Need Expert Guidance on My Existing Health Insurance Issues & OPD Add-On vs. Separate OPD Policy

[itsme.sumit]

exisitng policy details: hdfc ergo optima secure 10L base coverage with no co pay.​

Background – My Insurance & The Road Accident Nightmare​

At the start of 2024, I purchased HDFC Ergo Optima Secure health insurance via PolicyBazaar—a terrible aggregator, but the HDFC Ergo policy itself is decent with no co-pay.

A few months later, I was in a serious road accident, lost consciousness, and was taken to a government hospital by my friend and local police. Upon regaining consciousness, I discovered I had a broken clavicle (collarbone fracture), and the hospital referred me to a higher-end private hospital.

At the second hospital, despite clearly explaining my accidental case and existing HDFC Ergo insurance, they did not follow proper procedures:

• No documentation on whether I was under alcohol/drug influence (which might be required for claims).
• No police report was created again, leading to potential claim issues.
• They treated me as an OPD case instead of hospitalization, completely ignoring my condition.

Being new to such situations, I didn’t question their process. But looking back, it was insane—I had a broken bone, was unconscious earlier(which is mentioned in first hospital receipt), yet they refused proper hospitalization and milked money instead.

The Insurance Disaster – ₹50K Lost in OPD Expenses​

After the OPD consultation, the doctor recommended surgery but advised against it, prescribed meds, and sent me home. At that moment, I was too shocked and focused on recovery to think about insurance claims.

Later, after multiple consultations with different doctors, I spent over ₹50,000 on OPD visits, medications, and travel—only to realize none of it was covered since I was never hospitalized for 24+ hours.

I even called PolicyBazaar’s relationship manager that evening, but they were unavailable after 7 PM. HDFC Ergo customer care was equally useless, only saying, "Everything depends on the doctor’s prescription."

Future Claim Concern – Clavicle Injury Documentation Issue​

Since I didn’t file any claim for my clavicle fracture (as I didn’t opt for surgery), I never took any final clearance from any doctor after completing my prescribed medications.

The last doctor only prescribed iron tablets and pain gel, and thankfully, my fracture healed naturally. However, I still experience some irritation in the area.

Since this injury happened after my insurance purchase, I proactively asked both HDFC Ergo and PolicyBazaar about the claim process if I ever need surgery in the future.

Here’s the major issue:

• I know that MLC (Medico-Legal Case) reports are typically required at the time of claim in accident-related cases.
• But since I never filed a claim, my insurance company hasn’t asked for an MLC yet.
• The hospital that wrongly categorized me under OPD never gave me an MLC, and I have no way to obtain one now.
• If I require surgery or treatment in the next 1-2 years and my insurance company asks for an MLC at that time, how will I provide it?

I raised this concern with both HDFC Ergo and PolicyBazaar, but instead of providing clear guidance, they seemed confused themselves.

👉 How do I handle this missing MLC issue now to avoid claim rejection in the future?

New Health Issues – Gut & Psychological Breakdown​

Since October 2024, I have developed persistent gut issues:
✅ Smelly gas
✅ Sticky stool & constipation
✅ Dizziness, extreme weakness, and zero energy

By January 2025, this escalated into severe psychological issues:
⚠️ Brain fog, carelessness, and lack of focus
⚠️ Suicidal thoughts due to constant weakness and confusion

In November 2024, I consulted a gastroenterologist, who dismissed me as “stressed” just by looking at my weight and age. Still, he did an endoscopy, diagnosed me with gastric ulcers, and prescribed meds.

After completing the full course with no relief, I switched to AIG Hospital in February 2025 for better diagnosis. But here’s the problem:

• Despite my dizziness and extreme weakness, they refused to hospitalize me and kept it strictly OPD. i do not have any complaining about this.
• Hospitals just don’t take you seriously unless you’re bleeding internally or visibly critical.

Need Advice – OPD Coverage, Future Claims & Documentation Strategy​

Since I just renewed my HDFC Ergo policy in Feb 2025, I’m now considering:
🔹 Buying a separate OPD health insurance plan OR
🔹 Finding an add-on to my existing policy

However, I found out that:

• HDFC Ergo does NOT offer traditional OPD add-ons with Optima Secure.
• They do have an alternative add-on, but I was told it’s “not available” for my PIN code, which seems like a nonsense excuse.

