Max Bupa — Fraud By Max Bupa in giving Claim

Address:Gautam Buddh Nagar, Uttar Pradesh, 201301
Website:www.maxbupa.com

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
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Comments

Vivek - Do you not know not to go ahead with the operation until confirmed documents of the policy were received in post by you? Second, do you not know that that most health insurance companies have waiting period of 2-4 years before they cover known illnesses ( in this case your mothers knee pain)??

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