Max Bupa

I have been Max Bupa health Insurance customer since 7 years. I had medical Insurances from other companies for 15 years before that. I have paid Max Bupa lakhs of rupees in Insurance premium over the 7 years. My policy was a family floater policy. My wife who is covered by the Insurance was taken on 29th May 2020 to Apollo hospitals Hyderguda with difficulty in speech. She underwent a series of tests including MRI and a CT Scan. She was then admitted to the ICU and shifted to a room the next day. Her cashless request was initially approved for Rs.40, 000/- by Max Bupa. But for some unknown reason it was later cancelled. The hospital informed that the Insurance company has asked us to pay now and file for a reimbursement. Accordingly I paid the amount and filed for a reimbursement, amount of around Rs 68, 000/-. This was simply rejected with the statement "rejected as per your policy conditions" Upon further correspondence and talks they claimed that hospitalization was less than 24 hours. I stated that the discharge summary of the hospital clearly shows that it is more than 24 hours. After that they have been raising some pretext or the other to keep the issue pending without resolution. I am attaching a file containing my entire correspondence with them. Kindly ensure that justice is done to me.
Grievance Redressal
Tue, Nov 17, 11:17 AM
to me

Dear Sir,

Greetings from Max Bupa.

This is with reference to email appended below. We would like to inform you that we have got your claim request # 540514 reviewed by our panel of doctors the details shared by you and it has been observe that we have still not received below mentioned documents. Hence we request you to please provide us the documents in order to review further this claim speedily and judiciously:-

Please provide treating doctor certificate for duration of HTN, Asthma, depression with first consultation paper for all

Sir, we have tried our best to deal with the matter fairly and equitably. If you still feel you are not satisfied with the decision as shared by us. Please follow step-3 of the below mentioned link

https://transaction.maxbupa.com/customer-care/health-services/grievance-redressal.aspx

Should you require any further assistance, we request you to call us on our helpline number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com.

Assuring you of our best services

Yours Sincerely,

Sheetal Sharma

Officer - Grievance Redressal Team

Max Bupa Health Insurance Company Limited,

B-1/I-2, Mohan Cooperative Industrial Estate

Mathura Road, New Delhi-110044

https://www.maxbupa.com

This mail is classified as 'Public' by Sheetal. Sharma on November 17, 2020 at 11:16:47.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Wednesday, November 04, 2020 1:37 PM
To: Grievance Redressal
Subject: Re: Internal: Status update - Claim rejected / 540514

I am unable to understand your request. My wife did not go to the hospital for either HTN, Asthama or depression. She went because she could not speak properly after getting up from sleep. I am at a loss to understand what your mean by "doctor certificate for duration of HTN, Asthma, depression with first consultation paper for all". All the papers pertaining to her treatment at Apollo Hospital have already been submitted to you. Please clarify exactly what you want and why you want it? Matter urgent.

Yours Sincerely

S. Janardhan

On Mon, Nov 2, 2020 at 11:49 PM Grievance Redressal wrote:

Dear Sir

Greetings from Max Bupa

Please accept our apologies for the delay in response.

This is with the reference to your e-mail appended below, we request you to kindly provide us the below mentioned documents, in order to review this claim number 540514 speedily and judiciously.

Please provide treating doctor certificate for duration of HTN, Asthma, depression with first consultation paper for all

Should you require any further assistance, we request you to call us on our helpline-number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com / Sheetal. Sharma@maxbupa.com

Assuring you of our best services.

Yours Sincerely,

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

This mail is classified as 'Internal' by Sheetal. Sharma on November 02, 2020 at 23:49:38.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Monday, October 26, 2020 11:17 AM
To: GRO
Subject: Fwd: Status update - Claim rejected — Forwarded message — From: S Janardhan
Date: Mon, Oct 26, 2020 at 11:05 AM
Subject: Re: Status update - Claim rejected
To: Grievance Redressal,

Gentlemen,

I have very patiently followed up your unjustified rejection of my claim, after having paid you huge amounts as premium over the last 7 years. Even before that I have had health Insurance for a very long time (above 20 years). The first time I made a claim you have firstly rejected the same on improper grounds and then after I reminded you above the documents provided by me you have been delaying the claim on one pretext or the other. You had finally stated that you will settle my claim by 21st September 2020. It is now 26th October and you have still not settled the same in spite of repeated reminders. Please settle the same within 7 days of receipt of this mail, failing which I shall be constrained to approach the ombudsman. A copy of this email is also marked to them. Earlier correspondence is trailing below.

Yours Sincerely

S. Janardhan

On Sat, Oct 3, 2020 at 10:54 AM S Janardhan wrote:

Gentlemen,

Today is the 3rd of October 2020. AS per the trailing email sent by you, you wanted till 21st September to settle my claim. I do not see any reason for the delay since my documents clearly proves that your reason for rejection of my claim earlier is false. That the actual hospitalisation is clearly for more than 24 hours. Please arrange to settle my claim immediately and in case you are not willing to do the same please let me also know the same immediately as I would like to take up the matter with the Insurance ombudsman. Please treat the matter as most urgent.