💡 People say OPD plans are useless, but based on my experience, that’s false. I’ve already spent a fortune on OPD consultations, tests, and medications, which an OPD policy could have covered.

What I Need Help With:​

1️⃣ How to ensure proper hospitalization in future accident cases to secure claims?
2️⃣ Best OPD coverage options (separate policy or add-on)?
3️⃣ How do I handle the missing MLC report issue for my clavicle fracture to avoid future claim rejection?

Would appreciate any insights from people who’ve faced similar issues! Thanks in advance.

 

[sravanbrahma]

One of my friends parents were using https://even.in/ as their OPD insurance and he said positive things about it. I have no first hand experience with it. But you can research and try it out.

Also one advice on the gut issues based on personal experience. Stop taking meat and Have 10 thick slices of kira and carrot religiously for 45 days in each and every meal, It will definitely show improvement.

Psychological issues can be linked with gut issues as per recent research. Not fully conclusive in researches yet but fix your gut issues, probably psychological issues will go away. If they are not better consult for mental health and exercise well.

 

[dealminer]

Following!

Personaly for me, working out and running long distance weekly really helped me with psychological issues. I suggest you it'll improve your overall health. Even today if I skip any physical activity for more than two days I start feeling anxious and hollow. Humans are not ment to sit idle. If you need any help in that dm me and there are number of threads here too.

And get well soon!
Wait for expert opinion on your situation.

 

[itsme.sumit]

Following!

Personaly for me, working out and running long distance weekly really helped me with psychological issues. I suggest you it'll improve your overall health. Even today if I skip any physical activity for more than two days I start feeling anxious and hollow. Humans are not ment to sit idle. If you need any help in that dm me and there are number of threads here too.

And get well soon!
Wait for expert opinion on your situation.

I am a moderate active person with no cigrette, alcohol or any other drug addiction. At my current state of health i can not go to the gym even though i Walk around 7-10k 4-5 days in a week, my over-all health is rigged up for now. Yea i do try always to be active and in work. And thanks for your support. I appreciate your help

 

[itsme.sumit]

One of my friends parents were using https://even.in/ as their OPD insurance and he said positive things about it. I have no first hand experience with it. But you can research and try it out.

Also one advice on the gut issues based on personal experience. Stop taking meat and Have 10 thick slices of kira and carrot religiously for 45 days in each and every meal, It will definitely show improvement.

Psychological issues can be linked with gut issues as per recent research. Not fully conclusive in researches yet but fix your gut issues, probably psychological issues will go away. If they are not better consult for mental health and exercise well.

thanks for the reference. i did checked about this even opd insurance plan which is called even lite and the premium is around 8.7k after applying 12 month no cost icici offer & an employee sent me a code which doesn't looks unique giving 1.4k discount which is 8.1k premium in total but they are saying that 50% copay will be applicable in case of opd in non serviceable cashless pin code which is my permanent address. on the other hand there is star opd insurance which should be regulated under irdai and they are offering around 50k limit of opd care at 90k premium. i am waiting for an expert guidance as i know nothing much about the catches and etc. and i appreciate your response.

 

[sravanbrahma]

thanks for the reference. i did checked about this even opd insurance plan which is called even lite and the premium is around 8.7k after applying 12 month no cost icici offer & an employee sent me a code which doesn't looks unique giving 1.4k discount which is 8.1k premium in total but they are saying that 50% copay will be applicable in case of opd in non serviceable cashless pin code which is my permanent address. on the other hand there is star opd insurance which should be regulated under irdai and they are offering around 50k limit of opd care at 90k premium. i am waiting for an expert guidance as i know nothing much about the catches and etc. and i appreciate your response.

As of my memory serves he mentioned about the one with out copay. Also if you are looking for expert try ditto. They are insurance advisory and its free of cost. But just look out for spam calls later on.

 

[Lalit]

thanks for the reference. i did checked about this even opd insurance plan which is called even lite and the premium is around 8.7k after applying 12 month no cost icici offer & an employee sent me a code which doesn't looks unique giving 1.4k discount which is 8.1k premium in total but they are saying that 50% copay will be applicable in case of opd in non serviceable cashless pin code which is my permanent address. on the other hand there is star opd insurance which should be regulated under irdai and they are offering around 50k limit of opd care at 90k premium. i am waiting for an expert guidance as i know nothing much about the catches and etc. and i appreciate your response.

