their claim processing.

Claim #2 - 2020 Cashless Claim for Client B

Another client faced a similar situation in December 2020 with a bill of approximately Rs. 131,000. Initially, the insurance company covered only around Rs. 94,000, leaving a balance of approximately Rs. 37,000 to be paid by the client. After persistent follow-up, HDFC Ergo eventually reimbursed Rs. 36,500 out of the remaining Rs. 37,000. This resulted in a total bill coverage of Rs. 130,500, with just Rs. 500 deducted.

Claim #3 - Delayed MAIN HOSPITALISATION Expense Claim

One of the more challenging instances involved a claim for MAIN HOSPITALISATION expense. My client required cataract surgery and we had already compensated the initial amount out-of-pocket. Then, after discharge, we submitted two sets of documents: one related to PRE and POST HOSPITALIZATION expense and the other for MAIN HOSPITALISATION expense. While the PRE and POST HOSPITALIZATION expense was approved promptly, the MAIN HOSPITALISATION expense has been pending for 38 days as of the time of writing.

This situation arose due to an internal mistake by HDFC Ergo, who initially miscalculated the claim based on an incorrect assumption of a two-year waiting period. After clarification and follow-up, the claim was accepted and has remained pending. However, HDFC Ergo is committed to resolving this issue and ensuring the claim is processed promptly.

Conclusion

Is a 100% perfect claims experience possible with any health insurance provider? Unfortunately, no. However, HDFC Ergo stands out as a company that delivers on claims consistently and promptly. While there may be occasional hiccups, the overall service is commendable.

HDFC Ergo remains a reliable choice for health insurance, and I highly recommend it to those in search of a trustworthy and efficient insurance provider.