[Resolved]  Max Bupa Health Insurance Company — Claim Rejected on filmy reason claim id 136726

Address:Anand, Gujarat

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
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Aug 8, 2021
Complaint marked as Resolved 
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Dear Mr. Suchit Shah,

At the outset we regret that the services at Max Bupa have not been to your satisfaction. We would like to inform you that your case has been reviewed by our team of doctors and as mentioned earlier we still maintain our stand of not being able to honor the mentioned claim.

We cannot pass your claim due to non-disclosure of material facts at the time of sourcing the policy.

We once again apologize for the inconvenience caused.

All our endeavors is towards high customer satisfaction and we work relentlessly to achieve the same.

Thank you for writing to us.

Many Thanks
Team Max Bupa

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