Max Bupa Complaints & Reviews

Hello everybody

My name is Pankaj Kumar Dhall and i wanted to file a complaint Max Bupa health insurance. I bought a health insurance policy for Dad around 5-6 years ago and everything was going well until this year. We had to hospitalize our father to a hospital in Meerut as he was not well. My father ( Darshan Lal) was diagnosed with Diabetes and hepatitis C. After spending 10 days at the hospital nothing changed and his situation got worse and then we decided to move him to a different hospital in Ludhiana, Punjab. Hospital name is DMC.
They started his treated and send the bills to Max Bupa but they rejected our claim saying that the patient was already suffering from Diabetes and Hypertension prior to buying policy. When i spoke to them, they told me that the patient himself told the hospital that he is suffering for Diabetes from more than 10 years and signed the documents. I asked my Dad and he told me that he was asked this question by the hospital and he told them that he is suffering from Diabetes from few years but did say that he had this problem from 10 + years ( which is not true). We requested the hospital staff to look into this but they denied that and told us that they have already submitted the documents to the insurance company.

Here's the email we received from the insurance company:

Dear Darshan Kumar,

Greetings from Max Bupa!

This is with reference to your health insurance policy number [protected] for which we have received Pre-auth / Reimbursement Claim request Id 116083.We would like to inform you that during processing of the claim the below mentioned medical condition/s has been identified which was/were not disclosed to us at the time of applying for health insurance policy:

 DARSHAN KUMAR 
 Diabetes Mellitus & hypertension 12 years. 

We wish to inform you that the above said non-description/non-disclosure/misrepresentation on your part has materially affected our decision to underwrite the risk and we, are therefore, compelled to re-underwrite your proposal in light of the new facts coming to our knowledge and accordingly we intend to apply exclusions in your policy.

We propose to apply below exclusion(s) in the policy [protected] since inception of the policy basis non disclosure:

 DARSHAN KUMAR 
 EXCLUSIONS :
PRE-EXISTING : (Diabetes mellitus) & (Hypertensive diseases)
PERSONAL WAITING PERIOD : (Cerebrovascular Diseases) 

We would urge you to send us the acceptance of above exclusion(s) within 30 days from the date of receipt of this email by taking a print and signing the form provided at the end of this email. You can submit the signed form at your nearest Max Bupa Branch or send it to us at our registered office address:
To: Customer Service Team
Max Bupa Health Insurance Company Limited
Block B1/I-2, Mohan Cooperative Industrial Estate,
Mathura Road, New Delhi – 110044

I already sent couple of emails to them but i didn't receive any appropriate reply from them.

I will appreciate if you can help us in this regard. You can reach me on my email i.e. : [protected]@gmail.com

Thank You

I wanted to take Accident Care insurance online and contacted phone support. I have been charged Rs.6618 whereas buy online option comes at Rs.5955. Phone support cheated me on that part. Policy was issued but some unrelated questions mentioned in the policy document for which answer is given as "NO" where as it should be "NA (Not Applicable)". Phone support says that those questions are for Critical Care and I agree with them but it should be mentioned somewhere in the policy document or it should be "NA".

My experience with the e-mail and grievance support of Max Bupa is worst. You will never ever get a reply to your email and that is the standard of Max Bupa and other few companies in terms of TRANSPARENCY. They will never commit in written.

Now, I am stuck with wrong policy by paying more money and even after revealing everything honestly. It seems Max Bupa seems to take everything for granted. Thought of taking Health Insurance from them but after observing their support system, I assume that it is going to a BIGGEST mistake of my life. Should have considered Star Health as per my friend's suggestion.

To: bhaskar.[protected]@maxbupa.com, [protected]@maxbupa.com, Gargi.[protected]@maxbupa.com, amit.[protected]@maxbupa.com,
CC: sunil.[protected]@maxbupa.com, geetanjali.[protected]@maxbupa.com, [protected]@maxbupa.com, [protected]@maxbupa.com, [protected]@maxbupa.com,

Hi Bhaskar,

It’s good to finally hear from you, it’s tiresome to comprehend why it took two weeks for such an obstructive and bureaucratic response but nevertheless let’s get to the point. It troubles me to reason over such trifling issues with my health insurance provider but the disservice is despicable. When I was in Apollo hospital during my second angioplasty in the span of about 100 days I spoke to Yogesh, Mr. Parth Sharma, Nitish, Mr. Amit Kumar, Mr. Ankush Jain, Mr. Harish Dhyani and others from Max-Bupa customer service team and few of them require thoughtful sensitivity training.