I am using even insurance from last 3 years. I have taken even plus membership worth 10 lakhs per year with bangalore pincode so no copay for opd including dental and eye checkup. I find it to be best for opd claims. I have been using it without any issues including free of cost multiple tests ( recommended by doctors). And you will get 3800 off in even plus using my referral.

 

[drvirag]

exisitng policy details: hdfc ergo optima secure 10L base coverage with no co pay.​

Background – My Insurance & The Road Accident Nightmare​

At the start of 2024, I purchased HDFC Ergo Optima Secure health insurance via PolicyBazaar—a terrible aggregator, but the HDFC Ergo policy itself is decent with no co-pay.

A few months later, I was in a serious road accident, lost consciousness, and was taken to a government hospital by my friend and local police. Upon regaining consciousness, I discovered I had a broken clavicle (collarbone fracture), and the hospital referred me to a higher-end private hospital.

At the second hospital, despite clearly explaining my accidental case and existing HDFC Ergo insurance, they did not follow proper procedures:

• No documentation on whether I was under alcohol/drug influence (which might be required for claims).
• No police report was created again, leading to potential claim issues.
• They treated me as an OPD case instead of hospitalization, completely ignoring my condition.

Being new to such situations, I didn’t question their process. But looking back, it was insane—I had a broken bone, was unconscious earlier(which is mentioned in first hospital receipt), yet they refused proper hospitalization and milked money instead.

The Insurance Disaster – ₹50K Lost in OPD Expenses​

After the OPD consultation, the doctor recommended surgery but advised against it, prescribed meds, and sent me home. At that moment, I was too shocked and focused on recovery to think about insurance claims.

Later, after multiple consultations with different doctors, I spent over ₹50,000 on OPD visits, medications, and travel—only to realize none of it was covered since I was never hospitalized for 24+ hours.

I even called PolicyBazaar’s relationship manager that evening, but they were unavailable after 7 PM. HDFC Ergo customer care was equally useless, only saying, "Everything depends on the doctor’s prescription."

Future Claim Concern – Clavicle Injury Documentation Issue​

Since I didn’t file any claim for my clavicle fracture (as I didn’t opt for surgery), I never took any final clearance from any doctor after completing my prescribed medications.

The last doctor only prescribed iron tablets and pain gel, and thankfully, my fracture healed naturally. However, I still experience some irritation in the area.

Since this injury happened after my insurance purchase, I proactively asked both HDFC Ergo and PolicyBazaar about the claim process if I ever need surgery in the future.

Here’s the major issue:

• I know that MLC (Medico-Legal Case) reports are typically required at the time of claim in accident-related cases.
• But since I never filed a claim, my insurance company hasn’t asked for an MLC yet.
• The hospital that wrongly categorized me under OPD never gave me an MLC, and I have no way to obtain one now.
• If I require surgery or treatment in the next 1-2 years and my insurance company asks for an MLC at that time, how will I provide it?

I raised this concern with both HDFC Ergo and PolicyBazaar, but instead of providing clear guidance, they seemed confused themselves.

👉 How do I handle this missing MLC issue now to avoid claim rejection in the future?

New Health Issues – Gut & Psychological Breakdown​

Since October 2024, I have developed persistent gut issues:
✅ Smelly gas
✅ Sticky stool & constipation
✅ Dizziness, extreme weakness, and zero energy

By January 2025, this escalated into severe psychological issues:
⚠️ Brain fog, carelessness, and lack of focus
⚠️ Suicidal thoughts due to constant weakness and confusion

In November 2024, I consulted a gastroenterologist, who dismissed me as “stressed” just by looking at my weight and age. Still, he did an endoscopy, diagnosed me with gastric ulcers, and prescribed meds.

After completing the full course with no relief, I switched to AIG Hospital in February 2025 for better diagnosis. But here’s the problem:

• Despite my dizziness and extreme weakness, they refused to hospitalize me and kept it strictly OPD. i do not have any complaining about this.
• Hospitals just don’t take you seriously unless you’re bleeding internally or visibly critical.

Need Advice – OPD Coverage, Future Claims & Documentation Strategy​

Since I just renewed my HDFC Ergo policy in Feb 2025, I’m now considering:
🔹 Buying a separate OPD health insurance plan OR
🔹 Finding an add-on to my existing policy

However, I found out that:

• HDFC Ergo does NOT offer traditional OPD add-ons with Optima Secure.
• They do have an alternative add-on, but I was told it’s “not available” for my PIN code, which seems like a nonsense excuse.