Yours Sincerely

S. Janardhan

On Tue, Sep 15, 2020 at 7:05 PM Grievance Redressal wrote:

Dear Mr. Janardhan,

Greetings from Max Bupa

Please accept our apologies for the delay in response.

This is in reference to your email appended below, we would like to inform you that we are working on your case and we request you to kindly give us time till 21st Sep '2020 for us to communicate our decision with you.

Should you require any further assistance, we request you to call us on our helpline-number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com / Sheetal. Sharma@maxbupa.com

Assuring you of our best services.

Yours Sincerely,

Sheetal sharma

Grievance Redressal

Max Bupa Health Insurance Company Limited,

B-1/I-2, Mohan Cooperative Industrial Estate

Mathura Road, New Delhi-110044

This mail is classified as 'Public' by Sheetal. Sharma on September 15, 2020 at 19:05:07.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Saturday, September 12, 2020 12:01 PM
To: Grievance Redressal; Customer Care
Subject: Re: Status update - Claim rejected

Gentlemen,

This is a gentle reminder about my letter trailing below. I have not received any information pertaining to the same.

Yours Sincerely

S. Janardhan

On Tue, Sep 1, 2020 at 3:33 PM S Janardhan wrote:

Gentlemen,

I have received a letter from General Manager claims Dt: 18.08.2020 stating that my claim has been rejected stating that "As per received documents hospitalisation less than 24 hours, hence claim is rejected as per policy terms and condition". Kindly note that this an erroneous statement. I have very clearly stated that my wife was taken to the hospital on the evening of 28th May 2020 at around 20:30 hours. She was admitted first, into the emergency ward, where her blood tests were done, then an MRI was done, and then a CT scan was done to ensure that she is not suffering from Covid 19. She was then admitted into the ICU at 01:09:26 hrs of 29.05.2020. She was there all through the day and shifted to a room in the evening and was discharged the next day morning, i.e. 30.05.2020 at 11:12:35 hours. She was in the hospital from 20:30 hours on 28.05.2020 to 11:12;35 hours on 30th that is 38 hours and 12 minutes. Even if you do not want to admit the treatment in the emergency ward as part of the hospitalization, please note that as per the documents submitted to you she was admitted into the ICU at 01:09:25 on 29th may (copy enclosed) and discharged on 11:12:35 on 30th May, this constitutes 34 hours and 3 minutes. how can you then say that she was hospitalized for less than 24 hours.

Kindly remember that I have been paying you for the health Insurance for the last 7 years, and this is the first time that I have ever made a claim. In fact the last premium I paid to you was Rs.1.32 lacs. I request you to kindly reconsider your rejection, failing which I shall be constrained to take alternate action. I am once again attaching the first page of the bill submitted to you. which clearly details the time of admission into the ICU and the discharge time. You are at liberty to verify the details I have mentioned with the Apollo hospital.

Yours Sincerely

S. Janardhan

On Sat, Aug 29, 2020 at 9:50 PM Grievance Redressal wrote:

Dear Mr. Janardhan,

Greetings from Max Bupa

Please accept our apologies for the delay in response.

This is in reference to your email appended below, we would like to inform you that we acknowledge the receipt of your concern vide service request number # 4997890 and we request you to please give us time till 05th Sep ‘2020 for us to address the mentioned concern to your satisfaction.

Should you require any further assistance, we request you to call us on our helpline-number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com / Sheetal. Sharma@maxbupa.com

Assuring you of our best services.

Yours Sincerely,

Sheetal sharma

Grievance Redressal

Max Bupa Health Insurance Company Limited,

B-1/I-2, Mohan Cooperative Industrial Estate

Mathura Road, New Delhi-110044

This mail is classified as 'Public' by Sheetal. Sharma on August 29, 2020 at 21:50:00.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Saturday, August 08, 2020 1:08 PM
To: Grievance Redressal
Subject: Fwd: Status update - Claim rejected

Gentlemen,

I had a health Insurance policy with you for 7 years. In the first claim I made the result is given below. However as a layman, I do not understand on what basis the claim was rejected. It simply says that the claim has been rejected "based on the terms and conditions of your policy with us". Please spell out which term and which condition is the basis for your rejection. Once I receive the requested details I will then decide how to proceed further in this matter.

Yours Sincerely

S. Janardhan — Forwarded message — From:
Date: Sat, Aug 8, 2020 at 8:03 AM
Subject: Status update - Claim rejected
To:

Member Reimbursement Statement
Dear SAMBANDAMURTHY JANARDHAN,

Greetings!

We regret to inform you that claim ID 540514 of SAVITRI JANARDHAN has been denied for settlement based on the terms and conditions
of your policy with us. We apologize for the inconvenience caused due to this.

For any queries please email at customercare@maxbupa.com or visit www.maxbupa.com.

Grievance redressal:
In case of any grievance, please feel free to write to us at grievanceredressal@maxbupa.com.
You can also contact ombudsman for any unresolved grievances. The contact details and list of ombudsman offices is provided in
your policy pack.

Warm regards,
cid:image001. png@01D67E4D. C2DC5710
General Manager - Claims

For and on behalf of Max Bupa Health Insurance Company Limited

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

This message has been scanned for malware and Virus.