What’s the significance of customer service if you are disinclined to listen to your customers, we might just be policy holders for you but we are human being too and when we call you we’re fighting for our lives in many instances, I request you to listen to the call recordings- Your service reps are reluctant to deliberate upon customer’s point-of-view and if it has to be a one way conversation then what’s the point of having a customer service number in the first place.

We buy a policy thinking that at the time of need we’ll have someone to fall back upon but Max-Bupa makes it such an excruciating undertaking, all the verses in the policy document are twisted to serve Max-Bupa instead. The customer has to run from pillar to post to get what is genuinely due to him/her. Just refer the two facts I’m deliberating below and you might get a glimpse of the apathy and its appalling how you take your customers for granted and treat us with such impunity.

To keep things manageable lets address these two points first.

1st Hospitalization- Letter of Authorization (Dated: 06/06/2016, Pre Auth. ID.: 105011)
Issue 2: Page 2 of Letter of Authorization, Excess Deductions: INR 14, 760- I was told I would be sent a check, what’s the status? Sir, we request you to refer the reply of Issue- 1 of 6th point raised by you.
Misleading Response: As per the document dated- 06/06/2016 (Pre Auth ID- 105011), Page 2- Inpatient Package: I was informed by Max-Bupa telephonically in the month of June, 2016 that Apollo Hospital Bhubaneshwar has excessively charged me INR 14, 760 and the amount has been transferred to Max-Bupa by the Apollo Hospital. The amount was to be sent to me by DD/Check but today is the last day of September and I’m yet to receive any such DD/Check.
Can you kindly enlighten me that which part of Issue- 1 of 6th point is addressing to it?

6th Hospitalization- Letter of Authorization (Dated: 12/09/2016, Pre Auth. ID.: 115622)
1. Sir, we would like to inform you that the Sum Insured of your policy number [protected] is 5.50 Lacs (including 50K as Loyalty benefit) out of which we approved Rs. 3, 84, 131/- post deducting the applicable co-pay of 15% in claim number 193352. “Agreed”

2. Prior to applying for the pre-auth number 115622, as you were eligible for a maximum SI limit of Rs. 1, 40, 988/- i.e. 85% of 1, 65, 869 (5, 50, 000-3, 84, 131) “You just lost me over here”

I’ve never seen such dishonest interpretation of simple & plain English- As per the policy document shared with me: Page 9/22, Cost Sharing- Co-payment would be applicable in accordance with the table provided below, if any Insured Person is 65 years of age or over on the date of commencement of the current Policy Year, then it is agreed that “We will pay the percentage specified in the table below of the amount We assess for payment or reimbursement” in respect of any claim made by that Insured Person and the balance will be borne by the Insured Person.

Kindly don’t treat your customers like idiots, I’m no Ramanujan but your fraudulent interpretation of co-payment means that Max-Bupa has to pay 85% of balance limit but the clause specify the amount you assess for payment not the balance limit. Hence INR 1, 65, 869 was to be disbursed instead of INR 151, 187.37

I’m thoroughly disappointed by the deceitful practices of Max-Bupa and being a senior citizen and from healthcare profession it disheartens me to find a company of good repute slouching to this level to not to pay its fair share. My involvement with Max-Bupa has been of Max-Pain till now and I anticipate good sense prevails.

Best,
Dr. S. K. Sarangi
+[protected]

Dear sir,
My name is Ram Mohan holding policy in Max Bupa with policy no [protected].My father underwent cataract procedure a month back.They have rejected my claims stating my father is having diminished eye before taking insurance.I have submitted letter from doctor saying the argument was wrong.
They have still rejected saying we have proofs that my father has dimished eye from 2 years.When i have asked for proof they are saying it is confidential and cannot show.
I have taken this policy in oct 2014.I would have directly gone for surgery 2 years back itself if my father had diminished eye.Why will i wait for 2 years and then claim it.

I have filled the claim application with max-bupa on 02/06/2016 with all required documents and i have informed about this claim to the support people on the day of taking treatment and marked the intimation id as well.

I own max bupa health card through my employer since 26/11/2012, i have been requested to fill a self declaration form in which the there was a term "disease existing from" where i informed the representative that its been past 1 or 2 years and i am not sure about it, the representative asked me to mention it from childhood and i told him its not from childhood but he mentioned this will not create any problem in claiming as i have already holding the card for more than 4 years and i am not aware about this bull terms as representative itself said i marked it.
I was following this case since last month more than 50 days and haven't got a positive reply with respect all the documents has been submitted 40 days back.

