[Resolved]  Max Bupa — Claims Denied , Sales agent is also a cheat

Address:

Gurgaon, Haryana

Dear Customer Services Team, Like everyone else here I am too a victim of Max Bupa. I have a max bupa policy family first for my family of 6 people. Policy no : [protected] By name shyam bissa . Its a third year of my policy where we havent taken any claims so far .. This time we went for a preventive heart check up for my dad ( angio graphy ) since we have a family history of heart problems . Its a day care procedure so we applied for cashless claims stating reason for preexisting disease as diabetes and Hyper tension. Than later on our refund claim was also denied stating the same as a reason . I was shocked and then realized that just to add more people to take their policy 3 years back they gave us this policy without any paperwork or checkup. My dad was 59 years that time. . No as you mentioned the claim is denied stating the reason as below so there are few things I need to Clarify here. Firstly when we took this Policy the Insured Member, Mr Shyam Sunder Bissa, was taking a Medicine for HyperTension ( Basic ) and Used to ( was not taking ) take the medicine for Diabetes . We did mention the same their AGENT MR ASHISH VERMA, who while pushing us to take the policy on month ( 28 july 2012 ) end because he wanted to get us enrolled before end of july to meet his sales targets. BTW he also offered us a cash discount of 10 %, He gave me around 3500 cash after a week or so as he said its a discount . ( I never received any official discount summary for that ) . Our policy form was also filled by him and He was only interested in the payment which I did by 28th, He said he will arrange everything else . Also What he said to us that at this age everyone take these medicines and Hypertension is normal . and since at that moment He was not taking any medicines for Diabetes he said than no point mentioning this . ( My dad had very little sugar problem and the level was almost normal, for which we have submitted the copies of earlier test reports .) .So what am I Suppose to do ?? Now If you are giving a policy without the medical check up its not our responsibility later on, Its your duty to ask for check up before giving the policy .You have made this a habit to Deny the claims later on . You as a company should have asked for medical test ( which is also mentioned on your websites ) for a person above 45 years . ( my dad was nearling 60 at the time we took the policy ) . But just because you wanted to get ONE more customer enrolled at that time you skipped these basic requirements. Regarding CAD ( which they added later on ), since we had a family history so we always go for heart checkup every year and that was the reason we were taking preventive medicines ( hyper tension ) . So you mean to say going for a preventive health checkup makes you a patient ????? seriously . If I take a preventive medicines to be on safer side doesn't make me a patient for that ill ness. And we also have our Heart checkup reports for every year ( which is also normal, and we submitted that ) Now considering a fact you also have a waiting period of 24 months for Diabetes & related treatment so this time has already passed so the Diabetes should not be concern anyways. and Its only last one and half years he is strictlt taking a medicine for Diabetes. So what we requested the claim was for a Non Existing illness and the procedure, Angio graphy, which is to check the heart blockage . So how the hell is related to any of the other issues which you mentioned. Tomorrow you can give reason for anything ..Its a third year for us to have this policy and it was the first claim we asked for and this is what we get ??? Do you really think I should trust MAX BUPA now for any claims ?? So stop giving reasons for not giving any claims . You mean to say everyone first should take Max Bupa policy for 4 years ( so that all exceptions are over ) and than you will provide claims. And as far as I know as per your policy even the preexisting diseases are covered after a waiting period ?? Right .. we are through with 3 years so Diabetes doesnt count anyways and hypertension is also not considered a reason for denial. I really wanted to re review our case and hope to get some positive response from your side. Looking forward for a sensible reply this time from a senior executive from Max Bupa. And by the way since last two years we never ever received our policy documents inspite of calling their customer care more than 10 times over the years and mailing them equally and regularly .. Regrds Shreyash BISSA Dhaka - +880 [protected]