Niva Bupa delays cashless medical claim amid tussle with hospital

New Delhi, Oct 30 Amid continued tussle with private hospitals, health insurance company Niva Bupa has been delaying a cashless medical claim for several of its policyholders.

One such issue came to light, where a Noida-based woman spoke to IANS that despite paying all premiums in the last four years, she has yet to receive the claim of Rs 1.3 lakh for the surgery that happened in September at a leading private hospital in Delhi-NCR.

Rounika, who had to shell out money from her pocket to the hospital, stated that Niva Bupa has been delaying the claim, despite conducting the entire verification process.

Niva Bupa is yet to respond to the matter.

“We were having a mediclaim insurance cover through Niva Bupa for the last four years and paid all premiums on time. I underwent surgery at Max Hospital, where the cashless facility was not available for Niva Bupa customers. Having made full payment to the hospital, I submitted the claim post-surgery and discharge on September 20,” Rounika told IANS.

“After submission, I was informed via the company’s app that the claim will be processed by October 6. But since then, Niva Bupa has been delaying the dates,” she added.

The woman then spoke with the customer care, who said the verification process will take more time as "we are living in Noida/ Greater Noida (which they never said at the time of selling the policy)”.

While the insurance company conducted verification on October 8, the app "still shows under verification”.

“When I again called the customer care, they said that the processes will take longer due to Diwali. Now, I am not getting any response from them.

They are changing dates every week to harass a customer who had paid them on time,” Rounika told IANS.

Earlier in August, Niva Bupa suspended the cashless treatment facility at all Max Hospitals across India due to a failure to agree on tariff revisions, leaving thousands of policyholders stranded.

While the health insurer claimed, “they have put in place alternative arrangements to ensure customers’ treatment continues smoothly”, many policyholders continue to face issues.

Notably, Niva Bupa ranked amongst the top five health insurers, against whom the Council of Insurance Ombudsman (CIO) has received the maximum policyholder complaints (1,770) in FY2023-24, when it comes to complete or partial repudiation or rejection of claims.

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