Today (28/07/2016) when i called customer support team i was informed my claim got rejected due to "disease exist from childhood" and i have not disclosed about this at the time of opening the health policy.

Why is my claim rejected for a mistake i have not made and also all documents has submitted and verification was made and also you people accept pre existing disease treatments if i hold this card more than 3 years. now your people mark that i havent informed this at time of joining. my kid did not have any problem at the time of joining and so how i will add this point. due to your representative it has been marked that disease from childhood. does tonsilectomy comes from childhood???

Company not giving approval, i have already cashless card from max bupa insurance company, demanding again and again different medical prescription and previous history which i had already submitted. patient lying in emergency condition since 1 week. doctor recommended for urgent operation o[censored]rinal trac. information of patient as given-
name- krishna singh
customer id-[protected]
D.O.B- 16/06/1950
preauth id- 103141
insurance since- 14/10/2015
insurance till- 13/10/2016
diagnosis- urethral stricture

I am Jointly Insured with my Mother and my wife, I have attached the file of my policy in the attachment.


We went to DR. Ashok Rajgopal this march for consultation as my mother was suffering through pain in both her knees for past year and a half. However, since the pain had gradually increased over past 5/6 months we decided to go ahead with the operation. Subsequently, I applied for insurance since the operation charges were very high and we were relying on the insurance money completely for the operation. Hence, we decided to take a gap of 15 days in between the consultation and operation to get a smooth approval for our claim.


As a regular procedure during the consultation she was asked for how long is she been facing the problem etc. and she gave him the same response i.e she is been going through this pain for a year and a half. I have a complete document of his first consultation which you may find in the attachment for your reference, please note the same was sent to the hospital and the insurance company


Please find below a day by day background of what followed since the day my mother was admitted.


Day 1s​t -​ Before getting my mother admitted as a procedure we enquired at the admission counter for our insurance approval, to which we were infromed that yes our insurance is been approved with an initial amount of 1.5 ​lac (approx). We were also informed that the complete amount shall be approved to us on the day of discharge after we get the complete detailed bill from the hospital. Hospital also confirmed us after verifying our policy ( which easily cover 6 lac ) and initial approval that every thing is according to policy .

Day 2nd -

​Day of ​Operation.


Day 3rd - Regular Doctor visit


Day 4th -

​ On day four we received a mail saying that our insurance has been rejected. We immediately called the customer care to enquire fpr the reason behind the cancellation and were informed that its been rejected because (according to them) my mother was facing this problem for past 4 years. (I would like to bing into your notice here that this was neither verified by my mother or the concerned doctor)​. Although it was late in the night I still decided to follow up with doctor's PA and he confirmed to us that no such thing was ever mentioned to anyone. He also informed us that they forward the same information which the concerned Doctor(In our case DR. Ashok Rajgopal) send to them after the first consultation. He was understanding and assured us since it was quiet late and he couldn't check the information at that time, he would help us out the next morning. He said that there is any mistake than he will write to the insurance company again because the information was only shared with Dr. Ashok Rajgopal and anything otherwise written by the nurse/care taker would be considered and accepted as a mistake. Following which we received a mail the very next day from the finance department stating that they did not mention anything about the no.of years in the mail.

Day 5 ​- We decided to visit Medanta clinic in Delhi where we went for my mother's first consultation. Contrary to our expectation Dr. Ashok recognised us immediately and after us telling him the entire scenario he immediately recollected my mother mentioning about her suffering from this problem for about a year and a half. Even he was surprised with the whole 4 year issue, he also mentioned taht if any nurse/care taker has written as such then this will be considered baseless and he would do the required changes.
That day evening -

​ The same day evening we contacted the customer care again to inform everything that we learnt from the doctor and suddenly the customer care agent had a different story to tell. He said that they had received the document from the hospital stating that my mother is been suffering from this ​problem for 4 years. However, we requested the hospital to show the same file to us and found no such thing mentioned on the file. And we have verified it thrice so we are pretty much sure that there is no such thing mentioned on the file at all. The customer care agent ​informed us that they have received a document ​stating​ ( I am not taking guarantee of these line bcz these line​ were told to me​ by your customer care agent . )
-patient has problem in knee 4 year

