The Insurance industry is supposed to have a very strong governance system however it seems liek MAX BUPA has been able to circumvent those through loop holes!
The Direct Sales team made sweeping commitments while selling the policy, and one really does not want to think of using a health policy as it means some one near and dear being unwell or some thing unfortunate happening.
I was told that if I take the GOLD plan then pre-existing diseases would be covered. I asked if there were any tests required - I was told that no there would be no need.
When My wife developed pain in the head where there had been a lump but with no pain for a few months we decided to go to the doctor as over the last few weeks the size had started increasing and the pain had started to become constant!
The doctor recommended that the cyst be excised as it may cause an infection, though it is not an "Emergency" it would be better to get it done ASAP.
This was noted in the pre-Auth form and sent to the Insurer for approval.
The strange part is that you are asked to pay for a whole year of cover but the policy covers you for only 275 days!
The definition of pre-existing is fuzzy... if something surfaces after the policy is taken then it becomes pre-existing!
The insurance company makes you feel as if you are a fraudster trying to cheat the system whereas it is actually the other way around.
If you call the customer care - they tell you that it is the sales team and they may have made commitments that we are not aware of!
The mail trail of communication is attached.
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Dear Insurer,
I am a little concerned about the manner in which this request has been dealt with.
1. The Advisor (DST Mr. Naveen. R. under Team Leader Mr. Kush Khurana) who had met with me to get the policy had, in no uncertain terms confirmed that per-existing conditions were covered under the plan if I was to take the GOLD plan.
2. The need to approach the doctor only came up because in the last couple of days my wife is experiencing severe pain in the head originating from the Follicular cysts of skin and subcutaneous tissue on the scalp. Since it has started causing discomfort and there is an enlargement it obviously is important that the same be attended to at the earliest. It may not be classified as an emergency however it would definitely be prudent to have the same excised to prevent infection, considering that it is on the scalp.
3. Would your honourable medical team suggest that just because it has a 90 day hold period one should risk the spreading of infection?
4. I paid for a ONE YEAR cover!!! By putting in a clause of 90day hold period Max Bupa is in fact offering a cover only for 9 months for the money that was to cover us for 12 months.
5. Wilfully misleading a customer to gain a proposal due to year-ending is gross Misconduct!
I have been cheated and misled to believe that My family and I have a medical cover of 365 days when it is actually only 275 days.
I have been lied to when I was told that the policy covers pre-existing ailments and that I did not have to worry!!!
I fairly certain that the consumer forum will be happy to interact with your representative on this case.
Your organization is playing with the lives of people for making a quick sale during the year end pressure!!!
Putting people in the FALSE SENSE OF SECURITY that MAX BUPA is with us in our times of need!!!
Warm Regards
Subir Sen
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The People-i Consult |Villa #13 Hyde Parkk, Rustamji Layout, Whitefield Main Road, Bangalore 560066 |Mobile 91 (988) 637-8247 | Email: [email protected]
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Dear Mr. SUBIR SEN,
With reference to the pre-authorization request received in respect of Ms. SEEMA SEN for treatment in Manipal Hospital, Bangalore we regret to inform you that the request has been denied. Please find details of our response in the attached document.
Thank you for availing our services.
For and on behalf of
Max Bupa Health Insurance Company
Authorized Signatory
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Dear Sir / Madam,
We refer to your Pre-Authorisation request for the above customer. Our medical consultants appreciate your sending the information to us and have processed the same.
We, however, regret to inform you that we cannot issue a Letter of Authorization for the hospitalisation of the above customer due to reasons detailed below:
Admission date is within 90 days waiting period
The pre-auth and documents provided mentions that the patient has ailment since 6 months which is pre-existing to the policy and was also not disclosed while taking the proposal. Also the pre-auth request is received for planned hospitalization within 90 days of taking the policy. Hence pre-auth request is denied under clause 4a & 4b " Pre-exisiting disease" and under "90 days waiting period applicable for planned hospitalization".
We, therefore, request you to kindly contact SUBIR SEN with regard to settlement of your bills. In this matter, the customer has been notified today. We request you to share a copy of this letter with the customer.
In event of all your queries please feel free to contact our Customer Service Helpline 1800-3010-3333 (Toll Free) or 011-33003333 or mail us at [email protected].
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