Max Bupa Health Insurance Claim Settlement

Dear Members,
Please read this carefully, and tell your views if I should get my claim settlement or not?.
On 23rd February 2019 I started getting fever 100.4 - 101.5, dry cough, body ache, weakness, I tried taking homely remmidies but didn't help, on 24th February 2019 morning I went to my nearest Max Bupa network hospital for the check and on duty doctor examined me a insisted me to get admitted in hospital, and the treatment was started under Dr. Pritam Moon physician with antibiotics intakes and blood test x-ray sonography taken. I was stable and under observation and on 28th February 2019 doctor asked to get discharge. Titan Hospital has already raised cashless claim and pre-authorization taken from Max Bupa Health Insurance, and on 28th February when all discharge summary and records shared with Max Bupa Health Insurance team and they have rejected the claim ID 229075 for RS 41450 saying with justification of taking this treatment in OPD and not in hospital. And now tell me my friends how can a patient can decide whether he needs to get admitted when doctor insisted, or to call the Max Bupa Health Insurance team and ask whether I need to get admitted or OPD treatment. And I am sure there is no such provision in any insurance who can say to take OPD treatment or get admitted in hospital for the treatment. We are not doctors to decide. I have only followed the process of getting hospitalised in a cashless network hospital more than 24 hrs as per the policy terms. So In this case if Max Bupa Health Insurance is providing such a justification for the claim rejection then how can we trust such health insurance companies by paying heavy insurance premiums. Max Bupa Health Insurance is cheating its customers when it comes for claim settlement. Who is responsible here the medical team of Max Bupa Health Insurance or the doctor of the hospital who is giving the treatment to the patient. Please raise and give your views on this. more  

View all 24 comments Below 24 comments
It is the fault of hospital and doctor.

you need to file a cheating case against Hospital/Doctor and Insurance company. more  
Raise question, on what basis preauthorisation was approved. more  
Sine the doctor prescribed admission you can claim the settlement legally. First try with Ombudsman failing which please file in consumer court. more  
PLX.call 1600 11 4000 and get guided .B N DAS,SOUTH CITY ,KOLKATA more  
Most of the people might have bitter experience with almost all the health insurance companies as and when they submit their claims towards hospitalisation & treatment! Inspite of that, considering the huge amount of money one has to spend on medical treatment in the eventuality of sickness, one is often tempted to take health insurance policy as spending of huge amount of money at one stroke for medical treatment may be out of reach of most of us and perhaps only handful of persons like Dr.Neelam Nath may be able to afford to do so!

It is a known fact that the contracts of insurance are always totally one-sided and the customer-interest is not at all protected. Unfortunately, neither the Government nor the regulator,viz.IRDA, appears to have taken any steps to make the terms & conditions of the contract of insurance more consumer-friendly with the result that both the Public Sector Insurance Companies and the Private sector insurance companies have a field day not only to dictate and impose their own one-sided terms and conditions on the poor consumers but also to unjustly increase their premiums as a matter of routine and the IRDA becomes a moot spectator!

In the instant case, if you consider it proper, perhaps your course of action is to send a legal notice the Insurer concerned to respond within specified time-frame after which you may resort of legal remedies either before the IRDA or local Consumer Forum. more  
In nursing homes,insured patients are subjected to more tests, days of hospitalization are more & prescribed more medicines,because someone out there is paying for the same.
One admitted insured patient suffers,entire family has to do running around.
Non insured patients are looked after better because reputation of the nursing home is at stake
You know about consumer rights better being a student.
Nobody deserves to be admitted to nursing homes for routine fevers,if holistic approach about liver friendly foods,restful life is prescribed along with the medicines to bring down the fever.
During past 30 years,everyone who is insured is getting admitted to hospitals for minor complaints & criticizing doctors. more  
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