-patient has pain in knee 4 year

-patient has problem in climbing stair 4 year

​After enquiring with a junior doctor at the hospital about the above statements we were told that this is a casual conversation between the doctor and the patient, and no one emphasizes on the years like that.​
​Please ​Note - Doctor also ​informed us that only​ the​ information​ shared by the doctors who all are watching my mother ( patient ) regularly ​will be considered ​ ​and they also asked to check handwriting in that file where insurance company is saying problem for 4 years is mentioned.
​Meanwhile, the hospital had shared the actual information with the insurance company.​ I am also attaching that file which the hospital has sent to the Insurance Company.
​Day 6​ -​In the morning as a discharge procedure when we checked and were confirmed by the hospital that we had not received the approval from the insurance company, we decided to call the customer care again and were informed by the agent that they have received the documents from the hospital. We confirmed twice if he had surely received the mail and he said yes. I request you to kindly check your recordings for verification. I further decided to confirmhe finance department at the hospital who were quite supportive and shared the printout​ that clearly shows how MAX Bupa has changed the statement everytime. Now we have all the documents that hospital has sent to MAX BUPA and nowhere is there a mention of my mother facing the problem for 4 years. .
We also found out at the hospital that an agent had come from the insurance company for the verification of the documents and there is a high possibility that the documents were doctored. The agent was so much in hurry the day he visited the hospital that he didnot even wait for five minutes for any attendant to come and meet him.
​Now, I have no Idea about what where why and how. All I am aware of is that we have been getting a changed statement evrytime we talk to the customer care agent at MAX BUPA. Hospital has shared the entire information with Max Bupa then why is our insurance been rejected. I believe we have made ourselves very clear and would want you to take necessary action against whatever has transpired. We have all the information documented with us in case you wish to verify everything again.
​OUR ENTIRE FAMILY IS DISTURBED. WE HAD TAKEN THIS INSURANCE FOR MENTAL PEACE AND NOT MENTAL TRAUMA. IN TODAY'S WORLD IT IS VERY DIFFICULT FOR A COMMAN MAN TO ARRANGE FOR 6 LACS IN A DAY. AFTER RECEIVING A MAIL OF SUDDEN CANCELLATION FROM THE INSURANCE COMPANY WE HAD NO WHERE TO GO TO AND WERE COMPLETELY BLANK. BUT OF COURSE WE COULD NOT LEAVE MY MOTHER AT THE HOSPITAL AND AFTER MUCH EFFORT WE BORROWED MONEY FROM PEOPLE WE KNOW AND ARRANGED FOR THE MONEY. NOW WE HAVE TO RETURN THE SAME TO THE CONCERNED PEOPLE. HENCE WE REQUEST YOU TO KINDLY REIMBURSE OUR DUE.


I REQUEST MAX BUPA IF YOUR COMPANY REQUIRE ANY INVESTIGATION PLEASE DO THE NEEDFUL.


It seems there is a very big scam behind this which is happening in our country where if these companies are denying atleast 100 customers of 6 Lacs on daily basis they are playing with 2190 Crore of Public Money.

Please look into the matter if this problem is not solved I will go to the Court of Law and will to make sure any body in the future should not face similar problem what me and my family has faced in lack of money.

I am attaching few links which general citizens like me have posted online please go through those links also.


http://www.grahakseva.com/topic/max-bupa
http://www.consumercomplaints.in/complaints/max-bupa-navi-mumbai-mumbai-suburban...⇄
http://www.consumercomplaints.in/max-bupa-b105364
http://www.mouthshut.com/product-reviews/Max-Bupa-Health-Insurance-reviews[prote...⇄
http://www.consumercourt.in/medical-insurance/127836-max-bupa-health-insurance-n...⇄
http://www.complaintboard.in/complaints-reviews/max-bupa-health-insourance-delhi...⇄
https://indiankanoon.org/doc/[protected]/
http://www.complaintsboard.com/complaints/max-bupa-c340707.html
http://www.consumerforums.in/want-to-file-a-case-against-max-bupa
http://www.complaintslist.com/insurance/max-bupa/
http://www.consumerredressal.com/complaints/categoryID/1/Insurance

With great disappointment and grief i write this communication of max bupa, for following up a mediclaim for my daughters hospitalisation.

I had submitted an application of medical claim of my daughter ms. Shipra balasubramani (Student nid ahmedabad), and was acknowledged with a claim no. : 163898 on 8th january 2015.

I was given the answer that the claim was rejected because :

The hospitalization is for less than 24 hours.

I have explained in detail why the patient was discharged before 24 hours in an emergency.

The patient (A minor at the time of admission) was admitted in ahmedabad . She was flown down to chennai for continuation of treatment immediately. The bills for the doctors consultation for both the palces was submitted as claim.

This is a case of continuation of the treatment in ahmedabad and chennai.

