Notes by this user:
Director- Customer Services,
Operations, Technology &
Chief Quality Officer.
Max Bupa Insurance Company Litimed.
Mathura Road , New Delhi- 110044.
Respected Dear Sirs.
wish You All a Happy Diwali new year.
Received your E mail on 9/10/2014,
Sub: Member Reimbursement Statement for Claim Number 101369. Rs: 34271/
Claim Status Denied.
Your Copy Attached.
My Daughter Miss Chetana Jain aged 30 years,
dob 21/06/1984, D/o L.U.Sidhai Chand Jain,
R/O , plot No 5, Suman housing Colony,
West Marredpally, Secunderabad-26,
Membership No : 2344527.
customer ID : 2000046039.
DOB : 21/06/1984.
Valid From : 27/08/2014.
Gender : female.
Claim Number 101369.
Submitted in September.
Sirs, IS ACUTE LEUKAEMIA, NOT UNDER EMERGENCIES.
AS PER YOUR POLICY [MAX BUPA] where in mentioned AS fallow;
What are the major exclusion in the policy: As per Max Bupa
· Addictive conditions and disorders. Ageing and puberty. Artificial life maintenance. Circumcision. Conflict and disaster. Congenital conditions. Convalescence and rehabilitation. Cosmetic surgery. Dental/oral treatment. Drugs and dressings for out-patient or take-home use. Eyesight. Experimental treatment. Health hydros, nature cure, wellness clinics etc.• HIV and AIDS. Hereditary conditions (specified)• Items of personal comfort and convenience:• Alternative Treatment(except for Consultation and Diagnostic Tests (For Platinum Policyholders only)) • Psychiatric and Psychosomatic Conditions—• Obesity. Out-patient Treatment. Reproductive medicine - Birth control & Assisted reproduction:• Self-inflicted injuries. Sexual problems and gender issues. Sexually transmitted diseases. Sleep disorders. Speech disorders. Treatment for developmental problems. Treatment received outside India-(except for treatment undertaken under "Emergency Medical Evacuation and Hospitalization (for Platinum Policyholders only)" or "Specified Illness Cover for treatment abroad (For Platinum Policyholders only)" of the Policy Document)• Unrecognized physician or Hospital • Unlawful Activity. Genetic disorders • any other such permanent exclusions as may be specified in the Schedule • Expenses specified in the List of Expenses Generally Excluded at Annexure III to the Policy Terms & Conditions
Waiting period: As per Max Bupa
• 90 days for all illnesses except any accidents or emergencies.
• 2 years specific waiting period for the following conditions for persons above 60 years of age
• Stones in the urinary system • Stones in billiary system • Cataract • Benign prostatic hypertrophy •Mennoraghia, Fibromyoma, Uterine prolapse including any condition requiring Hysterectomy • piles • Hernia • Degenerative disorders of knee/hip • Chronic renal failure or end stage renal failure • Retinopathy • Diabetes and related treatments.
MAX BUPA HEALTH INSURANCE CO LTD
IRDA LICENCE NO. 145
YOUR EMBLEM IS: HEALTH FIRST
SIR I FATHER OF CHETANA JAIN, [PATIENT]
submitted first claim papers 16/ sep/2014
Sir my daughter as also stated in my earlier e-mail that she is keeping ill health since 3/4 days from 6/9/14, severe body pain, fever etc.
On 8/9/14 went to Dr Anoop Mehta, who presribed few medicines
& asked to come in 2 days if not recovered, with CBP reports.
As she was did not recovered, I got CBP @ SDRC, Secunderabad.
& on 10/9/14 evening, along with CBP report went to Doctor with my
daughter & was asked to admit & got admitted @
J.S.Mahavir Hospitals , Secunderabad of
Doctor Anoop Mehta, J.S.Mahavir Hospitals , Secunderabad
Further another test was asked , which was also done through SDRC,
& reports are submitted, N.Koteswara Rao, Supervisor - Flowcytometry, AmPath (American Institute of Pathology and Laboratory Sciences) Hyderabad .
After this report The Doctor Conferred Acute Leukemia, CALLA
positive B- Lymphoblastic leukemia.
Sir Never i knew that she will have such a big Diesese,
But as a Father I decided to get well and started treatment.
& also informed by my e-mails to your Max Bupa.
Sir since its ongoing treatement and need Liquid cash, as such through few mails requested Max Bupa to fast reimburse my claims.
Instead by their mail of 4/10 & 8/10, asking for fast reimbursement.
Received e mail on 5/10, asking that it will take further 21 days,
Then on 9/10 @ 3.56 pm mail ,asking for 7/8 working days.
Then immidiately on very same day by another mail in evening they sent e-mail thet my claim is denied.
Writing Me As Fallow:
As per documents, hospitalization date falls within first 90
days of the policy so claim is not payable as per policy terms
Claim Status : Denied.
Sir, I like to know if Acute Leukemia, CALLA positive B- Lymphoblastic leukemia.
Is not under EMERGENCIES.
Sir as Earth Quakes are not predicted same newer I thought that My Daughter will have Blood Cancer,
Is Blood cancer Predicted.
Sir to cover up your delay in reimbursement , and my frequent writing e- mails made your self to shed away from responsibility & denying the claim status.
Evev your self asked on 9/10 e-mail for 7/8 working days, but fastly e-mailed very same day, that it is 90 days waiting peroid.
Sir Do me Need Full.
A fast reimbursement of Claims will help me to take care of My Daughters Health Emergencies, for Ongoing this treatement.
Even Knew about Max Bupa a very Trusted & reputed Health Insurance company, AND Because of this I went for This very Policy.
Copy Subitted to above E-Mails
Consumer Affairs Department