Click here to report this email as spam.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

S Janardhan
Nov 17, 2020, 11:58 AM
to Grievance, sheetal. sharma, Grievance

Dear Ms. Sheetal
I am still unable to understand why do you need "treating doctor certificate for duration of HTN, Asthma, depression with first consultation paper for all". It has been clearly stated that her Asthama is a pre-existing problem, and the other problems as mentioned were treated long time back and many of the medicines were discontinued. However her hospitalization for which our claim is made was for a totally different problem, and even if, as per your diagnosis they are related to her existing diseases it is surely now included in the policy since we have the policy with you alone for 7 years. I request you clearly explain to me why you require these certificates, since I feel that these requests seem to me to be simply a ploy to drag the matter further. Your treatment of this claim, as per my impression has not been fair. Treat the matter as urgent.

Yours Sincerely
S. Janardhan

On Tue, Nov 17, 2020 at 11:17 AM Grievance Redressal wrote:
Dear Sir,

Greetings from Max Bupa.

This is with reference to email appended below. We would like to inform you that we have got your claim request # 540514 reviewed by our panel of doctors the details shared by you and it has been observe that we have still not received below mentioned documents. Hence we request you to please provide us the documents in order to review further this claim speedily and judiciously:-

Please provide treating doctor certificate for duration of HTN, Asthma, depression with first consultation paper for all

Sir, we have tried our best to deal with the matter fairly and equitably. If you still feel you are not satisfied with the decision as shared by us. Please follow step-3 of the below mentioned link

https://transaction.maxbupa.com/customer-care/health-services/grievance-redressal.aspx

Should you require any further assistance, we request you to call us on our helpline number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com.

Assuring you of our best services

Yours Sincerely,

Sheetal Sharma

Officer - Grievance Redressal Team

Max Bupa Health Insurance Company Limited,

B-1/I-2, Mohan Cooperative Industrial Estate

Mathura Road, New Delhi-110044

https://www.maxbupa.com

This mail is classified as 'Public' by Sheetal. Sharma on November 17, 2020 at 11:16:47.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Wednesday, November 04, 2020 1:37 PM
To: Grievance Redressal
Subject: Re: Internal: Status update - Claim rejected / 540514

I am unable to understand your request. My wife did not go to the hospital for either HTN, Asthama or depression. She went because she could not speak properly after getting up from sleep. I am at a loss to understand what your mean by "doctor certificate for duration of HTN, Asthma, depression with first consultation paper for all". All the papers pertaining to her treatment at Apollo Hospital have already been submitted to you. Please clarify exactly what you want and why you want it? Matter urgent.

Yours Sincerely

S. Janardhan

On Mon, Nov 2, 2020 at 11:49 PM Grievance Redressal wrote:

Dear Sir

Greetings from Max Bupa

Please accept our apologies for the delay in response.

This is with the reference to your e-mail appended below, we request you to kindly provide us the below mentioned documents, in order to review this claim number 540514 speedily and judiciously.

Please provide treating doctor certificate for duration of HTN, Asthma, depression with first consultation paper for all

Should you require any further assistance, we request you to call us on our helpline-number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com / Sheetal. Sharma@maxbupa.com

Assuring you of our best services.

Yours Sincerely,

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

This mail is classified as 'Internal' by Sheetal. Sharma on November 02, 2020 at 23:49:38.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Monday, October 26, 2020 11:17 AM
To: GRO
Subject: Fwd: Status update - Claim rejected — Forwarded message — From: S Janardhan
Date: Mon, Oct 26, 2020 at 11:05 AM
Subject: Re: Status update - Claim rejected
To: Grievance Redressal,

Gentlemen,

I have very patiently followed up your unjustified rejection of my claim, after having paid you huge amounts as premium over the last 7 years. Even before that I have had health Insurance for a very long time (above 20 years). The first time I made a claim you have firstly rejected the same on improper grounds and then after I reminded you above the documents provided by me you have been delaying the claim on one pretext or the other. You had finally stated that you will settle my claim by 21st September 2020. It is now 26th October and you have still not settled the same in spite of repeated reminders. Please settle the same within 7 days of receipt of this mail, failing which I shall be constrained to approach the ombudsman. A copy of this email is also marked to them. Earlier correspondence is trailing below.

Yours Sincerely

S. Janardhan

On Sat, Oct 3, 2020 at 10:54 AM S Janardhan wrote:

Gentlemen,

Today is the 3rd of October 2020. AS per the trailing email sent by you, you wanted till 21st September to settle my claim. I do not see any reason for the delay since my documents clearly proves that your reason for rejection of my claim earlier is false. That the actual hospitalisation is clearly for more than 24 hours. Please arrange to settle my claim immediately and in case you are not willing to do the same please let me also know the same immediately as I would like to take up the matter with the Insurance ombudsman. Please treat the matter as most urgent.

Yours Sincerely

S. Janardhan

On Tue, Sep 15, 2020 at 7:05 PM Grievance Redressal wrote:

Dear Mr. Janardhan,

Greetings from Max Bupa

Please accept our apologies for the delay in response.

