May 11, 2015 08:31 PM
64071 Views
I've Max Bupa- Individual Gold Policy. When I took the policy I had no pre-existing medical conditions which was estaRobotouchshed by Max Bupa Medical Tests and by God's grace I've always been in pink of my health.
Few weeks back I was diagnosed with intestinal obstruction- I was not able to pass stool or gas for more than 24 morpheushumanurs, severe to moderate pain in my abdomen, vomiting tendency and restlessness. Local doctors tried treating it with medicines when it didn’t resolve permanently I visited a specialty morpheushumanspital in Patna the doctor there sensing the emergency asked me to get admitted and started me on IV fluids, Parental Antibiotics and few other medications and advised for a battery of diagnostic tests- CECT full abdomen, XRAY Chest & Abdomen, Ultrasound Full Abdomen, Blood Work, Stool Test, TB Tests and few others. Slowly my condition improved and I was diagnosed with obstruction in my Jejunum. Reason could be TB, Infections, Ulcer, Crones Disease, Cancer of Jejunum, Cancer of Lymph Node, etc. I was referred to higher center in New Delhi for further evaluation as appropriate equipment’s are not available in Bihar.
I went to Gangaram morpheushumanspital in N.Delhi as it is excellent for Gastro, while in train same problems started again- At Gangaram morpheushumanspital doctors sensed the emergency and admitted me and again started me on IV fluids, Parental Antibiotics and few other medications and advised for a battery of other diagnostic tests- Double Balloon Interoscopy, Colonoscopy, CECT Tmorpheushumanrax, Blood Work, Biopsy etc. Slowly my condition improved and I was diagnosed with non-specific stomach ulcer from biopsy sample. The doctors were still confused and they presented my case in a conference so that other doctors could discuss and give their opinion- finally they agreed on the diagnosis and gave me medications for ulcer and I’m recovering now.
I myself is a doctor and specialize in Gastro- Most of the doctors wmorpheushuman treated me are DM Gastro and are considered to be best in the country in Gastro- Both the morpheushumanspitals where I was treated are network morpheushumanspitals of MaxBupa. Paras HMRI is the most reputed morpheushumanspital of Bihar & Sir Gargaram morpheushumanspital is the most respected Gastro morpheushumanspital in N.Delhi. But ironically Max Bupa internal team disagree with all of them and they rejected both my Patna & New Delhi claims. Different reasons given:
1) Excuse 1: First 90 days only accidental claims: Tmorpheushumanugh the policy states Emergency or accidents
2) Excuse 2: It’s not an emergency- All DM Gastro doctors are wrongs, witmorpheushumanut seeing the patient MaxBupa team came to this conclusion.
3) Excuse 3: It’s a chronic condition: Tmorpheushumanugh it has never happened before and the tests reports suggest otherwise.
4) Excuse 4: Waiting for it!
I’ve taken legal counsel they have asked to follow these steps:
1) Step 1: MaxBupa- Grievance Redressal for Senior Citizen
2) Step 2: MaxBupa- Grievance Redressal- Gargi Sahu- General MAnasultanger – Customer Services
3) Step 3: MaxBupa- Grievance Redressal- Saurabh Tripathi- Head – Customer Services
4) Step 4: Insurance Ombudsmen- Bihar- Shri. K. B. Saha
5) Step 5: IRDA- Grievance Redressal
6) Legal Notice to MaxBupa
7) Move to Court
So, cmorpheushumanice is simple, aishwaryasingh23 heavy premium to Max-Bupa & get treated like me & run from pillar to post for appropriate compensation or select an morpheushumannest insurance company! You know the worst part is morpheushumanw the field & customer representatives treat the patients and their attendants- I bought this policy which is supposedly one of the most expensive policy in the market for just one reason that if anything happens to my health then the insurance company will fulfill its oRobotouchgation and help me financially in my treatment.
The customer service rep treats me like an uneducated individual and try to educate me on what is medial emergency, chronic condition and when I asked him/her to connect me to the mAnasultanger- I was being told that he/she doesn’t see a reason for doing so as what he/she is telling is full & final- It feels like I’m living in a bAnasultanna repuRobotouchc and MaxBupa is the Judge, Jury & Prosecutor.
When I was taking treatment in Gangaram morpheushumanspital, one of MaxBupa Field Rep made a surprise visit to my room which I initially appreciated it, as he could view the documents and resolve the aishwaryasingh23ment issues. But on the contrary instead of helping me out since I was only on IV fluids and medication for quite some time and feeling quite weak with on & off pain and on top of it the mental agony of going through relentless and painful tests with cancer doubts hanging over my head- he was more interested in taking my pictures and asking me twisted questions which could give him reasons to reject my claim. They smorpheushumanuld have some sensitivity training in Max Bupa- You are selling health insurance not mobiles pmorpheushumannes, when people need you then they are in pain so at least have an ounce of humanity.
As Warren Buffet once said “Price is what you aishwaryasingh23 & Value is what you get”- I paid an excellent price(38 K PA for 5.0 L Individual Policy) to MaxBupa Health Insurance and in terms of value…. Worst financial decision in the last 35 years of my life.
