I Ameet Khandelwal aged 45 years, am having a medical insurance (Cash less policy) from MAX BUPA since 17/11/2014
I was diagnosed with Diabetes in April 2018, by my family Dr. Bijendra Singh.
Later after a few consultations with my family doctor and taking medicines for Diabetes for some time, I found that my Diabetes was still not in control. Therefore I searched on the Internet and found that there was this metabolic surgery for Diabetes, which can lead to remission of Diabetes after the surgery.
So I met Dr. Randeep Wadhawan at Fortis Hospital (Vasant Kunj) and after consulting with him he agreed to operate me for the remission of Diabetes. 29th August 2018 was the date decided for operation and therefore I informed my health Insurer MAX BUPA for my cashless policy through the TPA at Fortis Hospital and also through email.
Later on before the operation MAX BUPA denied my claim of cash less on the pretext that the surgery I was getting done does not fall in the terms of my policy by which they meant was that surgery was not allowed for weight loss. The fact is that I wanted to get Metabolic surgery done for remission of my Diabetes where as they twisted the surgery cause as weight loss just to deny my claim.
I did undergo the surgery on 29/08/2018 and spent Rs.2,96,893 from my credit card. I was discharged from the hospital on 31st August and then I filed a claim for reimbursement of my surgery expenses along with all the invoices from Hospital and all the necessary documents asked by MAX BUPA along with the claim form given to me by them.
I have all the proof in writing, claim form being filled by the doctor stating Metabolic surgery for remission of diabetes, and also the hospital invoices and Discharge summary from Hospital stating Metabolic procedure ( Laparoscopic Roux-En-Y Gastric Bypass)
Yesterday I received a message from MAX BUPA that my claim has been denied and again they mentioned reason as some terms of policy.
I am really surprised and also feel cheated and harassed.
I have been paying heavy premium for my health insurance policy since 2014 and today when it comes to claiming my rights they want to deny my claim just on the pretext of their terms which I am not aware of and just because they do not want to honor my claim and thus they are deliberately misunderstanding this surgery as weight loss surgery.
I am attaching hereby all the necessary documents for your review from which you can make out that the purpose of this surgery is remission of Diabetes and not weight loss.
Please help me claim my surgery expenses, which amount to Rs.2,96,893.
Also the delay in reimbursing my medical expenses is causing me a lot of agony, & mental trauma.