[Resolved]  Max Bupa Health Insurance Delhi — claim denied by max bupa

Address:Gurgaon, Haryana

India Consumer Complent Forum.
Dear Sir/Madam.
I had taken health policy for my wife from Max Bupa Health Insourance of India.I am giving details as under.Max Bupa has been denied my claim case.They have cheated me.

Subject---Request for claim for Policy no-[protected],ID No-[protected]

Dear Sir,
I sunil kumar having the health policy on the name of my wife Pushpa Yadav as mentioned above .I purchase this policy by your executive Mr Manish Chabra when he traced me up to four months and after convincing me by the doctors team of Max Bupa Health Insurance and that time your doctors team said to me that there is no requirement of medical checkup for my wife Pushpa Yadav, I gave every information about my wife Pushpa yadav to your doctors team . I asked with your doctors & executive about the covering of diseases in your health policy then they said to me that they (Max Bupa Health Insurance) covers all diseases except aids and they said also if patient admits in any panel hospital of Max Bupa Health Insurance for half an hour or more than it then there is cashless treatment and if patient go in other hospital(which is not in the panel of Max Bupa Health Insurance) and admits for half an hour or more than it then bills would be claimable on Max Bupa Health Insurance.After that I purchase your policy.

Suddenly on[protected] my wife Pushpa Yadav have experienced a serious pain in his throat and soiling and she was unable to consumption anything then I discussed with your executive Mr Manish Chabra & your doctors team and they suggested me to visit at Max Hospital at gurgaon ,on[protected] I visited at Max Hospital Gurgaon there I met with Dr Viwan Talwar and they said to me that it is an emergency case and medical test endoscope is necessary in this case , endoscope have been done at Max Hospital Gurgaon and after that other following medical test also have been done on the direction of Dr Viwan Talwar.
(1)FNAC (2)MONTAUX(3) X-RAY of chest and paid the fee of all these test by cash
After getting the report of all medical test Dr Viwan Talwar said to me due to emergency case operation is urgent and Surgeon told me for operation estimate and it was of RS-25000(Date[protected] and said it may also increase of RS 10000 More depend on the condition of patient after saying about the holder of health policy of you,
They replied me to deposit all the documents of health policy of Max Bupa Health Insurance they replied to my wife to come on next day and also said they will contact to concerned person of Max Bupa Health Insurance,Next day when my wife visited at Max hospital they answered that they did not get any reply from Max Bupa Health Insurance hence deposit estimated amount for operation.
When I did not get any co-operation from your staff I went to Tirathram Hospital Gurgaon (because my wife condition was serious) and at late night the Doctors of Tirathram Hospital Gurgaon discussed with the doctors team of Max Bupa Health Insurance team,and after assuring by Max Bupa Health Insurance doctors team that it is a claimable emergency case and operation sould be done,and operation has been done on[protected] and discharged on[protected] and after that I submitted all documents of both hospitals at your office by Speed registered post then I got a sms on my cell from your side that within 15 days claimed amount would be given to Pushpa Yadav and on[protected] I got a letter (claim no-39) and in this letter there was requirements of some documents,I have submitted all required documents but I got a sms on[protected] from your side that claim no-39 has been denied., on contacting with you the following reason has been said for denying claim-
1) The waiting period of 90 days not been cover
2) This disease can not be covered

But in your policy it is mentioned that for emergency case claim is applicable ,and it is not mentioned in your policy that the disease by which Pushpa Yadav was suffered is not cover in your policy and also not mentioned that case was not emergency.

I was cheated by your staff and your staff put me in the dark, due to your staff cheated behavior my wife has suffered very much and loss a huge amount .hence I request you that please look into this matter seriously and action may be taken for releasing my claim and it would be good for maintaining your company values and
Identity sir I am a good customer and if I would get the solution of my problem I would be your continuous customer and could advertise your company behavior to others.

Thanks & Regards

Sunil kumar
c/o-R.k Rao
H.No-111 gali no-1
hans enclave near rajiv chowk
Ph no-[protected]
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Aug 13, 2020
Complaint marked as Resolved 
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Grievance RedressalPrint

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.

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