[Resolved]  Policybazaar.com — Denial of claim by Max Bupa, policy sold by policybazaar.com with wrong information about portability & pre-existing diseases

Address:

Kolkata, West Bengal

Ref: Max Bupa Customer ID:[protected]: Denial of claim I and my family were insured with The New India Assurance Company Ltd in the Good Health Plan through my Citibank credit card since 2002. Thankfully, we never had the need to ever make a claim. Unfortunately, we decided to port our policy to MaxBupa this year to their Family Floater plan. Since our policy date was the 28th of feb, we started the process in early january this year. We decided to do so through Policybazaar.com and the person guiding us through this entire process was Mr Vinod Kumar. After filling in innumerable forms via Policybazaar, we were told that the policy has successfully been ported. We were informed that only one year would be ported, but that would not make any difference to our cover since there would be no exclusions for any pre-existing diseases. Both o[censored]s being doctors and so being aware of the loopholes of mediclaim policies and the usual trend of health Insurance companies to deny claims and create obstructions for the claimants, we were very anxious about the pre-existing exclusions. We were repeatedly reassured by Mr Vinod Kumar that even though only 1 year was being ported, there were absolutely no exclusions and we had nothing to worry about since the newly ported Max Bupa policy would be treated as a 12 year old policy since 2002. Since both my wife and I are doctors ourselves and since we are both fit and well, we did not foresee any problems after being assured repeatedly that our policy would document the no exclusion part which is in fact mentioned clearly on Page 4 of our policy document. We confirmed this on receiving the policy documents and were again reassured by Mr Vinod Kumar. My wife had acute abdominal pain in end of june this year. Since we are both doctors, we initially treated this with medicines. However, when the pain persisted, she consulted a surgeon colleague and was advised a USG whole abdomen. This revealed the presence of gallstones. She had incidentally undergone a USG in june 2013, which had been reported normal, the report of which had been forwarded to Max Bupa. She has also been experiencing heavy periods for the past 6 months. Her Gynaecologist colleague felt that this should be investigated by a Hysteroscopy and biopsy since this was not settling with medication and cancer should be excluded in her age group. We were denied cashless benefit based on two allegations: 1.The gallstones were pre-existing. 2. The severe menorrhagia was not disclosed in the application form We refute these allegations because: 1. There is a USG report from june 2013 which does not show gallstones 2. Severe menorrhagia means heavy menstrual periods which is persistent and repetitive. My wife did not have a problem in january when we filled in the forms for Max Bupa for the porting of the policy. Her heavy periods started around March. So it was impossible for us to predict in January that she would start having heavy periods 2 months later.It is also not appropriate to expect us to fill in symptoms in the application form. Menorrhagia is a symptom, not a disease. On hearing of this denial, my wife repeatedly phoned Mr Vinod Kumar from the 31st of July to the 2nd of August since her operation was scheduled for the 5th of August. He was totally unable to help and appeared to be absolutely clueless about pre-existing exclusions. He had himself reassured us repeatedly at the time of selling the Max Bupa policy to us and so it was now shocking to discover that he had probably just quoted false information to us in Jan-Feb 2014 just to get us to buy the policy.. We feel extremely insulted and humiliated that after having an insurance policy for 12 years, we are still being treated with suspicion and disrespect. Even after personally talking to the Max Bupa doctors, we could not have this simple problem resolved, which leads us to suspect both the quality and the intent of their medical staff. My wife has undergone the surgery as scheduled on the 5th of August. The embarassment for us was our surgeon and gynaecologist colleagues initially refusing to take their due fees since the mediclaim was denied and it is awkward for them to charge us. This whole episode has left us feeling rather bitter and cheated. It reinforces our opinion that the primary aim of the insurance companies is to deny all claims, however genuine and legitimate they are. And the primary aim of organizations like Policybazaar.com is to make false promises to clients online and cheat them into buying policies. Most people are very suspicious about buying policies online, which you have just proved right ! I have made an official complaint to Max Bupa & will also forward this letter to IRDA to take action against Policybazaar.com so that you will think twice before cheating customers with fake promises and misleading them just to be able to sell them a policy. Yours sincerely, Dr. G R Vijay Kumar Senior Consultant Neurosurgeon Fortis Hospital, Kolkata Mob: [protected] E mail - [protected]@hotmail.com