I have a Heart Beat Gold Mediclaim policy of Max Bupa. Me and my wife are both the members of this.
My wife underwent Broad Ligament fibroid surgery on 8th October, 2013. I had intimated Max Bupa about the surgery days before the due date and also took their principal consent to help me for cashless insurance. They also gave me a pre authorization approval of 60, 000/-. We were speaking to Mr. Amit from Max Bupa’s customer care team.
Now on 10th Oct, when the doctor allowed us to get discharged, we requested them to send their approval for the balance amount for which they made us wait for good 6 hours approx and moreover after waiting for that long, they chose to reject our cashless claim.
On inquiring their customer care and Doctors team represented by one Dr. Manju gives us the reason that because we are getting treated for Infertility the claim cannot be passed. There have been no tests, no proceedings, no discussions and no reports about infertility and hence the same objection raised by Max Bupa is totally insane and baseless.
We also got our doctor ( Gycanologist) to speak to Dr. Manju and explained that we never came to them for the infertility treatment but for the case of fibroid removal. ( The due sonography reports are there).
Dr. Manju asked my doctor to give in writing the same thing that the treatment was not for infertility but for Fibroid removal, which my doctor sent( of which I have the copy), yet they rejected our cashless claim by merely saying that the doctors team of Max Bupa are not convinced with our doctors explanation. This is totally weird as infertility is NOT something we went for a treatment as that was never a problem. And this has nothing to do with our fibroid surgery as if the fibroid had not been removed, the patient would have undergone tremendous complications.
We have been given the surgery CD by the hospital authorities and they completely support us for challenging the wrong claim rejection of Max Bupa.
We have been sincerely paying Max Bupa’s premium for availing their cashless benefit in our hour of need and when that need arises, this is how Max Bupa treats us.
Now, the hospital has raised us a bill of close to 1, 00, 000 ( 1 LAKH) and Max Bupa has not only rejected the balance claim of 40, 000 approx but has also gone back on their commitment of 60, 000 that they had approved earlier. ( which they gave based on our pre surgery investigation reports).
I have all the records, the papers, my hospital’s evidences to prove my point.