The patient could not be admitted in hospital in chennai due to torrential rains and floods that lashed chennai during that time.

The hospital did not have the electricity, the doctor attended tot he patient at home. Bills for all this is submitted.

Hence rejection of claim for the reason of not staying in the hospital for 24 hours is not valid in this case.

Chennai rains were declared as a national disaster.

This is an exceptional case in chennai's history and no reference can be made or compared to the disaster that stuck us

Max bhupa not understanding the emotions and pain of people who are suffering shows their indifference to the society.

Through this mail i bring out the inhuman behavior of an organization which poses as a professional firm. But fundamentally fails to fulfill its duty.

When the telecom, home loan / car loan service providers have understood the grave situation and have given waiver of payments / laons for the people of chennai its unfortunate that max bhupa is unwilling to understand the human situation.

I hereby seek justice through this forum to my claim and thereby accept my bills for settlement.


Padma balasubramani
Mother of shipra balasubramani (Student)

D1 lakshmi,
179 / 104 lloyds road,
Royapettah,
Chennai 600 014
Tamilnadu

Phone : +[protected]
[protected]@hotmail.com

My parents have 16 Lac mediclaim policy with max bupa for 2 years now. My mother was diagnosed with multiple myeloma form of bone cancer and the doctors started their sessions of chemotherapy for 16 weeks. The so called insurance company rejected the claim straight away saying that we have hidden this disease prior to taking the policy. They simply are not understanding that if my mother suffers from cancer they why will we wait for 2 years to get the treatment done.

My Claim id is 159804.

The took 3 months to give their decision on the claim and finally rejected it. In the mean time we have sent over 9 Lacs already on the treatment and the so called insurance company MAXBUPA is least bothered and have taken no action what so ever. Also we lost fair bit of time as well as they took 3 months to give this false decision and we were sure that we would get help from them.


This in my view is utter non-sense and companies like these should be shut asap. My Claim id is 159804.

I had applied for an online medical cover for my wife and self on 03rd Jan 2016 through Max bupa online mode. I paid Rs35945 under ref Rec: NOC/16/1311001 online. A fellow came home to collect some blood as part of their medical requirements on 09th Jan. Since then, I have been consistently following up with Max bupa by email about the policy/cover note. Absolutely no communications whatsoever from them. I then went into a live chat 15th Jan. I strongly expressed my disappointment and then wanted a full refunds of the money that the errant has been keeping unauthorizedly for the past 15 days. After all these follow ups I then got a mail for the first time from them stating that they need a confirmation of some exclusions . I wrote them back saying it would be ok if the policy /cover note is immediately received with policy/cover staring on and from 03rd Jan. I also reiterated by previous stand that I would not like to continue with such inept organizations and wanted to have full refunds settled immediately. These people have still not communicated with me. About 20 days have passed and they are still keeping the funds with them. I would like to ask your effective intervention in enforcing specific performance by this errant organization. Looking forward to getting the full refunds immediately. - Anant Krishnan Iyer

I am suffring from dengue in last week of nov 2015. Then i am in critical condition.my parents admitted me in emergency condition.after the treatment i was unable to gave amount of hospital of 48000.then max bupa decline my request two time of giving claim.my policy aslo cover 82 days at that time.

Mai dt.16-12-15 ko helth insorenc 2adlt+1child ka polici liya campni ki tarf se koi dokoments lagane ke bare ma nhi bataya gaya tha aaj jab cal karake puchta hu to bataya gata hai ye docoments chahiy bo docoments chahiy aaj dt 30/12/15tak polici issu bhi nhi kar rhe hai lagatar mughko mansic or aarthik presan kiya ja rha ha

Dear Sir, I Padam Chand have taken the Health policy (Policy No.[protected]) from Max Bupa Health Insurance Co Ltd on 27/06/2015 to 26/06/2016. This policy is running in its 3rd year.This was sold me your Employee ( Dheeraj Sharma ( Mobile No. [protected] ) who was informed about each question he asked & policy was issued to me. Now a claim due to cervical occurred & the same is declined by the insurance company. I am not that qualified to understand each fine lines of the proposal but I did not conceal any fact from the person who sold me the policy. I explained my past record to the person to the best of my knowledge. My problem this time which resulted claim is also not related to the past health history. I will request you to please look into the matter & redress my grievance related to the claim. The way my claim is declined, I feel cheated by the insurance company. Your kind intervention is required to settle my claim.

