Is Niva Bupa Delaying Cashless Medical Claims Amid Disputes with Hospitals?
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Synopsis
Niva Bupa faces criticism for delaying cashless medical claims amidst disputes with private hospitals. Policyholders like Rounika have reported significant issues, including long waiting times for claim processing despite timely premium payments. This has raised concerns about the insurer's reliability.
Key Takeaways
- Niva Bupa is facing criticism for delayed claims.
- Policyholders are experiencing financial strain.
- Customer service responses have been inadequate.
- High volume of complaints reported to the Insurance Ombudsman.
- Important for consumers to stay informed about their rights.
New Delhi, Oct 30 (NationPress) Amid ongoing disputes with private hospitals, the health insurance provider Niva Bupa has been postponing cashless medical claims for numerous policyholders.
One notable case involved a woman from Noida who revealed to IANS that despite consistently paying her premiums for the past four years, she has not yet received a claim of Rs 1.3 lakh for surgery performed in September at a prominent private hospital in the Delhi-NCR region.
Rounika, who had to pay out of her own pocket to the hospital, expressed that Niva Bupa has been stalling the claim even after completing the entire verification process.
Niva Bupa has not yet addressed this issue publicly.
“We have held a mediclaim insurance policy through Niva Bupa for the last four years and have paid all premiums on schedule. I underwent surgery at Max Hospital, where the cashless option was unavailable for Niva Bupa clients. After settling the hospital bill, I submitted the claim following my discharge on September 20,” Rounika disclosed to IANS.
“Upon submission, I was notified through the company's app that the claim would be processed by October 6. However, since that date, Niva Bupa has been extending the timeline,” she elaborated.
The woman later contacted customer service, where she was informed that the verification process would take longer as “we are located in Noida/Greater Noida (a detail they did not disclose at the time of policy purchase).”
Although the insurance company conducted verification on October 8, the app continues to display that it is “under verification.”
“When I reached out to customer care again, they informed me that the processes would take longer due to Diwali. Now, I am receiving no updates from them.
They keep altering the deadlines weekly to frustrate a customer who has consistently made timely payments,” Rounika stated to IANS.
Earlier in August, Niva Bupa halted the cashless treatment service at all Max Hospitals nationwide due to a disagreement over tariff adjustments, leaving thousands of policyholders in a difficult situation.
While the health insurer asserted, “they have established alternative measures to ensure the smooth continuation of customer treatment,” many policyholders are still encountering challenges.
Importantly, Niva Bupa ranked among the top five health insurers that received the highest number of policyholder complaints (1,770) reported to the Council of Insurance Ombudsman (CIO) in FY2023-24, particularly concerning the total or partial denial of claims.
Point of View
It is vital to highlight the growing concerns surrounding Niva Bupa's delay in processing cashless medical claims. This issue not only affects individual policyholders but also raises broader questions about the accountability and reliability of health insurance providers in India. With a significant number of complaints filed, it is imperative for consumers to be aware and vigilant.
NationPress
31/10/2025
Frequently Asked Questions
Why is Niva Bupa delaying cashless medical claims?
Niva Bupa is reportedly delaying cashless medical claims due to ongoing disputes with private hospitals regarding tariff agreements and internal verification processes.
What should policyholders do if their claims are delayed?
Policyholders should contact Niva Bupa's customer service for updates and consider lodging a complaint with the Council of Insurance Ombudsman if they continue to face issues.
How many complaints has Niva Bupa received?
In FY2023-24, Niva Bupa received 1,770 complaints, making it one of the top five health insurers with the highest customer grievances.
Are there alternatives for treatment if cashless facilities are suspended?
Niva Bupa claims to have alternative arrangements, but many policyholders have reported ongoing difficulties despite these assurances.
What steps are being taken to resolve these issues?
Niva Bupa has not publicly disclosed specific steps to resolve the claim delays, but they are conducting internal verifications.