This is in reference to your e-mail appended below, we would like to inform you that we are working on your case and we request you to kindly give us time till 21st Sep '2020 for us to communicate our decision with you.

Should you require any further assistance, we request you to call us on our helpline-number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com / Sheetal. Sharma@maxbupa.com

Assuring you of our best services.

Yours Sincerely,

Sheetal sharma

Grievance Redressal

Max Bupa Health Insurance Company Limited,

B-1/I-2, Mohan Cooperative Industrial Estate

Mathura Road, New Delhi-110044

This mail is classified as 'Public' by Sheetal. Sharma on September 15, 2020 at 19:05:07.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Saturday, September 12, 2020 12:01 PM
To: Grievance Redressal; Customer Care
Subject: Re: Status update - Claim rejected

Gentlemen,

This is a gentle reminder about my letter trailing below. I have not received any information pertaining to the same.

Yours Sincerely

S. Janardhan

On Tue, Sep 1, 2020 at 3:33 PM S Janardhan wrote:

Gentlemen,

I have received a letter from General Manager claims Dt: 18.08.2020 stating that my claim has been rejected stating that "As per received documents hospitalisation less than 24 hours, hence claim is rejected as per policy terms and condition". Kindly note that this an erroneous statement. I have very clearly stated that my wife was taken to the hospital on the evening of 28th May 2020 at around 20:30 hours. She was admitted first, into the emergency ward, where her blood tests were done, then an MRI was done, and then a CT scan was done to ensure that she is not suffering from Covid 19. She was then admitted into the ICU at 01:09:26 hrs of 29.05.2020. She was there all through the day and shifted to a room in the evening and was discharged the next day morning, i.e. 30.05.2020 at 11:12:35 hours. She was in the hospital from 20:30 hours on 28.05.2020 to 11:12;35 hours on 30th that is 38 hours and 12 minutes. Even if you do not want to admit the treatment in the emergency ward as part of the hospitalization, please note that as per the documents submitted to you she was admitted into the ICU at 01:09:25 on 29th may (copy enclosed) and discharged on 11:12:35 on 30th May, this constitutes 34 hours and 3 minutes. how can you then say that she was hospitalized for less than 24 hours.

Kindly remember that I have been paying you for the health Insurance for the last 7 years, and this is the first time that I have ever made a claim. In fact the last premium I paid to you was Rs.1.32 lacs. I request you to kindly reconsider your rejection, failing which I shall be constrained to take alternate action. I am once again attaching the first page of the bill submitted to you. which clearly details the time of admission into the ICU and the discharge time. You are at liberty to verify the details I have mentioned with the Apollo hospital.

Yours Sincerely

S. Janardhan

On Sat, Aug 29, 2020 at 9:50 PM Grievance Redressal wrote:

Dear Mr. Janardhan,

Greetings from Max Bupa

Please accept our apologies for the delay in response.

This is in reference to your e-mail appended below, we would like to inform you that we acknowledge the receipt of your concern vide service request number # 4997890 and we request you to please give us time till 05th Sep ‘2020 for us to address the mentioned concern to your satisfaction.

Should you require any further assistance, we request you to call us on our helpline-number 1860-500-8888 or write to us at grievanceredressal@maxbupa.com / Sheetal. Sharma@maxbupa.com

Assuring you of our best services.

Yours Sincerely,

Sheetal sharma

Grievance Redressal

Max Bupa Health Insurance Company Limited,

B-1/I-2, Mohan Cooperative Industrial Estate

Mathura Road, New Delhi-110044

This mail is classified as 'Public' by Sheetal. Sharma on August 29, 2020 at 21:50:00.

From: S Janardhan [mailto:[protected]@gmail.com]
Sent: Saturday, August 08, 2020 1:08 PM
To: Grievance Redressal
Subject: Fwd: Status update - Claim rejected

Gentlemen,

I had a health Insurance policy with you for 7 years. In the first claim I made the result is given below. However as a layman, I do not understand on what basis the claim was rejected. It simply says that the claim has been rejected "based on the terms and conditions of your policy with us". Please spell out which term and which condition is the basis for your rejection. Once I receive the requested details I will then decide how to proceed further in this matter.

Yours Sincerely

S. Janardhan — Forwarded message — From:
Date: Sat, Aug 8, 2020 at 8:03 AM
Subject: Status update - Claim rejected
To:

Member Reimbursement Statement
Dear SAMBANDAMURTHY JANARDHAN,

Greetings!

We regret to inform you that claim ID 540514 of SAVITRI JANARDHAN has been denied for settlement based on the terms and conditions
of your policy with us. We apologize for the inconvenience caused due to this.

For any queries please email at customercare@maxbupa.com or visit www.maxbupa.com.

Grievance redressal:
In case of any grievance, please feel free to write to us at grievanceredressal@maxbupa.com.
You can also contact ombudsman for any unresolved grievances. The contact details and list of ombudsman offices is provided in
your policy pack.

Warm regards,
cid:image001. png@01D67E4D. C2DC5710
General Manager - Claims

For and on behalf of Max Bupa Health Insurance Company Limited

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

This message has been scanned for malware and Virus.

Click here to report this email as spam.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

Please do not print this email unless it is absolutely necessary.

