"I paid for a ₹5 Lakh Policy.
The Bank Paid Only ₹2.3 Lakhs."

I thought I was smart. I had bought a Health Insurance policy online 5 years ago. No agent commission, direct purchase. I paid every premium on time. I felt safe.

Last November, my father was diagnosed with Dengue and his platelets dropped dangerously low. We rushed him to a good corporate hospital.

At the admission desk, the staff asked, "Sir, do you want a Twin Sharing room or a Private Room?"

My father was in pain. I wanted him to be comfortable. I asked, "What is the difference?"

"Twin Sharing is ₹4,000. Private Room is ₹6,500," she said.

I did a quick mental calculation. My policy cover is ₹5 Lakhs. The total bill would be maybe ₹1 Lakh. Why pinch pennies? "Give us the Private Room," I said confidently. That was my ₹2 Lakh mistake.

The Settlement Shock

My father recovered in 5 days. The total hospital bill was ₹1,40,000. I submitted the cashless claim, expecting full payment.

The insurance company approved only ₹72,000. I had to pay the remaining ₹68,000 from my pocket.

I was furious. I called the TPA (Third Party Administrator). "Why? My limit is 5 Lakhs! Why are you paying only half?"

The executive replied calmly, "Sir, your policy has a 1% Room Rent Capping. Your sum insured is ₹5 Lakhs, so your room rent limit is ₹5,000 per day. You chose a room that cost ₹6,500. So, Proportionate Deduction applies."

The Mathematics of Loss

Because I exceeded the room limit by roughly 30%, the insurance company deducted roughly 30-40% from the ENTIRE bill, not just the room rent.

How I Fought Back (And Failed)

I wrote to the Grievance Officer. I argued that the doctor's fee shouldn't change just because the room is different. They replied with a screenshot of my policy document, Clause 4.2. It was there in black and white.

I couldn't recover the money because technically, I had agreed to it. But I learned a life lesson that I am sharing with you now.