[Resolved] Max Bupa Health Insurance — BEWARE of Fraudulent Sales Tactics | |||
The Insurance industry is supposed to have a very strong governance system however it seems liek MAX BUPA has been able to circumvent those through loop holes! The Direct Sales team made sweeping commitments while selling the policy, and one really does not want to think o[censored]sing a health policy as it means some one near and dear being unwell or some thing unfortunate happening. I was told that if I take the GOLD plan then pre-existing diseases would be covered. I asked if there were any tests required - I was told that no there would be no need. When My wife developed pain in the head where there had been a lump but with no pain for a few months we decided to go to the doctor as over the last few weeks the size had started increasing and the pain had started to become constant! The doctor recommended that the cyst be excised as it may cause an infection, though it is not an "Emergency" it would be better to get it done ASAP. This was noted in the pre-Auth form and sent to the Insurer for approval. The strange part is that you are asked to pay for a whole year of cover but the policy covers you for only 275 days! The definition of pre-existing is fuzzy.... if something surfaces after the policy is taken then it becomes pre-existing! The insurance company makes you feel as if you are a fraudster trying to cheat the system whereas it is actually the other way around. If you call the customer care - they tell you that it is the sales team and they may have made commitments that we are not aware of! The mail trail of communication is attached. [protected][protected][protected][protected][protected][protected][protected][pr...⇄ Dear Insurer, I am a little concerned about the manner in which this request has been dealt with. 1. The Advisor ( DST Mr. Naveen. R. under Team Leader Mr. Kush Khurana)who had met with me to get the policy had, in no uncertain terms confirmed that per-existing conditions were covered under the plan if I was to take the GOLD plan. 2. The need to approach the doctor only came up because in the last couple of days my wife is experiencing severe pain in the head originating from the Follicular cysts of skin and subcutaneous tissue on the scalp. Since it has started causing discomfort and there is an enlargement it obviously is important that the same be attended to at the earliest. It may not be classified as an emergency however it would definitely be prudent to have the same excised to prevent infection, considering that it is on the scalp. 3. Would your honourable medical team suggest that just because it has a 90 day hold period one should risk the spreading of infection? 4. I paid for a ONE YEAR cover!!! By putting in a clause of 90day hold period Max Bupa is in fact offering a cover only for 9 months for the money that was to cover us for 12 months. 5. Wilfully misleading a customer to gain a proposal due to year-ending is gross Misconduct! I have been cheated and misled to believe that My family and I have a medical cover of 365 days when it is actually only 275 days. I have been lied to when I was told that the policy covers pre-existing ailments and that I did not have to worry!!! I fairly certain that the consumer forum will be happy to interact with your representative on this case. Your organization is playing with the lives of people for making a quick sale during the year end pressure!!! Putting people in the FALSE SENSE OF SECURITY that MAX BUPA is with us in our times of need!!! Warm Regards Subir Sen ________________________________________________________________________________...⇄ The People-i Consult |Villa #13 Hyde Parkk, Rustamji Layout, Whitefield Main Road, Bangalore 560066 |Mobile +[protected] | Email: subir.[protected]@subirsen.com [protected][protected][protected][protected][protected][protected][protected][pr...⇄ Dear Mr. SUBIR SEN, With reference to the pre-authorization request received in respect of Ms. SEEMA SEN for treatment in Manipal Hospital, Bangalore we regret to inform you that the request has been denied. Please find details of our response in the attached document. Thank you for availing our services. For and on behalf of Max Bupa Health Insurance Company Authorized Signatory [protected][protected][protected][protected][protected][protected][protected] Dear Sir / Madam, We refer to your Pre-Authorisation request for the above customer. Our medical consultants appreciate your sending the information to us and have processed the same. We, however, regret to inform you that we cannot issue a Letter of Authorization for the hospitalisation of the above customer due to reasons detailed below: Admission date is within 90 days waiting period The pre-auth and documents provided mentions that the patient has ailment since 6 months which is pre-existing to the policy and was also not disclosed while taking the proposal. Also the pre-auth request is received for planned hospitalization within 90 days of taking the policy. Hence pre-auth request is denied under clause 4a & 4b " Pre-exisiting disease" and under "90 days waiting period applicable for planned hospitalization". We, therefore, request you to kindly contact SUBIR SEN with regard to settlement of your bills. In this matter, the customer has been notified today. We request you to share a copy of this letter with the customer. In event of all your queries please feel free to contact our Customer Service Helpline[protected]Toll Free) or[protected] or mail us at customer.[protected]@maxbupa.com. Was this information helpful? | |||
Aug 13, 2020 Complaint marked as Resolved | |||
 16 Comments | |||
Comments
Hi,
My Customer ID is 18810, by the name of MOHD IMRAN
I was hospitalize in Max Saket emergency yesterday night for treatment.