The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain proprietary, confidential or privileged information. If you are not the intended recipient, you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The intention expressed in the mail is for discussion purpose only. Any commitments made towards award of service/business, or sale/purchase of any goods shall not be binding and Max Bupa Health Insurance Company Limited (Max Bupa) shall not be under an obligation to fulfill any of the commitments made towards award of service/business, or sale/purchase of any goods unless a Purchase Order is issued or an agreement is duly executed by the authorized representatives of Max Bupa.

The agent assigned to me has very little knowledge about using email or whatsapp — a&expects me to call him from abroad to get updates / resolve issues.

I have posted a full review of this on mouthshut.com & consumecomplaints.in, which you can check the url below for:

https://www.mouthshut.com/review/Max-Bupa-Health-Insurance-review-onluonlrlrn

I raised a pre approval id - 192262

without even seeing anything they declined cashless even I have heartbeat policy that covers my disease it after 30 days policy and costumer team said they we need to take decision in 30 mins so we cannot decide first pay and get treated and them  ask for reimbursement . Total cheaters . I am from media not going to leave these cheaters who dont help people in problems

my number is [protected]

We holding maxbupa health insurance. Paying for 2 years together. We have renewed for the 2nd round. The 1st 2 year we never had anything to get claimed. When we renewed 2nd time they offered annual health check up. When we went to checkup the service not upto the mark and when we asked about the reports and physical consultation on our test they said they give only to maxbupa and maxbupa will communicate with us. Also there is no medical consultation provided, if I need I can go to any 3rd party doctor once get the reports from max bupa where as maxbupa says health check up includes physician consultation and they say when go for collecting reports I should get this facility where as clinic says they cant give reports to me directly and it should be through maxbupa... What a bad set up on the process between the clinic and maxbupa... Once I back home on january 3rd onwards till today I sent almost 10 emails and 3 times phone and registered complaint, but till today they couldn't come up with a support. Any calls they says will talk to clinic and get the appointment plan and now almost 1.5 month and nothing happened. I feel that they looted my money and zero service.

Max Bupa Health Insurance Fraud Company

MaxBupa's famous tagline "Your Health First" is as fake as all their policies and assurance. They are very well known for fooling innocent customers by luring them by adverstisment. They prey on their policy holder's money. I had purchased the health policy for my family on 23rd August, 2016 by paying an amount of Rs. 30, 292/-. After a span of four months I was diagnosed with acidity and visited Kapadia Hospital. I was under the examination of Dr Modi's RMO and they advised me to get admitted but I denied. Instead I did some tests and sonography as prescribed by them. My reports were normal.
On 31st May, 2017, I visited Matoshree Gomati Hospital due to acidity. And there I was examined by RMO of Dr J K Tiwari. Then I was shifted to Prarthana Hospital on 1st June, 2017 to get hospitalized as there were no beds available in Gomati Hospital and got discharge on 3rd June, 2017. I paid hospital bills of total amount of Rs 27679/- (Twenty Seven Thousand Six Seventy Nine) in cash.
I had applied for reimbursement on 29th June and all the required dpcuments had been submitted to the Delhi Office via courier. On 2nd of August, 2017 I got SMS from Max Bupa and came to know that my claimm has been rejected. I didnt get any mail related to denial of my claim. I had a word with customer care representative Ms. Deepa on the very next day and came to know that my claim was rejected for no reason. Later I received email from Max Bupa where it was mentioned that on OPD Paper of 23rd Dec 2016, I was written 6 to 7 months which is not true. I have all the xerox copy of the same. I read it and there was nothing mentioned there. I mailed my grievance redressal to clear this confusion, Ms Jyoti was the contacted person and she to failed to give proper explaination on why my claim got rejected. All they told me showing proper documentation was against their guidelines stating it as non discloser. They have send me an non dislcoser form stating I had this problem before buying the policy and if I dont sign the policy will get terminated.
I have yet not recieved and reply and have lost my money. The false claim and promises of MaxBupa is something that is way to famous now. I am not the only one that got ditched by the company. I would only advice everyone to not go on good reviews stated but focuson bad reviews as they are the actual probem that is faced by the customer. We should all stop buying these policy which neither fulfill their promise nor gives a clear idea about all the guidelines. Please do spread awarness so that no other person's money goes to waste. Be a smart customer and dont get fooled by such fraud company.

Never believe on positive reviews always check negative reviews to know the truth.
To read more genuine reviews just Google 'Max bupa fraud' and see the results.

Name : Chandan Thakur
My policy number is [protected] and claim id is 259868.