💡 People say OPD plans are useless, but based on my experience, that’s false. I’ve already spent a fortune on OPD consultations, tests, and medications, which an OPD policy could have covered.

What I Need Help With:​

1️⃣ How to ensure proper hospitalization in future accident cases to secure claims?
2️⃣ Best OPD coverage options (separate policy or add-on)?
3️⃣ How do I handle the missing MLC report issue for my clavicle fracture to avoid future claim rejection?

Would appreciate any insights from people who’ve faced similar issues! Thanks in advance.

as u asked
1: future accident n its plan will depend on hospital and ur condition at that time. for most of the claims atleast 24 hour admission is required unless it is day care treatment. usually private hospitals insure dat u r admitted fot atleast 24 hr. however govt hospitals wish to release pt as soon as possible to avoid paper work specially if it is mlc.
2: no need to take opd coverage. as for small problems u wont take claim and for hospital admission u r already covered
3: no need for missing mlc. As dere ws no case n u hv not taken any claim so for the insurance company u r fit. any1 can hv any problm in future. they will not reject ur future claim just bcoz u hv not taken this claim.

 

[itsme.sumit]

as u asked
1: future accident n its plan will depend on hospital and ur condition at that time. for most of the claims atleast 24 hour admission is required unless it is day care treatment. usually private hospitals insure dat u r admitted fot atleast 24 hr. however govt hospitals wish to release pt as soon as possible to avoid paper work specially if it is mlc.
2: no need to take opd coverage. as for small problems u wont take claim and for hospital admission u r already covered
3: no need for missing mlc. As dere ws no case n u hv not taken any claim so for the insurance company u r fit. any1 can hv any problm in future. they will not reject ur future claim just bcoz u hv not taken this claim.

I am having serious gut issues right now which became persistant from November with no medical history related this. Already spent around 30-40k on opd lol.

 

[itsme.sumit]

I am using even insurance from last 3 years. I have taken even plus membership worth 10 lakhs per year with bangalore pincode so no copay for opd including dental and eye checkup. I find it to be best for opd claims. I have been using it without any issues including free of cost multiple tests ( recommended by doctors). And you will get 3800 off in even plus using my referral.

Dm the referral code to my ib.

 

[drvirag]

I am having serious gut issues right now which became persistant from November with no medical history related this. Already spent around 30-40k on opd lol.

u r having gut issues with no clear diagnosis. then too no company will pay u dis mch opd charges.

 

[itsme.sumit]

I

u r having gut issues with no clear diagnosis. then too no company will pay u dis mch opd charges.

Just the basic diagnosis been done in my case like several blood tests endoscopy and helfty amount of doctor consultation charges along with medicines without figuring out the proper cause.

 

[drvirag]

I

Just the basic diagnosis been done in my case like several blood tests endoscopy and helfty amount of doctor consultation charges along with medicines without figuring out the proper cause.

trust me no company will pay u this mch opd charges whtever policy u take. u cn claim ur tests frm hdfc. i m sure they mst b having option for tests.

 

[itsme.sumit]

I

Just the basic diagnosis been done in my case like several blood tests endoscopy and helfty amount of doctor consultation charges along with medicines without figuring out the proper cause.

MRI CT scans or other critical tests are next ticket of my treatment as per my experience. Which gonna bankrupt me soon😂

 

[S U D O]

exisitng policy details: hdfc ergo optima secure 10L base coverage with no co pay.​

Background – My Insurance & The Road Accident Nightmare​

At the start of 2024, I purchased HDFC Ergo Optima Secure health insurance via PolicyBazaar—a terrible aggregator, but the HDFC Ergo policy itself is decent with no co-pay.

A few months later, I was in a serious road accident, lost consciousness, and was taken to a government hospital by my friend and local police. Upon regaining consciousness, I discovered I had a broken clavicle (collarbone fracture), and the hospital referred me to a higher-end private hospital.

At the second hospital, despite clearly explaining my accidental case and existing HDFC Ergo insurance, they did not follow proper procedures:

• No documentation on whether I was under alcohol/drug influence (which might be required for claims).
• No police report was created again, leading to potential claim issues.
• They treated me as an OPD case instead of hospitalization, completely ignoring my condition.

