Is the Viral Social Media Post on Cashless Denial of a Policyholder Really ‘Baseless’?
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Synopsis
Niva Bupa Health Insurance has labeled a viral social media post regarding the cashless claim denial of a Mumbai policyholder as 'baseless'. This case raises crucial questions about the health insurance industry's integrity and the importance of having coverage against unexpected medical expenses. Explore the facts behind this viral story.
Key Takeaways
- Niva Bupa defends itself against viral allegations
- Claim denial based on hospital's request for increased funds
- Importance of health insurance highlighted in crisis
- Cashless treatment services suspended at Max Hospitals
- Ongoing discussions about health insurance premiums
New Delhi, Sep 2 (NationPress) Niva Bupa Health Insurance issued a clarification on Tuesday, stating that the viral social media post concerning the cashless denial of a policyholder from Mumbai is ‘baseless’.
The controversial post, which circulated on the professional networking platform LinkedIn, detailed the situation of Chandra Kumar Jain, who is currently fighting Myeloid Leukaemia and urgently requires a Bone Marrow Transplant (BMT) at Sir HN Reliance Foundation Hospital in Mumbai.
In the post shared by health insurance and investment advisor Avigyan Mitra, it was claimed that a policyholder with a Rs 2.40 crore insurance policy was denied a cashless claim of Rs 61 lakh for this life-saving procedure.
Niva Bupa responded to these accusations, labeling them as “baseless”, and condemned the “fear-mongering narratives” surrounding the case.
The company noted that Jain has been a policyholder since November 18, 2021, and this marks his third claim request made in 2025.
“In the previous two claims, a total of 22.72 lakhs has already been disbursed,” the health insurance provider stated.
In the current situation, the insurer confirmed that it approved 25 lakh for pre-authorisation cashless requests along with an additional charge of Rs 77,000.
However, the insurer did not approve the hospital's request to raise the pre-authorisation amount from the initially approved Rs 25 lakh to Rs 61 lakh, citing escalating treatment costs that had reached Rs 80 lakh by September 1.
“Contrary to allegations made, the approved Rs 25 lakh pre-authorisation remains valid,” the company emphasized.
“Those calling the health insurance sector a 'scam' are being reckless and misleading. Health insurance is crucial for safeguarding families against unexpected medical costs, and this unfortunate incident underscores the significance of having health insurance,” the company remarked.
This post follows Niva Bupa's announcement on Monday regarding the suspension of cashless treatment services at Max Hospitals throughout India.
According to Dr. Bhabhtosh Mishra, Director and COO of Niva Bupa Health Insurance, the company’s agreement with Max expired in May 2025, and discussions over premium adjustments failed, leading to the suspension of cashless services.
Meanwhile, Max Hospitals clarified that they continued to offer cashless services long after the contract's termination, stating that “any further reduction is unviable”.
“Max Healthcare has continued to provide cashless services to Niva Bupa policyholders even after the contract expired in May 2025. Niva Bupa has requested Max Healthcare to further cut tariffs, which are already at 2022 levels,” said the spokesperson.
“Max Healthcare believes that any further reduction is unfeasible and could jeopardize patient safety and quality of care. To assist patients, Max Healthcare has established an express desk to facilitate claims from insurers without requiring upfront payments at their hospitals,” the spokesperson added.
Point of View
I emphasize the importance of approaching such stories with a balanced perspective. While the allegations against Niva Bupa are serious, it is crucial to consider the company's statements and the nuances of the health insurance industry. This case serves as a reminder of the essential role health insurance plays in protecting families from unexpected medical costs.
NationPress
02/09/2025
Frequently Asked Questions
Is the claim denial of Chandra Kumar Jain valid?
Niva Bupa has stated that the claim denial is based on the hospital's request for an increased pre-authorisation amount, which they did not approve. The originally approved amount remains valid.
How long has Chandra Kumar Jain been a policyholder?
Chandra Kumar Jain has been a policyholder with Niva Bupa since November 18, 2021.
What is the current status of cashless services at Max Hospitals?
Niva Bupa has suspended cashless services at Max Hospitals due to a contract expiration and failed negotiation on premium revisions.