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,

Hello,
I’m a Max Bupa Health Insurance Policy Holder (Policy No.: [protected], Customer ID: [protected]), I’ve availed your services in the last four months and would like to discusses some issues but before we could get into that- I would like to request some information so that we both are on the same page.
a) 1st Hospitalization- Letter of Authorization (Dated: 06/06/2016, Pre Auth. ID.: 105011)
Issue 1: Can you kindly email me a copy of the Letter of Authorization?
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?
Issue 3: What all post hospitalization expenses (60 Days from the day of discharge) would be covered?
b) 2nd Hospitalization- Paras Hospital, Patna (D.O.A.: 30/08/16. 17:34)
Issue 1: Can you kindly email me a copy of the Letter of Authorization?
Issue 2: What all pre hospitalization expenses (30 Days from the day of hospitalization) would be covered?
c) 3rd Hospital Visit- Apollo Hospital (Bhubaneshwar): Emergency (Dated: 04/09/16)
Issue 1: What all pre hospitalization expenses (30 Days from the day of hospitalization) would be covered?
d) 4th Hospital Visit- Apollo Hospital (Bhubaneshwar): Coronary Angiogram Procedure (Dated: 05/09/16)
Issue 1: What all pre hospitalization expenses (30 Days from the day of hospitalization) would be covered?
e) 5th Hospital Visit- Apollo Hospital (Bhubaneshwar): OPD Consultation (Dated: 08/09/16)
Issue 1: What all pre hospitalization expenses (30 Days from the day of hospitalization) would be covered?
f) 6th Hospitalization- Letter of Authorization (Dated: 12/09/2016, Pre Auth. ID.: 115622)
Issue 1: Page 2 of Letter of Authorization, INR 1, 93, 396 Benefit Limit is exceeded- If my annual limit of INR 5.50 Lac has not been disbursed then how my benefit limit has exceeded?
Issue 2: What all post hospitalization expenses (60 Days from the day of discharge) would be covered?
I’ve one specific request kindly reply me on email- No calls please!, Thanks for doing the needful.
Best,
Dr. S. K. Sarangi
+[protected]

Insurance Max Bupa: Email 2

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 7 protracted days since my preliminary email- What’s the anticipated time horizon on this grievance redressal platform, I hope its unlike the customer service department whose appellation doesn’t do justice to the disservice it provides to it habitué.
Best,
Dr. S. K. Sarangi
+[protected]

Insurance Max Bupa: Email 3

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,
As you wish.

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

Insurance Max Bupa: Email 4

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]

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]

Response from Max-Bupa
from: Grievance Redressal
to: SUDHANSHU KUMAR SARANGI

cc: Gargi A Sahu

date: Mon, Oct 3, 2016 at 7:06 PM
subject: 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, 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
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]

Max-Bupa or Max-Pain: Part VI
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Tue, Oct 4, 2016 at 6:56 PM
subject: Re: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com

Response Awaited.

Max-Bupa or Max-Pain: Part VII
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Wed, Oct 5, 2016 at 12:02 PM
subject: Re: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com

Response Awaited.

Response from Max-Bupa
from: Grievance Redressal
to: Sudhanshu Kumar Sarangi

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

Max-Bupa or Max-Pain: Part VIII
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Wed, Oct 5, 2016 at 4:04 PM
subject: Fwd: FW: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com

And I regret the the amount of time your are taking.

Max-Bupa or Max-Pain: Part IX
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Fri, Oct 7, 2016 at 11:34 AM
subject: Re: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com

Dear Bhaskar, Response awaited.

Max-Bupa or Max-Pain: Part IX
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Sat, Oct 8, 2016 at 10:58 AM
subject: Re: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com
Response Awaited.

Max-Bupa or Max-Pain: Part X
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Sun, Oct 9, 2016 at 11:40 AM
subject: Re: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com
Response Awaited.

Max-Bupa or Max-Pain: Part XI
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Mon, Oct 10, 2016 at 12:00 PM
subject: Re: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com
Response Awaited.
Max-Bupa or Max-Pain: Part XII
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Wed, Oct 12, 2016 at 10:30 AM
subject: Re: Max Bupa | Service Request 1126031 ||[protected]
mailed-by: gmail.com
?

Response from Max-Bupa
from: Grievance Redressal
to: SUDHANSHU KUMAR SARANGI

date: Wed, Oct 12, 2016 at 5:53 PM
subject: Max Bupa | Service Request 1140068 ||[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 your balance sum Insured of policy number [protected] is 14, 682 i.e. Total Sum Insured less approved amount (5, 50, 000-3, 84, 131-1, 51, 187). Further, we would request you to kindly send your documents for reimbursement. 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

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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

Max-Bupa or Max-Pain: Part XIV
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Thu, Oct 13, 2016 at 5:28 PM
subject: Re: Max Bupa | Service Request 1140068 ||[protected]
mailed-by: gmail.com
Kindly Advice.

Max-Bupa or Max-Pain: Part XV
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
to: bhaskar.[protected]@maxbupa.com,
Grievance Redressal,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

date: Thu, Oct 13, 2016 at 5:28 PM
subject: Re: Max Bupa | Service Request 1140068 ||[protected]
mailed-by: gmail.com
Kindly Advice.

Response from Max-Bupa
from: Grievance Redressal
to: SUDHANSHU KUMAR SARANGI

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

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
to: Grievance Redressal,
bhaskar.[protected]@maxbupa.com,
Gargi A Sahu,
amit.[protected]@maxbupa.com

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

Max-Bupa or Max-Pain Part II

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]

I am a heart beat policy customer with max bupa for the past 3 years policy no [protected] and was due for renewal on Sept 19th 2015. While renewal I was trying to add my spouse to the coverage and I got the first shocker to know that I cannot add her to my existing policy and that I need to take a fresh policy for her. I was given the commitment from the sales team when I enrolled that I can add my wife in my existing policy any time want.

