| Address: Plot No, 119, Sector 44, Gurugram, Haryana 122001, India |
| Website: www. Policybazzar.com |
This is regarding policy [protected]. I am reaching out to you because of repeated harassments done by Niva Bupa and policybazzar team. I have tried reaching out customer care but no response.It seems my problems with Niva Bupa ( Max Bupa) are unending.
Now main concern is that they are changing policy terms. While taking policy, both Max Bupa and policybazzar team had repeatedly told me that right and left organs ( like right or left hand, right or left kidney or knee or leg or eyes etc) will be treated as different organs and different illnesses and refill will happen. Policybazzar had given it in writing after cross checking with Max Bupa team. Now same team is saying that right and left illnesses will not be treated as different and it is same illness. Why such manipulation now??
The policy clause about refill mentions that refill can be used for different illness. But the definition of different illness is not mentioned or clarified. That's why beforehand only, 3 years ago, while taking policy itself, I had very well asked about this clarification. Being a doctor, I was keen to take well informed decision and based upon repeated confirmation given by Max Bupa/Niva Bupa team that right and left will be treated as different organs and different illnesses and restoration can be done using refill, I went ahead with policy. So after 3 years, why are they denying it now??
Now policy bazaar team has written to me that policy bazaar communication was with reference to fracture and not with reference to osteoarthritis or any other illnesses. This is clear manipulation. I have not accepted this statement of policybazzar as I had multiple times on the phone calls and email mentioned multiple right and left illnesses examples( like right and left hand fracture, right and left eye or right and left kidney etc). In the mail too, I had explained fracture as an example only. My query was about in general covering all illnesses and not specific to fracture. Both max bupa and policy bazzar can very well check all my recorded communications from [protected] and [protected] and [protected].
I had repeatedly said that after my repeated phone calls and mails, ruby from policybazzar had given clarification as left and right illness. She didn't specify that she had written with reference to fracture only. It is a general statement. If it was with reference to particular illness like fracture, that should have been mentioned which she didn't. Now that I am asking to fulfill requirements, they are getting away with excuse that it was pertaining to fracture.
When I had asked question in general with giving multiple examples over multiple phonecalls how can policybazzar expect me to understand that their answer was specifically restricted for one illness or one example??
The mail dated 29th December by Ruby from policybazzar was after my mail and after 3-4 telephone calls wherein I had given multiple possible illnesses of right and left organs ( not specifically about fracture), then on which basis, policy bazaar is saying that Ruby wrote with reference to fracture???? Without listening to telephone calls, it is absolutely wrong to interpret.
Ruby's statement was in general statement and if it was specific to fracture, that was supposed to be mentioned clearly which she didn't.
More over, verbally both max bupa and policy bazzar had repeatedly told me over phone that right and left organs will be treated as different illnesses and restoration will be provided. Based upon written and verbal assurance, I went ahead with max bupa. If they would have told me that if refill is not possible for right and left organs, I would have easily taken higher coverage.
I already have faced multiple harassment issues done by Niva Bupa.
Mr. Varun from policybazzar argued with me that osteoarthritis is general condition and whole body's bones gets affected. That's such a funny statement. Osteoarthritis and osteoporosis are two different terms. Osteoarthritis is loss of cartilage and it affects particularly weight-bearing larges bones or joints like knee, hip or spine and usually not whole body and depending upon extent of loss of cartilage, surgical intervention or traditional treatment is offered.Also Osteoarthritis OA -- usually does not affect other joints unless previous injury, excessive stress or an underlying disorder of cartilage is involved.
It is absolutely baseless argument to say that osteoarthritis affects whole body. While writing diagnosis, doctors do right as " osteoarthritis knee or osteoarthritis spine or osteoarthritis hip", meaning particular bone. No doctor will right diagnosis as osteoarthritis of all bones. But when it comes to osteoporosis, it is generally related to weakness of all bones. Mr.Varun from policybazzar completely messed up two things.
Osteoporosis can affect whole body per say. Osteoarthritis usually is limited to particular bone/ joint ; even in RA, either few small joints
and few large joints are involved or only small joints are involved but not whole body.
( There are 206 bones in adults, few adults may have 213).
Second thing, as per Mr. Varun's statement, for fracture, refill is possible and apparently that's because I had asked about fracture in my mail. Though I already have clarified that fracture was for example as I had written "if" in my mail and in my telephonic conversations, I had given examples of multiple illnesses and not just fracture. Even max bupa team had given multiple examples while explaining left and right organ illness.
If you are covering fracture of all bones, you are technically covering conditions of limited bones as well unless you specify strictly.Trauma is common cause in both conditions. If you are treating outcome of trauma for fracture, outcome of trauma in OA gets covered automatically, unless you are mentioning that we cover trauma cases resulting in fracture but not covering trauma cases resulting in osteoarthritis.
There is no such specifications or exception in Ruby's mail.
Policybazzar is accepting fracture of different bones as different illness as different organs which is applicable to all bone conditions or bone disorders. That categorically says bone conditions or bone disorders affecting different bones will be treated as different, may it be fracture or osteoarthritis unless you are putting fracture as exception. If you would have written that we are covering disease involving only large joints, it would have put restrictions to particular joint but that specification is not mentioned here. Point is that specification was required to be mentioned and policy bazzar statement doesn't have any specifications or exceptions.
When we count 206 bones in body, we count individual bones on right and left sides like 12 pairs of ribs, nasal bone ( 2, right and left) etc. We don't consider right or left rib as one entity. So it will be absolutely illogical to say that right or left osteoarthritis will be same illness as it is different bone altogether and extent of disease will be different on both sides. No two fractures or two sides osteoarthritis or osteoporosis or rheumatoid arthritis will be same. Very rarely, it will be same. In both conditions trauma and or old age are most common causes. So technically speaking only fracture covering trauma / old age outcome for particular condition needs special mentioning, otherwise it stands as in general statement strictly.
In nutshell, if you have accepted fracture as a condition of bone involving possibility of 206 bones, it Automatically gets applied to condition of bones involving limited bones out of 206 bones. When you are accepting fracture ( as per policy bazzar interpretation)bone conditions of right and left, you are accepting anatomically right and left bones as different organs.
Do you mean to say that for fracture, right and left bones are different but for osteoarthritis, right and left bones are not different???? Bones are bones, how can they be treated differently as single entity or different entity as per disease condition???? ;Unless, it is specifically mentioned as exception. No exception is mentioned in policy bazzar mail statement by Ruby.
Since refill was committed to me both verbally and written, both by max bupa and policy bazzar, it should be given to me.
would appreciate if you kindly look into it.
If max bupa or your team would have informed me that right or left illness will not be treated as different, I would have easily taken enhanced cover of 7.5 or 10 lakhs without waiting. Because they gave me information as left and right will be treated as different organs, I went ahead with that information. Is that mistake of a customer to trust interpretation given by you?????
Helping customer should be priority and not harassing customers. Niva Bupa team has already harassed me multiple times for my previous claims. I don't want similar scenario again.
If refill benefit was communicated to me verbally and in writing with reference to right and left organs, that should be provided to me.
Please help.
Regards,
Dr.Alaknanda ( Dr.Alka)
+1.437.241.1123
+91 [protected] ( whats app only, )
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