Being new to such situations, I didn’t question their process. But looking back, it was insane—I had a broken bone, was unconscious earlier(which is mentioned in first hospital receipt), yet they refused proper hospitalization and milked money instead.

The Insurance Disaster – ₹50K Lost in OPD Expenses​

After the OPD consultation, the doctor recommended surgery but advised against it, prescribed meds, and sent me home. At that moment, I was too shocked and focused on recovery to think about insurance claims.

Later, after multiple consultations with different doctors, I spent over ₹50,000 on OPD visits, medications, and travel—only to realize none of it was covered since I was never hospitalized for 24+ hours.

I even called PolicyBazaar’s relationship manager that evening, but they were unavailable after 7 PM. HDFC Ergo customer care was equally useless, only saying, "Everything depends on the doctor’s prescription."

Future Claim Concern – Clavicle Injury Documentation Issue​

Since I didn’t file any claim for my clavicle fracture (as I didn’t opt for surgery), I never took any final clearance from any doctor after completing my prescribed medications.

The last doctor only prescribed iron tablets and pain gel, and thankfully, my fracture healed naturally. However, I still experience some irritation in the area.

Since this injury happened after my insurance purchase, I proactively asked both HDFC Ergo and PolicyBazaar about the claim process if I ever need surgery in the future.

Here’s the major issue:

• I know that MLC (Medico-Legal Case) reports are typically required at the time of claim in accident-related cases.
• But since I never filed a claim, my insurance company hasn’t asked for an MLC yet.
• The hospital that wrongly categorized me under OPD never gave me an MLC, and I have no way to obtain one now.
• If I require surgery or treatment in the next 1-2 years and my insurance company asks for an MLC at that time, how will I provide it?

I raised this concern with both HDFC Ergo and PolicyBazaar, but instead of providing clear guidance, they seemed confused themselves.

👉 How do I handle this missing MLC issue now to avoid claim rejection in the future?

New Health Issues – Gut & Psychological Breakdown​

Since October 2024, I have developed persistent gut issues:
✅ Smelly gas
✅ Sticky stool & constipation
✅ Dizziness, extreme weakness, and zero energy

By January 2025, this escalated into severe psychological issues:
⚠️ Brain fog, carelessness, and lack of focus
⚠️ Suicidal thoughts due to constant weakness and confusion

In November 2024, I consulted a gastroenterologist, who dismissed me as “stressed” just by looking at my weight and age. Still, he did an endoscopy, diagnosed me with gastric ulcers, and prescribed meds.

After completing the full course with no relief, I switched to AIG Hospital in February 2025 for better diagnosis. But here’s the problem:

• Despite my dizziness and extreme weakness, they refused to hospitalize me and kept it strictly OPD. i do not have any complaining about this.
• Hospitals just don’t take you seriously unless you’re bleeding internally or visibly critical.

Need Advice – OPD Coverage, Future Claims & Documentation Strategy​

Since I just renewed my HDFC Ergo policy in Feb 2025, I’m now considering:
🔹 Buying a separate OPD health insurance plan OR
🔹 Finding an add-on to my existing policy

However, I found out that:

• HDFC Ergo does NOT offer traditional OPD add-ons with Optima Secure.
• They do have an alternative add-on, but I was told it’s “not available” for my PIN code, which seems like a nonsense excuse.

💡 People say OPD plans are useless, but based on my experience, that’s false. I’ve already spent a fortune on OPD consultations, tests, and medications, which an OPD policy could have covered.

What I Need Help With:​

1️⃣ How to ensure proper hospitalization in future accident cases to secure claims?
2️⃣ Best OPD coverage options (separate policy or add-on)?
3️⃣ How do I handle the missing MLC report issue for my clavicle fracture to avoid future claim rejection?

Would appreciate any insights from people who’ve faced similar issues! Thanks in advance.

Bro!
a) There are plans with certain day-care treatments included and OPD and certain scans/tests as add-ons. You need to explore. Aditya Birla, Niva Bupa etc do offer such plans i guess.
b) Buy plans with unlimited 100% restoration of base cover. This comes in handy.
c) For your Gut issue, i would suggest you to check for food allergies - you might have acquired gluten allergy or some other allergy. Find out the root cause of your gut issue. I would also suggest you to eat 80% of your appetite only. Do not overeat (ever). Eat less and more frequently. FODMAP diet might help.

I hope you get well soon man!