Max Bupa — Max-bupa or max-pain

Oct 03, 2016

Updated by Dr. S. K. Sarangi 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]

Oct 13, 2016

Updated by Dr. S. K. Sarangi Max Bupa or Max Pain

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,

It’s been good two weeks since my initial email and I’m still waiting for the necessary information- I’m astounded by the abysmal response mechanism, I was under the false impression that pitiable customer service is restricted to the customer service department but it seems it’s malignant.

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

Oct 13, 2016

Updated by Dr. S. K. Sarangi Response By Max Bupa

Dear Sir,

At the outset, we regret that the services at Max Bupa have not been to your satisfaction. We truly value your feedback as we work relentlessly towards constant improvement of services. This is with reference to your mail appended below, please find below the resolution of your queries point wise:
Can you kindly enlighten me that which part of Issue- 1 of 6th point is addressing to it? Sir, Issue- 1 of 6th point means below mentioned reply: “ 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. 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) but the approval shared by us was for Rs. 1, 51, 187 which is already in excess of your eligibility limit.”
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. Sir, we would like to inform you that 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 (15% co-pay applicable on remaining Sum Insured) but the approval shared by us was for Rs. 1, 51, 187 which is already in excess of your eligibility limit.
Sir, you will appreciate that we have tried to deal with the issue in fair and equitable manner. Further, we would also like to share our grievance-redressal mechanism for your reference, please find enclosed the below link. http://www.maxbupa.com/customer-care/health-services/grievance-redressal.aspx Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write us [protected]@maxbupa.com/ bhaskar.[protected]@maxbupa.com . You may have Ms. Gargi Sahu-General Manager, Customer Services (gargi.[protected]@maxbupa.com) email ID for your reference. Assuring you of our best services.

Yours Sincerely,

Bhaskar A
Assistant Manager- Grievance Redressal
Max Bupa Health Insurance Company Limited,
B-1/I-2, Mohan Cooperative Industrial Estate
Mathura Road, New Delhi-110044

Oct 13, 2016

Updated by Dr. S. K. Sarangi Max-Bupa or Max-Pain: Part V

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,

Good Evening Bhaskar,

Thank you for your response, Can you kindly educate me on these two topics so that if I’m at fault then I could correct myself:
1st Hospitalization- Letter of Authorization (Dated: 06/06/2016, Pre Auth. ID.: 105011)
Have you received a refund of INR 14, 760 from Apollo Bhubaneshwar on my behalf?
6th Hospitalization- Letter of Authorization (Dated: 12/09/2016, Pre Auth. ID.: 115622)
INR 3, 84, 131 (1st Disbursement) + INR 151, 187.37 (2nd Disbursement) = INR 5, 34, 318.37 (Total Disbursement) – INR 5, 50, 000.00 (Total Limit) = INR 15, 861.83 (So, Is this the balance for future claim?)

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

Oct 13, 2016

Updated by Dr. S. K. Sarangi Response from Max-Bupa

from: Grievance Redressal <[protected]@maxbupa.com>
to: Sudhanshu Kumar Sarangi <[protected]@gmail.com>

date: Wed, Oct 5, 2016 at 3:56 PM
subject: FW: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: maxbupa.com

Dear Sir,

At the outset, we regret that the services at Max Bupa have not been to your satisfaction. We truly value your feedback as we work relentlessly towards constant improvement of services. This is with reference to your mail appended below, we would like to inform you that we acknowledge the receipt of your concern and we request you to please give us time till 10/10/2016 for us to address the concern to your satisfaction. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write us [protected]@maxbupa.com / bhaskar.[protected]@maxbupa.com. Assuring you of our best services.

Yours Sincerely,

Bhaskar A
Assistant Manager- Grievance Redressal
Max Bupa Health Insurance Company Limited,
B-1/I-2, Mohan Cooperative Industrial Estate
Mathura Road, New Delhi-110044

Oct 13, 2016

Updated by Dr. S. K. Sarangi Max-Bupa or Max-Pain: Part XIII

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,

from: Sudhanshu Kumar Sarangi <[protected]@gmail.com>
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal <[protected]@maxbupa.com>,
Gargi A Sahu <Gargi.[protected]@maxbupa.com>,
amit.[protected]@maxbupa.com

cc: sunil.[protected]@maxbupa.com,
geetanjali.[protected]@maxbupa.com,
[protected]@maxbupa.com,
Customer Care <[protected]@maxbupa.com>,
[protected]@maxbupa.com

date: Wed, Oct 12, 2016 at 6:28 PM
subject: Re: Max Bupa | Service Request 1140068 ||[protected]
mailed-by: gmail.com

Good Evening Bhaskar,

Thank you for your response, No need for an apology- I understand. I believe you have already been shared with all the documents by Apollo Bhubaneshwar. Kindly Advice.

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

Oct 13, 2016

Updated by Dr. S. K. Sarangi Response from Max-Bupa

from: Grievance Redressal <[protected]@maxbupa.com>
to: SUDHANSHU KUMAR SARANGI <[protected]@gmail.com>

date: Thu, Oct 13, 2016 at 6:16 PM
subject: Max Bupa | Service Request 1142271 ||[protected]
mailed-by: maxbupa.com

Dear Sir,

Thank you for writing to Max Bupa Health Insurance. This is with reference to your mail appended below, we would like to inform you that in order to process your claim, we would require below mentioned documents to be sent to our mentioned office address, once we will received the mentioned documents, your claim will be processed within TAT of 30 days as per the terms and conditions of the policy.

• Duly filled Claim form
• Valid photo id proof/Age proof, Bank details
• Original bills, receipts and discharge certificate/card from Hospital/Doctor
• Original bills from chemists supported by proper prescription.
• Original investigation test reports and payment receipts.
• Doctor’s referral letter advising hospitalization in non-accident cases.
• Details of any other insurance policy that may respond to the claim.

Please find attached the claim form for your reference. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write us [protected]@maxbupa.com / bhaskar.[protected]@maxbupa.com. Assuring you of our best services.

Yours Sincerely,

Bhaskar A
Assistant Manager- Grievance Redressal
Max Bupa Health Insurance Company Limited,
B-1/I-2, Mohan Cooperative Industrial Estate
Mathura Road, New Delhi-110044

Oct 13, 2016

Updated by Dr. S. K. Sarangi Max-Bupa or Max-Pain: Part XVI

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,

from: Sudhanshu Kumar Sarangi <[protected]@gmail.com>
to: Grievance Redressal <[protected]@maxbupa.com>,
bhaskar.[protected]@maxbupa.com,
Gargi A Sahu <Gargi.[protected]@maxbupa.com>,
amit.[protected]@maxbupa.com

cc: sunil.[protected]@maxbupa.com,
geetanjali.[protected]@maxbupa.com,
[protected]@maxbupa.com,
Customer Care <[protected]@maxbupa.com>,
[protected]@maxbupa.com

date: Thu, Oct 13, 2016 at 7:27 PM
subject: Re: Max Bupa | Service Request 1142271 ||[protected]
mailed-by: gmail.com

Dear Bhaskar,

It's good to hear from you and thank you for the attachment, I'll repeat myself again, since my question was unanswered:

Question 1) "1st Repeat" Since Max-Bupa has made part payment after reviewing the bills/records which were sent by Apollo- Bhubaneshwar when I underwent the procedures then why do you want me to resend it?

Question 2) I've Top-Up Insurance from L&T hence if I'll send all the original documents/records to Max-Bupa then how shall I get the balance amount reimbursed from L&T Insurance?

I hope you answer me, otherwise you can very well expect me to ask the same question in my next email. Thanks for doing the needful.

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