At the time of discharge in morning, surprise and disappointed to know that the cashier deny to consider my health policy. I had requested him to cross check with some of your person as this was covered under my plan (I was told by your executive during the time of taking policy that your persons are always there to assist) but again they deny to consider.
I had no choice except to clear the dues at that time. Later on I had called to cust care no and your representative says it is reimbursable and they did mistake by billing you, and I need to courier all document to you and it will take 10-15 days to get reversal.
I am extremely disappointed on this. Why should I suffer due to your mistake. at the time of signing of the policy you guys ready to come at our place 'N' nos of time, then why can't you help us to send somebody who can come and collect all document.
Kindly do the necessary so that my claim get reimburse.
Didnt expect this from MAX BUPA.
Regards
Mohd Imran
[protected]
My Customer ID is 18810, by the name of MOHD IMRAN
I was hospitalize in Max Saket emergency yesterday night for treatment.
At the time of discharge in morning, surprise and disappointed to know that the cashier deny to consider my health policy. I had requested him to cross check with some of your person as this was covered under my plan (I was told by your executive during the time of taking policy that your persons are always there to assist) but again they deny to consider.
I had no choice except to clear the dues at that time. Later on I had called to cust care no and your representative says it is reimbursable and they did mistake by billing you, and I need to courier all document to you and it will take 10-15 days to get reversal.
I am extremely disappointed on this. Why should I suffer due to your mistake. at the time of signing of the policy you guys ready to come at our place 'N' nos of time, then why can't you help us to send somebody who can come and collect all document.
Kindly do the necessary so that my claim get reimburse.
Didnt expect this from MAX BUPA.
Regards
Mohd Imran
[protected]
This is very peculiar that Max bhupa sales representation was chasing me for the insurance (Medical policy)He insisted me a lot than I took the same for my son and my daughter in law. I paid an amount of Rs5071 but the actual insurance receipt I got is for Rs.3172/- fact at the time of given cheque the max bhupa reprsentative assured me to refund the balane amount within a week along with policy.but so far i have received policy only without my refund cheque .I tried to contact the repsentative but every time he disconnect my telephone my cutomer ID [protected]. it seems that there is no customer service after the insurance .only at the time of issuing insurance policy they will come to you again and again after insurance no[protected].
I again request that balance amount may be refunded to me immidiatly if not please refund my total amount.Since you are not providing me proper after insurance service.
I again request that balance amount may be refunded to me immidiatly if not please refund my total amount.Since you are not providing me proper after insurance service.
Sorry for the bitter experience. Thanks for sharing the information and saving me to be a prey to them. I Planned 3 X 10K. meaning along with my friends and relatives. While reading the letter I felt the pain, what you might have realised.
They are big cheater. They simply decline the claim. Their customer care have no clue about the reason for decline.
Same thing happened with policy I took for my close friend. Even though a valid claim they simply rejected saying pre- existing .
They are big fraud and don't pay a single rupee to anyone. Only option I am left with going to insurance ombudus.
Same thing happened with policy I took for my close friend. Even though a valid claim they simply rejected saying pre- existing .
They are big fraud and don't pay a single rupee to anyone. Only option I am left with going to insurance ombudus.
Hi,
My name is Souvik kandari, i am also a customer of max bupa.
I am dissatisfied With Mr.subir sen Because in my case i have got the pre authorisation within 15 min after 30 days of purchasing the policy.
Yes that is true that max bupa cover the hopitalization after 90 days but the its cover emergency and accident after 24 hours of purchasing the policy. As in my case i was addmitted in emergency condition, my nose was bleeding suddenly and i had rush to the hospital and within 15 min i had got the pre auth and max bupa had paid whole 1, 38, 000 to the hospiatl. But in case of Mr. Subir sen, As It was not emergency, It was planned.And planned is covered after 90 days.
And The pre existing condition is there in every company, if any company find out that the following illness that you want to claim for has been there in your body before taking the policy then no company will give any claim. In my case i have a Blood pressure and i know that my illness will be covered after 48 months, so if i had taken any claim of diabeties then oviously it would not be covered.
If the customer Disclose its medical history to the company at the time of taking the policy so, the company will be also provide the services that its promised for.
In my case i am satisfied customer of max bupa, for last Three Year and i have also Available maternity benefit claim for my wife, and the best part was that my baby was born with jaundice and with low weight, and he has to be sent in incubation for 8 days, the total cost was given by max bupa.
So i belive in max bupa
Regards
Souvik kandari
My name is Souvik kandari, i am also a customer of max bupa.
I am dissatisfied With Mr.subir sen Because in my case i have got the pre authorisation within 15 min after 30 days of purchasing the policy.
