Max Bupa — max bupa - arbitrarily canceling my health insurance policy

Address:	Hyderabad, Andhra Pradesh, 500081
Website:	maxbupa.com

Hi team,

I wish to log a complaint against max bupa company which is canceling my health policy ([protected]) arbitrarily. I have been a victim of slight miscommunication with the doctor and insolence of max bupa company.

My mother had undergone a minor procedure of hysteroscopy and implanting marine by doctor rooma sinha from apollo jubilee hills, hyderabad. Previously we had consulted with doctor varalaxmi from rainbow hospitals madhapur, hyderabad who had suggested us to go for hysterectomy and pelvic floor repair, which we anyway did not go ahead with.
1. Hysterectomy - due to # bleeding on and off since last 3 years.
2. Pelvic floor repair - due to endometrial mass since 10 years (Which she mistook for '2 years' due to language issues). My mother being a hindi spoken lady and doctor being an english/telgu background, having no common comfortable language.

When i applied for pre-auth request for my mother's procedure from apollo jubilee hills, being a responsible customer i submitted all (Even the previous consultation, although i needed not to) the consultations to max bupa transparently. But i believe there is no value of transparency in the insurance sector, as the claim was rejected. Further, they also canceled my policy quoting clause 3: cancellation by us: you or any insured person has not disclosed the material facts or misrepresented in relation to the policy. They even tried (In writing) relating the # bleeding with endometrial mass which is technical wrong quoting the following, because of which i have a doubt on their team of doctors:
"it has been observed that the patient is known case of endometrial mass since 10 years and bleeding per # on & off since 3 years is a complication of endometrial mass, which falls prior to policy inception date with max bupa."

I have been paying my premiums on time and never claimed a single rupee since inception (Last 4 years). I wish interference from irda to direct max bupa to revoke their decision of canceling the policy since it put the insured at a high risk despite of paying all the premiums and restore the trust in insurance sector.

Insurance details as follows:
Company - max bupa
Product - heartbeat silver 3l 2a
Policy number - [protected] (Running the fourth year)
Sum insured - rs. 3 lakh
Insured persons - shailendra gupta 58 years and rashmi gupta 53 years.
No claims till date since its initial inception (28/02/2015).
Pre-auth claim number - 183808

I have the following scanned copies for your reference, but not able to attach kindly share an email id where i can attach and share with you:

1. 01_maxbupa_policypapers. Pdf - policy papers
2. 02_rainbowhospital_previousconsultation_page12. Pdf - doctor's statement which created concern. At page 12 "c/o mass per # x 10 years".
3. 03_maxbupa_claimdenial. Pdf - pre-auth denial document from max bupa.
4. 04_maxbupa_grievancecommunication. Pdf - grievance communication with max bupa
5. 05_maxbupa_policycancellationnotice. Pdf - policy cancellation notice from max bupa.
6. 06_rainbowhospital_explaination_damagecontrol. Pdf - doctor (Same doctor for point#2) wrote this note for damage control now. I am sending this to max bupa today.
7. 07_rashmigupta_affidavit. Pdf - the affidavit provided to the max bupa company where we have declared that there was a miscommunication due to the language issue.
8. 08_maxbupa_furthergrievancecommunication. Pdf - latest communication with grievance department with affidavit.