Policy no. [protected]. Policy commencement date : 21/Jan/2015 till 20/Jan/2016 Policy Name : Family first silver 5lacs + 15 lacs I would also like to tell that : 1. The application form was filled by the agent. 2. As per agent Medical issues to be told to the doctor. 3. Medicals were carried out at residence by a normal person and not by doctor. He could not understand anything. He only knows to make the medical test. 4. Thalassemia minor was reported but there is no note of it. Incident: My father was hospital on 03/July/2015 due chest pain and was advised angioplasty after angiography. Discharged on 05/July/2015. After filing the claim form underwriter sent a doctor for verification. He asked us to show all the old medical reports and papers. He took some papers photocopy and told us it will help in claim process. Following are the conversation between me and maxbupa team. Grievance Redressal To: [protected]@yahoo.co.in Oct 30 at 2:30 PM Dear Sir, Greetings from Max Bupa Health Insurance! This is with reference to your e-mail appended below. We request you to please refer to the definition 14 and clause 3 of the policy Terms and Conditions reproduced below for your ready reference: Def 14: Disclosure to Information Norm: The Policy shall be void and all premium paid herein shall be forfeited to the Company, in the event of misrepresentation, mis-description or non-disclosure of any material facts. Clause 3: Cancellation by us: Without prejudice to the above, We may terminate this policy during the Policy Period by sending 30 days prior written notice to your Address shown in the Schedule of Insurance Certificate without refund of Premium if: · You or any Insured Person or any person acting on behalf of either has acted in a dishonest or fraudulent manner under or in relation to this Policy; and/or · You or any Insured Person has not disclosed the material facts or misrepresented in relation to the Policy; and/or · You or any Insured Persons has not co-operated with Us. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write to us at [protected]@maxbupa.com/geetanjali.[protected]@maxbupa.com . Yours sincerely, Geetanjali Sapkota Executive- Grievance Redressal Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected][protected][protected][protected][protected][protected]------- From: jeetu dhawde [mailto:[protected]@yahoo.co.in] Sent: Wednesday, October 28, 2015 9:36 PM To: Grievance Redressal Subject: Re: Max Bupa | Service Request 416489 ||[protected] good day... I understand that u have decided to cancel my policy as per underwriters guidelines. therefore I request to refund my premium. Jeetendra Dhawde On Thursday, 15 October 2015 12:07 PM, Grievance Redressal wrote: Dear Sir, At the outset, we regret that the services at Max Bupa have not been to your satisfaction. We value your feedback as we work relentlessly towards constant improvement of services and customer satisfaction. This is with reference to our email appended below. We would like to inform you that we have got your case reviewed by our panel of doctors and it has been observed that the patient is a known case of Lt ear CSOM on treatment and anemia since 2013 along with for cirrhosis liver, portal Hypertension, anemia and thalassemia minor prior to 7/5/2014 ( History of chronic alcoholism). This has been noted from the documents received from the hospital. We have noticed that the mentioned conditions were not disclosed to us at the time of taking the policy. Further, basis the non disclosures of the material facts, we have decided to cancel the policy as per our underwriting guidelines. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write to us at [protected]@maxbupa.com/geetanjali.[protected]@maxbupa.com. Yours sincerely, Geetanjali Sapkota Executive- Grievance Redressal Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected][protected][protected][protected][protected][protected][protected] From: Grievance Redressal Sent: Thursday, October 08, 2015 3:13 PM To: [protected]@yahoo.co.in Subject: Max Bupa | Service Request 416489 ||[protected] Importance: High Dear Sir, At the outset, we regret that the services at Max Bupa have not been to your satisfaction. We value your feedback as we work relentlessly towards constant improvement of services and customer satisfaction. This is with reference to your email appended below. We would like to inform you that we are working on your case and we request you to please give us 7 days for us to share our decision. Your Service request number is 485312. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write to us at [protected]@maxbupa.com/geetanjali.[protected]@maxbupa.com. Yours sincerely, Geetanjali Sapkota Executive- Grievance Redressal Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected][protected][protected][protected][protected][protected][protected] From: jeetu dhawde [mailto:[protected]@yahoo.co.in] Sent: Thursday, October 01, 2015 8:32 PM To: Customer Care Subject: Re: Max Bupa | Service Request 416489 ||[protected] good day all, pls note 1. My father was not suffering from hypertension and was never taking any medicine for the hypertension. 2. Prior taking policy from maxbupa the medicals were carried by maxbupa representative. 3. Medical policy was approved by maxbupa after medicals were cleared. 4. My father was hospitalised around in month of May- 2014 but no medicines were continued after that as not prescribed by doctors. 5. Left ear was treated as infected while swimming...it was in 2013. 6. Anaemia(it's hereditary and hence can never be cured) was reported to medical representative who came to conduct the medicals of my father. This was also reported to agent. therefore pls consider my claims and do the needful asap thanku. Jeetendra Dhawde [protected] [protected][protected][protected][protected][protected][protected][protected] On Wednesday, 2 September 2015 12:37 PM, Customer Care wrote: Dear Mr. Dhawde, Kindly ignore the previous email. Thank you for your email dated 26th August 2015 regarding Policy number [protected]. With reference to the mail below, we would like to inform you that during processing of your claim request, we have detected the following medical conditions which were not disclosed to us at proposal stage i.e. at the time of applying for policy number [protected]. 1) Since 2013 insured is a Known case of, Lt earChronic suppurative otitis media on treatment and anaemia. 2) On treatment for cirrhosis liver, anaemia and thalassemia minor as per prescription dated 7/5/2014 ( H/o chronic alcoholism ) 3) Admitted for obstructive airway disease between 17/5/2014 to 21/5/2015 with cirrhosis liver, anaemia and thalassemia minor It is our endeavour to be fair and equitable with all our customers and this commitment can only be honoured if our customers ensure that they disclose their medical condition in the proposal form submitted to us. We regret to inform you that we would have to cancel the policy number [protected] as it would have impacted our underwriting decision at the time of proposal and we are unable to refund the premium. We request you to please refer to the definition 14 and clause 3 of the policy Terms and Conditions reproduced below for your ready reference: Def 14: Disclosure to Information Norm: The Policy shall be void and all premium paid herein shall be forfeited to the Company, in the event of misrepresentation, mis-description or non-disclosure of any material facts. Clause 3: Cancellation by us: Without prejudice to the above, We may terminate this policy during the Policy Period by sending 30 days prior written notice to your Address shown in the Schedule of Insurance Certificate without refund of Premium if: I. You or any Insured Person or any person acting on behalf of either has acted in a dishonest or fraudulent manner under or in relation to this Policy; and/or II. You or any Insured Person has not disclosed the material facts or misrepresented in relation to the Policy; and/or III. You or any Insured Persons has not co-operated with Us. For avoidance of doubt, it is clarified that no claims shall be admitted and/or paid by Us during the Notice Period. We request you to please provide us with valid justification letter along with supporting document in case you want us to review the cancellation induced by company within 30 days of receipt of the email at [protected]@maxbupa.com from registered email ID. In case you need further assistance, please do call us on our toll free number[protected] or write to us at [protected]@maxbupa.com. We will do our best to help you. Yours Sincerely, Customer Services Team Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected] Original Message[protected] From: JEETENDRA DHAWDE Received: 26/Aug/15 11:14 AM To: ; ; Customer Care Subject: POLICY NO.[protected] Dear all, As my claim no. 143788 is denied, kindly advice me the further steps to be taken by me, to avoid reoccurrence of denial. Let me also express the reason given of denial is a simple excuse from your side. This claim denial had disappointed me. policy holder Jeetendra Dhawde