Yes that is true that max bupa cover the hopitalization after 90 days but the its cover emergency and accident after 24 hours of purchasing the policy. As in my case i was addmitted in emergency condition, my nose was bleeding suddenly and i had rush to the hospital and within 15 min i had got the pre auth and max bupa had paid whole 1, 38, 000 to the hospiatl. But in case of Mr. Subir sen, As It was not emergency, It was planned.And planned is covered after 90 days.
And The pre existing condition is there in every company, if any company find out that the following illness that you want to claim for has been there in your body before taking the policy then no company will give any claim. In my case i have a Blood pressure and i know that my illness will be covered after 48 months, so if i had taken any claim of diabeties then oviously it would not be covered.
If the customer Disclose its medical history to the company at the time of taking the policy so, the company will be also provide the services that its promised for.
In my case i am satisfied customer of max bupa, for last Three Year and i have also Available maternity benefit claim for my wife, and the best part was that my baby was born with jaundice and with low weight, and he has to be sent in incubation for 8 days, the total cost was given by max bupa.
So i belive in max bupa
Regards
Souvik kandari
I tried to contact the repsentative but every time he disconnect my telephone my cutomer ID [protected]. it seems that there is no customer service after the insurance .only at the time of issuing insurance policy they will come to you again and again after insurance no[protected].
There is very bad services of the customer. i have tried on[protected] and[protected].
but no one is responses.I have recorded call . i will go to court with full proof.
but no one is responses.I have recorded call . i will go to court with full proof.
Beware of this services.
As per my experience its a very good co. in relation to the service and the response and the claim. My claim amount was of rs 57540 rs and i got the full amount without any deduction I took a gold plan for my family where me my wife and my kid are covered, it was a small surgery for stone removal . I had a very good response from " MR VARUN SHARMA " of DST team he guided me the right policy according to my requirement, He is a nice and a gentle man. . I am planning a policy for my parents this APRIL, would suggest all the people to go ahead with the policy, ya but do read all the documents before taking it as MR. VARUN has suggested me to do the same and i'm very much satisfied with the way he responded and thanks to MAXBUPA for the same .
Regards,
Girish K.
Regards,
Girish K.
Dear Mr. Judah,
As per your conversation with our customer service team, we are specifically asking for details of the ailment mentioned in the email sent across. Without that it's difficult for us to proceed further. Its our sincere request to you, to send the details at the earliest.
Many Thanks,
Team Max Bupa
As per your conversation with our customer service team, we are specifically asking for details of the ailment mentioned in the email sent across. Without that it's difficult for us to proceed further. Its our sincere request to you, to send the details at the earliest.
Many Thanks,
Team Max Bupa
Dear R K Judah,
Thank you for providing us all the document details. We have thoroughly gone through your policy and claim details and we are sorry to inform you that your claim has been declined. As per medical documents, patient was suffering from the said ailment since the past 4 to 5 years & the same was not disclosed at the time of taking the policy . We, therefore, regret to inform you that we are not in a position to pay the claim due to non disclosure of material fact by you.
We once again apologize for the inconvenience caused to you.
Many Thanks,
Team Max Bupa
Thank you for providing us all the document details. We have thoroughly gone through your policy and claim details and we are sorry to inform you that your claim has been declined. As per medical documents, patient was suffering from the said ailment since the past 4 to 5 years & the same was not disclosed at the time of taking the policy . We, therefore, regret to inform you that we are not in a position to pay the claim due to non disclosure of material fact by you.
We once again apologize for the inconvenience caused to you.
Many Thanks,
Team Max Bupa
I am Sandeep with customer id- [protected] and my healthcare provider is Max Bupa Health Insurance, a customer since January 2011
Background
Please treat this email as an escalated complaint for the services that Max Bupa has denied me. In the month of November 2013 i am diagnosed with Varicose veins problem as i was experiencing pain in my legs for a week, the doctor eventually suggested bilateral surgery and i submitted the documents for pre authorization request on the 5th of December, the hospital Nova super specialty has informed the of the condition to Max Bupa and provided documents what ever they have requested including details that it has been diagnosed in the month of November and the hospital has no history that it was an existing condition.
Current Situation
Max Bupa have rejected me cashless and sent me an SMS confirming that it has been denied
Reason for Denial they gave
Max Bupa have informed me that this is a pre-existing condition and that is why the cashless has been rejected, they are asking to go for cash payment.
Dispute
The above medical condition is not a pre-existing as it was diagnosed for the first time in the month of November 2013 and no history is available with the hospital prior to this diagnosis, there is no reason for them to force me for only cash payment and they said that after making cash payment i can apply for claim reimbursement but Nova super speciality is a network hospital and as per the terms and conditions i can avail cashless.