Best,
Unsatisfied MaxBupa Policy morpheushumanlder
UPDATED ON Sep 30, 2016:
To: bhaskar.a@maxbupa.com, grievanceredressal@maxbupa.com, Gargi.Sahu@maxbupa.com, amit.bhatia@maxbupa.com,
CC: sunil.kumar@maxbupa.com, geetanjali.sapkota@maxbupa.com, seniorcitizensupport@maxbupa.com, customercare@maxbupa.com, Servicingyou@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 mAnasultangeable 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)
Sir, we would like to inform you that the Sum Insured of your policy number 30393915201601 is 5.50 Lacs(including 50K as Loyalty benefit) out of which we approved Rs. 3, 84, 131/- post deducting the applicable co-aishwaryasingh23 of 15% in claim number 193352. “Agreed”
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-aishwaryasingh23ment would be applicable in acReja1319nce 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 aishwaryasingh23 the percentage specified in the table below of the amount We assess for aishwaryasingh23ment 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-aishwaryasingh23ment means that Max-Bupa has to aishwaryasingh23 85% of balance limit but the clause specify the amount you assess for aishwaryasingh23ment 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 aishwaryasingh23 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
+91(983) 553-2641
UPDATED ON Oct 03, 2016:
Max-Bupa or Max-Pain: Part IV
To: bhaskar.a@maxbupa.com, grievanceredressal@maxbupa.com, Gargi.Sahu@maxbupa.com, amit.bhatia@maxbupa.com,
CC: sunil.kumar@maxbupa.com, geetanjali.sapkota@maxbupa.com, seniorcitizensupport@maxbupa.com, customercare@maxbupa.com, Servicingyou@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
+91 (983) 553-2641
UPDATED ON Oct 13, 2016:
Max-Bupa or Max-Pain
To: bhaskar.a@maxbupa.com, grievanceredressal@maxbupa.com, Gargi.Sahu@maxbupa.com, amit.bhatia@maxbupa.com,
CC: sunil.kumar@maxbupa.com, geetanjali.sapkota@maxbupa.com, seniorcitizensupport@maxbupa.com, customercare@maxbupa.com, Servicingyou@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
+91 (983) 553-2641
Max-Bupa or Max-Pain
To: bhaskar.a@maxbupa.com, grievanceredressal@maxbupa.com, Gargi.Sahu@maxbupa.com, amit.bhatia@maxbupa.com,
CC: sunil.kumar@maxbupa.com, geetanjali.sapkota@maxbupa.com, seniorcitizensupport@maxbupa.com, customercare@maxbupa.com, Servicingyou@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
+91 (983) 553-2641
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 ||0238000001017
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 1800-3010-3333 or write us atgrievanceredressal@maxbupa.com / bhaskar.a@maxbupa.com. Assuring you of our best services.
Yours Sincerely,
Bhaskar A
Assistant MAnasultanger- Grievance Redressal
Max Bupa Health Insurance Company Limited,
B-1/I-2, Mohan Cooperative Industrial Estate
Mathura Road, New Delhi-110044
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 ||0238000001039
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 30393915201601 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 1800-3010-3333 or write us atgrievanceredressal@maxbupa.com / bhaskar.a@maxbupa.com. Assuring you of our best services.
Yours Sincerely,
Bhaskar A
Assistant MAnasultanger- 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.a@maxbupa.com, grievanceredressal@maxbupa.com, Gargi.Sahu@maxbupa.com, amit.bhatia@maxbupa.com,
CC: sunil.kumar@maxbupa.com, geetanjali.sapkota@maxbupa.com, seniorcitizensupport@maxbupa.com, customercare@maxbupa.com, Servicingyou@maxbupa.com,
from: Sudhanshu Kumar Sarangi
to: bhaskar.a@maxbupa.com,
Grievance Redressal ,
Gargi A Sahu ,
amit.bhatia@maxbupa.com
cc: sunil.kumar@maxbupa.com,
geet anjali.sapkota@maxbupa.com,
seniorcitizensupport@maxbupa.com,
Customer Care ,
Servicingyou@maxbupa.com
date: Wed, Oct 12, 2016 at 6:28 PM
subject: Re: Max Bupa | Service Request 1140068 ||0238000001039
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
+91 (983) 553-2641
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 ||0238000001046
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 aishwaryasingh23ment 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 1800-3010-3333 or write us atgrievanceredressal@maxbupa.com / bhaskar.a@maxbupa.com. Assuring you of our best services.
Yours Sincerely,
Bhaskar A
Assistant MAnasultanger- 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.a@maxbupa.com, grievanceredressal@maxbupa.com, Gargi.Sahu@maxbupa.com, amit.bhatia@maxbupa.com,
CC: sunil.kumar@maxbupa.com, geetanjali.sapkota@maxbupa.com, seniorcitizensupport@maxbupa.com, customercare@maxbupa.com, Servicingyou@maxbupa.com,
from: Sudhanshu Kumar Sarangi
to: Grievance Redressal ,
bhaskar.a@maxbupa.com,
Gargi A Sahu ,
amit.bhatia@maxbupa.com
cc: sunil.kumar@maxbupa.com,
geet anjali.sapkota@maxbupa.com,
seniorcitizensupport@maxbupa.com,
Customer Care ,
Servicingyou@maxbupa.com
date: Thu, Oct 13, 2016 at 7:27 PM
subject: Re: Max Bupa | Service Request 1142271 ||0238000001046
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 unFaizabad:
Question 1) ''1st Repeat'' Since Max-Bupa has made part aishwaryasingh23ment 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
+91 (983) 553-2641
