A viral social media post on LinkedIn claimed that Niva Bupa Health Insurance had denied a cashless claim of Rs 61 lakh for a policyholder, Chandra Kumar Jain, who is battling Myeloid Leukaemia and requires a Bone Marrow Transplant (BMT) at Sir HN Reliance Foundation Hospital in Mumbai. However, Niva Bupa has clarified that the allegations are “baseless” and that the company had already approved a pre-authorisation cashless request of Rs 25 lakh, as well as an additional charge of Rs 77,000.
The company stated that Jain, a policyholder since 2021, had already availed two claims totaling Rs 22.72 lakh. In the current instance, the hospital had requested an increase in pre-authorisation from Rs 25 lakh to Rs 61 lakh, citing escalating treatment costs, but Niva Bupa did not approve this request. The company emphasized that the originally approved Rs 25 lakh pre-authorisation still stands valid.
Niva Bupa also responded to criticism of the health insurance sector, stating that those labelling it as a “scam” are “highly irresponsible and misleading”. The company emphasized the importance of health insurance in protecting families against unforeseen medical expenses.
In a separate development, Niva Bupa announced that it has suspended the cashless treatment facility at Max Hospitals across India, citing an expired agreement and unsuccessful talks over premium revisions. Max Hospitals responded by stating that it had continued to provide cashless services to Niva Bupa policyholders despite the contract expiring in May 2025, but that further reductions in tariffs would be “unviable” and could compromise patient safety and quality of care.
The dispute between Niva Bupa and Max Hospitals highlights the challenges of negotiating contracts and tariffs in the health insurance sector. While Niva Bupa has emphasized its commitment to providing health insurance coverage, Max Hospitals has prioritized patient safety and quality of care. The incident also underscores the importance of transparency and communication in the health insurance sector, particularly when it comes to claims and pre-authorisations.