Reason for dispute
1. If this condition existed in the past i would have got it treated long ago, the policy was taken originally in January 2011 and i have asked for cashless only after getting diagnosed with this medical condition, which was in November 2013.
2. I have accepted their offer of policy as they offered my cashless facility during the time of medical condition, this medical condition above mentioned by all means is eligible for cashless facility.
3. I am adhering to the policy terms and conditions and requested Max Bupa to do the same, i also advised that the hospital and the doctor could give you additional clarification if needed and i believe they have already done that by confirming that the medical condition was diagnosed in the month of November 2013.
I reminded them that cashless facility can't be rejected on the reasons they gave which is totally baseless, and it would be a breach of trust and acceptance of health cover policy.
I look forward to receiving a positive statement from you and hope that my complaint would be considered carefully, i further anticipate that the issue will be resolved at the earliest
since the hospital advised that the cost of surgery would be around 130, 000 rupees, i advised that they can't force me for Cash payment as i am entitled for cashless.
I also want to add that first sent email the email complaint on the 8th December to max Bupa and a follow mail was sent by me again on 12th December and till date there is no written communication, the overall communication from Max Bupa has been bad.
What a terrible experience with MAX BUPA, no wonder they want to make profits at the cost of innocent people, but the matter has just started with ombudsman, subsequently with district consumer forum.
Background
Please treat this email as an escalated complaint for the services that Max Bupa has denied me. In the month of November 2013 i am diagnosed with Varicose veins problem as i was experiencing pain in my legs for a week, the doctor eventually suggested bilateral surgery and i submitted the documents for pre authorization request on the 5th of December, the hospital Nova super specialty has informed the of the condition to Max Bupa and provided documents what ever they have requested including details that it has been diagnosed in the month of November and the hospital has no history that it was an existing condition.
Current Situation
Max Bupa have rejected me cashless and sent me an SMS confirming that it has been denied
Reason for Denial they gave
Max Bupa have informed me that this is a pre-existing condition and that is why the cashless has been rejected, they are asking to go for cash payment.
Dispute
The above medical condition is not a pre-existing as it was diagnosed for the first time in the month of November 2013 and no history is available with the hospital prior to this diagnosis, there is no reason for them to force me for only cash payment and they said that after making cash payment i can apply for claim reimbursement but Nova super speciality is a network hospital and as per the terms and conditions i can avail cashless.
Reason for dispute
1. If this condition existed in the past i would have got it treated long ago, the policy was taken originally in January 2011 and i have asked for cashless only after getting diagnosed with this medical condition, which was in November 2013.
2. I have accepted their offer of policy as they offered my cashless facility during the time of medical condition, this medical condition above mentioned by all means is eligible for cashless facility.
3. I am adhering to the policy terms and conditions and requested Max Bupa to do the same, i also advised that the hospital and the doctor could give you additional clarification if needed and i believe they have already done that by confirming that the medical condition was diagnosed in the month of November 2013.
I reminded them that cashless facility can't be rejected on the reasons they gave which is totally baseless, and it would be a breach of trust and acceptance of health cover policy.
I look forward to receiving a positive statement from you and hope that my complaint would be considered carefully, i further anticipate that the issue will be resolved at the earliest
since the hospital advised that the cost of surgery would be around 130, 000 rupees, i advised that they can't force me for Cash payment as i am entitled for cashless.
I also want to add that first sent email the email complaint on the 8th December to max Bupa and a follow mail was sent by me again on 12th December and till date there is no written communication, the overall communication from Max Bupa has been bad.
What a terrible experience with MAX BUPA, no wonder they want to make profits at the cost of innocent people, but the matter has just started with ombudsman, subsequently with district consumer forum.
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We at Max Bupa are very keen to hear about the aspects of your Policy that you believe can be improved. If something does not go well and as expected or promised, here are some simple ways to ensure that your concerns are dealt with as quickly and effectively as possible.
Step 1:
Our helpline is always the first number to call if you have any comments or feedback. Please call us on Toll Free number[protected] . Alternatively write to us at
Customer Services Unit
Max Bupa Health Insurance Company Limited
D-1, 2nd Floor, Salcon Ras Vilas, District Centre, Saket, New Delhi-110 017.
Step 2:
If the resolution has not met your expectation, kindly write to
Mr.Amit Bhatia
Deputy Manager – Customer Services
Click here
Step 3:
If we have not been able to resolve the issue and you wish to make a further suggestion or a complaint, please write to:
Ms. Anjana Agrawal
Head – Customer Services & Operations
Click here
Step 4:
If after having followed Steps 1, 2 and 3, in the rare case that we have not been able to resolve your concern, you can address the same independently to the Insurance Ombudsman Office.