I got my 2nd shocker when they told me that if I take a fresh policy for my spouse I again need to wait for 2 years for maternity to be covered, the reason I enrolled with max bupa was for the maternity benefit, now the 3 years premium that I paid was for a bluff.

I got my 3rd shocker when I got to know that I had enrolled for a sum insured increase benefit (Renewal benefit, not sure of the exact name), where as I had asked for the loyalty points benefit, there was an e-mail sent by the renewal agent to me confirming the loyalty points benefit along with the payment link to make my payment last yer, This e-mail was shared to the customer care team aswell.

Now i'm trying to get this issue resolved and I have no one from max bupa taking interest in have this resolved, I have called the customer care more than 10 times trying to sort this out but all I get to hear is that "this is the problem of the renewal team and they will get back to you." I paid max bupa and dont care which team's problem it is.

I have an open Service Request 436903 raised on the 8th of sept 2015 and none of them from the renewal team has checked it instead they keep giving me reminder calls to pay my premium. I have spoken to number of ppl in the customer care team including the customer care manager Mr. Alam, who has given big commitments in solving my problem but all is in vein. he was not even able to honor his call back commitment.

I'm fine will all the false commitments and bull s*t that I have received so far from MAX bupa and i'm still ready to pay my insurance premium as soon as my loyalty benefit issue is solved and fail to understand why it is taking more than 20 days to get this resolved.

My policy is now in its grace period and I do not want to loose the money that I have paid so far, Incase my policy expires for it not being my fault, Max bupa will have tobear up for any of my medical expenses and revive my existing policy without any break in insurance.

Hi Team,
We are using MaxBupa Health Insurance for our family. We are registered with Family First Silver policy and paying a premium of more than Rs. 40, 000/- . As per our policy there are no capping and hence we will be paid everything without any deductions.

I had gone for my mother's cataract surgery after confirming from MaxBupa that there will be no deductions in the charges. However, my agent has also confirmed the same. When the claim got passed, our amount of Rs.18000/- got deducted and the reason which Maxbupa is giving is that Multifocal lenses are not payable.

However, in our policy wordings no where it is mentioned that multifocal lenses will not get paid. Pls find attached proofs of policy.

Regards

Dear Manager,
Max Bupa
I am just recovering from a large surgery, but due to Max Bupa irresponsible behavior and unethical practices to reject any claim No 57074, I should raise my voice and show you facts that this is a proper unethical rejection done by Max Bupa. I know these insurance companies have 1000 reasons to reject claim and they only make money on rejecting and selling. FYI I am taking this matter to consumer court with mental harassment also.
FYI…First symptoms and diagnostic of GERD happened after inception of the policy and I have complete documents with doctor’s certificate. They just rejected the claim as some junior doctor has written in my IPD document 3 To 4 Years instead of 3 years. Anyway I have my treating doctor’s certificate attached and Max Bupa should reconsider my case.
First time diagnosis of my hernia covered by Max Bupa please find below details -:

Member Reimbursement Statement
Dear Mr. SINGH,

We refer to your claim for reimbursement of eligible medical expenses for your hospitalization as detailed under. We wish to inform you that your claim has been approved for settlement. If any deductions have been applied to your claim, please find appended details of such deductions.

Claimant name : CHARANPAL SINGH
Customer ID : [protected]
Diagnosis : Other specified abdominal hernia with gangrene
Claim number : 3718
Date of Admission : 18/10/2011
Date of Claim Receipt : 02/11/2011
Claim Amount :Rs. 7, 625.00
Applicable Co-Pay :Rs. 0.00
Shortfall Amount :Rs. 155.00
Settlement Amount :Rs. 7, 470.00

Total shortfall amount is INR 155.00 as described below:
Shortfall amount Service Type Reject description
Rs. 155.00 Accommodation non payable items
I was suffering from a problem Hiatus hernia and 1st time got diagnostic by an endoscopy after inception of my max bupa policy number – [protected]. 1st identified – 18/10/11 claim Number 3718 - with an endoscopy of course this disease not comes in pre existing clause at all. And maxbupa reimbursed the complete amount of 1st diagnostic without any issues.
Now treatment started I was on medicine from past two years, and my doctor has suggested me a surgery I have taken an approval of a planned surgery pre-authorization 57074, I got accordingly started process done all the arrangement. At the day of discharge I got a rejection message from Max Bupa suddenly they identified that this disease comes under preexisting and coincidently Max bupa has covered my first identification of the same disease with any problem.
I have not Hided anything from Max Bupa which cleared in the attached doctors certificate as my problem got diagnosed after purchase of policy Max Bupa have no rights to reject my claim in any circumstances.
Suddenly I arranged Rs 1, 14, 000 to pay my hospital bill tonight it was totally harassment and in this condition I have taken lots of tension.
I will fight for it now weather you refund my money or not I will tell with the help of media and putting a case in consumer court so that consumer think 1000 times before dealing with Max Bupa.