Blood and urine samples taken on 20th Nov .Rejected case on 21Nov.I wrote a letter on 24thNov to reverse immediately Re 16000. They take the money in advance earn interest by parking for long. they should have the tests and approval/rejection prior to taking the money. Moreover after so much of scrutiny (Hue and Cry) which other companies never do they rejected with lame excuses like my father is diabetic just by overlooking the positive point i.e.he is living happily at the age of 90. Second lame excuse is their requirement of cataract operation which ridiculous that you are searching negativity in cataract also. Hats off to their panel of Doctors. But to conclude I want the reversal all at once without any delay of 4 days as now-a-days the electronic transactions have made it possible within one day. Kindly revers the amount immediately to avoid legal allegation of parking the money for monetary benefits. Thanks and Best Regards Shiv Prasad Chatterjee On Tue, 24 Nov 2015 14:39:21 +0530 Customer Care wrote

My self vijay belhekar. my policy no is [protected]. last month i was suffering from dengue tretement. that time i have call to maxbupa and tell i goning to admit in aditya hosppital. after submition all paper for policy claim. maxbupa raise the quetion that your dr is not regisrator and hospital is unregcongised. ihave provide dr registration certificate and this hospiatl is under list o[censored]nrecognised hospital list which available in max bupa websie. so Im very upsate. i was have lat two year customer of mabbupa. so i requested you please dont puchase any policy from maxbupa. regards, vijay belhekar [protected]