Regards,
Charan Pal Singh

Hi,
This is regarding Max Bupa Health Insurance. They have no checks on their DSA / Agents and they provide all false information to get policies done.

This has happened with my mother, who is a senior citizen and they have done health policies fradulently taking advantage of my Late father. The details to the communication are being provided below.

=
Hi,
This is regarding the above mentioned Policy No - [protected] in the name of Mrs. Iva Mukherjee, my mother.

It has been observed that, the same policy is been done with a fraudulant intention and for that I am looking ahead for a legal course of action with the person / persons involved from the DSA and their respective phone numbers.

As you can understand, this is not at all good for your organisation reputation and is hampering your goodwill.

However, the purpose of writing this mail is to understand and seek clarification from your organisation.

1) Would like to know the exit policy and the amount that we get as a refund for the same
2) My mother was told that in case there is no claim in the period of the policy then the entire sum of premuim is refundable. Would like to know the amount of truth behind this statement
3) For renewals, I would like to stop any standing instructions given whatsoever to any bank, to deduct the premuim for forthcoming years of renewal.

I would like to hear from you at the earliest and in detail.

Warm Regards
Abhijit Mukherjee
[protected]

S/o Mrs. Iva Mukherjee

Dear sir,
I purchased Heartbeat (Family Floater) plan of MAXBUPA (policy number - [protected], Customer id - [protected]) 2 years back and this year in 5th October I renewed my policy. Before payment I contacted customer care of Max Bupa as I decided to include
my daughter in the policy who is 1 yr. old. At that time it was told to me that pay the required amount (around INR 8200.00) and with in 3-4 days I will receive the health card and other documents. But
after payment there was no information from max bupa for 3 months. after calling around 20 times I informed that my policy is not renewed because some documents regarding my baby is required. I
submit the document then. but again nothing was done. again contacting 10 times at least they told that they have to make health checkup of my baby for that they need to visit my place. I provided
them my address a month back. but the same pause from other side. again after long list of mails and telephones and every time I am attended with a totally new person and need to tell him again since
starting it was again told to me that send me all the mails I don't know why he was unable to see the mails I sent on customer care email id by the way after getting mail they will take action within 2-3
days. but again one week is over and my policy hasn't renewed so far. That is I paid money without any service being provided by them.
I am really frustrated and don't know what to do next, or where should I contact to get justice.
Please help me and guide me so that these companies do not dare to cheat consumers in this mean manner.
Regards
Anand Kumar
[protected]

Pathetic customer service,

I wanted to add my newly born baby to the presently policy with paying some amount, I was calling the field guy, since 3 weeks, the guy gives me some stories all ways, IM at client place, IM out of town, IM on leave, and all...bull ### things.

I logged a complaint on the website, but doesnt seem to working fine. Till now no one called or replied to my msg.

The website is also worse, you cant see the complete detials of the policy or add an individual.

Guys dont ever opt max bupa. Worst customer service.

Below is the guy who is troubling me is

samuel richards, relationship manager,
max bupa health insurance co.Ltd.
F k regency:10-5-11/12,
main road, masabtank, rd no1,
banjara hills hyderabad-500028

Alert

Dont go for max bupa

I have taken a policy as they told there will be no third party and I got a claim and put for reimbursement and after that their third party person from health india came for verification and asked for money 20% to settle my claim.

Cheater max bupa. They told there will be no third party

Looter health india asked for money 20% to settle my claim

Bakara me

One month back I made online enquiry for Maxbupa Medical Insurance.Within 5 min I got call from their Delhi team and encourage me to buy their product. Minimum 10-15 times they called me for buying their policy.Finally I decided to buy policy.They helped me on call to buy it online because I have credit card.Finally I thought I got my medical insurance.
I waited for 3-4 weeks but no email, no mail, no single call regarding policy document.
Finally after 4 week I called on their toll free number, luckily I had stored my Application Number/customer Number .On calling they told me that my policy has been rejected.
I don't have issue with the rejection but at least they should inform me by mail, email or sms.
If they can call, sms, mail, email me 10-15 times before buying then why they could not inform me the status of my policy once only?
Why were they waiting for my call ?

Max Bupa has started its health insurance policies with lots of FALSE advertising. Their claim of covering everybody whatever their existing illness is false. They charged Rs. 19, 100 as premium before they could even issue policy for my mother. I had disclosed to them that my mother suffers from diabetes (initial stage) and had undergone knee replacement surgeries. They said they have to do some medical tests on my mother and after which they will tell what will be not covered for 4 years. They also assured everything will be covered after 4 years. They conducted medical tests of my mother and informed that we will be contacted within a week. I contacted them after more than 2 weeks after I did not get any response from their side. They asked for 24 hours time to get back and called me after 48 hours and told that their company has DECLINED the policy. I asked for the reason and they could not share the same with me and insisted that its company policy. The worst of all is that they are claiming to send a cheque of Rs. 16000 odd rupees and the balance they are claiming to be the medical test charges. Before conducting the medical tests, they have very clearly mentioned that medical tests will be conducted on the expense of Max Bupa and we did not have to pay anything.

ALL IN ALL ...A FRAUD COMPANY FULL OF LIES!

PLEASE BEWARE!