Guys never ever go for any insurance with MAX BUPA this company is fraud and full of complaints, they always lie to their customers and once the customer pay for their insurance they never get their claim but giving such a pathetic excuse.. if you are paying them you are wasting your money, It happened with me and it has happened with lot of consumers i have already filed a case in consumer court against them and also have involved IRDA Grievance department along. my name is ajay and my number is +91-[protected]

I am a heart beat policy customer with max bupa for the past 3 years policy no [protected] and was due for renewal on Sept 19th 2015. While renewal i was trying to add my spouse to the coverage and i got the first shocker to know that i cannot add her to my existing policy and that i need to take a fresh policy for her. I was given the commitment from the sales team when i enrolled that i can add my wife in my existing policy any time want. I got my 2nd shocker when they told me that if i take a fresh policy for my spouse i again need to wait for 2 years for maternity to be covered, the reason i enrolled with max bupa was for the maternity benefit, now the 3 years premium that i paid was for a bluff. I got my 3rd shocker when i got to know that i had enrolled for a sum insured increase benefit (Renewal benefit, not sure of the exact name), where as i had asked for the loyalty points benefit, there was an e-mail sent by the renewal agent to me confirming the loyalty points benefit along with the payment link to make my payment last yer, This e-mail was shared to the customer care team aswell. Now i'm trying to get this issue resolved and i have no one from max bupa taking interest in have this resolved, I have called the customer care more than 10 times trying to sort this out but all i get to hear is that "this is the problem of the renewal team and they will get back to you." I paid max bupa and dont care which team's problem it is. I have an open Service Request 436903 raised on the 8th of sept 2015 and none of them from the renewal team has checked it instead they keep giving me reminder calls to pay my premium. I have spoken to number of ppl in the customer care team including the customer care manager Mr. Alam, who has given big commitments in solving my problem but all is in vein. he was not even able to honor his call back commitment. I'm fine will all the false commitments and bull s**t that i have received so far from MAX bupa and i'm still ready to pay my insurance premium as soon as my loyalty benefit issue is solved and fail to understand why it is taking more than 20 days to get this resolved. My policy is now in its grace period and i do not want to loose the money that i have paid so far, Incase my policy expires for it not being my fault, Max bupa will have tobear up for any of my medical expenses and revive my existing policy without any break in insurance.

Myself Suchit B Shah had taken Max Bupa Health Heart Beat Silver plan for Rs. 3 lac vide Policy No [protected] dated 05/01/2015. I was admitted to hospital at Anand (Gujarat) for treatment of Malaria for a period of 12.05.2015 to 20.5.2015. Intimation of hospitalization was given to Max Bupa Toll Free No & Claim intimation No 1289343 & claim ID 136726 was generated.. I had submitted claim for Rs. 37773 alongwith required supporting & Discharge summery etc to Max Bupa Baroda Branch on 13th June 2015. On 03rd July 2015, To my grate surprise, I came to know from my advisor that my claim has been rejected citing reason of discrepancies in claim paper/ forged document by Max Bupa. After hearing this I was shocked. I came to understand that Investigator appointed by Max Bupa had given false report that there is discrepancy in patient name mentioned in 2 medical bills claimed is not matching with bill book with medical stores shopkeeper. Hence, Investigator of Max Bupa assumed that entire claim is fabricated & hence liable to reject.. What a filmy & Silly reason to reject a genuine claim. I had personally visited medical stores to verify this & observed that medical stores maintain two bill books for raising CASH MEMO. Bilsl from bill book 1 having large (full Page) is used incase billing items are more & bill book no 2 small is used in case of billing items are less. Investigator checked only bill book one in which he could not find my name on 2 bills. He didn’t even bother to check the bill book No2 & reported Fraud claim?? I had taken the photograph of bills from Bill Book No2 & submitted the same to Max Bupa health insurance Baroda Branch. I had also requested them to reopen the claim on account of documentary proof provided by me. But till date I have not received any further communication from Max Bupa in this regards… I feel cheated by max bupa as I becomes victim of malpractices of Max Bupa. I really wanted to re review my case and hope to get some positive response from Max Bupa side. Looking forward for a sensible reply this time from a senior executive from Max Bupa. With regards Suchit B Shah M.[protected], [protected]@gmail.com

My self Dharmesh Gotawala.i claim for my mother amount 32919. but it has been rejected by maxbupa company. reason is that my mother went out from the hospital but it is not true.i am already send doctor certificate but again it has been rejectded for same reason ... so i am going consumer court for case to maxbupa company...