Pathetic is a less severe word for them!. Review on Niva Bupa Health Insurance

I live in Agra and here through one acquaintance, I met this fellow Jayant(doesn't know his full name) in November 2021. He represents NIVA Bupa Health Insurance company and presented the Reassure plan to me.

During our conversation, I asked him multiple times what benefits are not covered under the plan but he kept saying, "Except pre-existing illnesses(waiting period of 2/3 years), everything is covered and you will get cashless benefits in their network hospitals." I found the plan good and made the payment.

Fast forward, August 2022.

As I fell down on my right shoulder on 12th August, 2022 and even after trying medication and Physio when the pain didn't go, I took consultation of a renowned orthopedist in my city. The doc said that I have a partial tear in my rotator cuff and its permanent treatment is arthroscopic surgery. Hearing this, I first tried to get back to Mr Jayant both on call and on Whatsapp but no response, whatsoever. I shared my policy details with my doc. He said I would get the cashless claim benefit because the injury is due to trauma. I first tried for it in a local hospital but there I got to know that I would have to pay Rs 40k extra even if I got the claim benefit.

I told them that I have insurance cover of Rs 25 lac. They laughed at me and said that every surgery is categorised in a package and they offer only Rs 45k as claim benefit. Upon this, I once again tried to reach Mr Jayant and even this time he was not willing to take my calls. I kept calling him and finally he received the call. I shared my experience with him and to my surprise, he too was aware of such clauses. When I asked him why I was not made aware of this earlier. He replied, "Sir! Ye cheezen batane wali thodi na hoti hain. Ye to understood hai. Company aapko wohi claim to degi jiska bill use milega." After getting such response I lost all my hopes on him.

I then once again talked to my doc and as per his suggestion got admitted to the hospital in Grt Noida on 17th Nov 2022 but in the evening I got to know that my claim request has been rejected stating that such surgeries are covered only after 24 months. I called their customer support and mailed them again saying that it should be considered a treatment as it is given in case of fracture(trauma) but no avail. I lost - money, time and faith in these health insurance policies and the people like Jayant who are shameless like hell and have the audacity to make you fool on your face and thrive upon their hard-earned money.

Truly speaking, these policies are devised in such a manner that no one in general can trace what's hiding among those small sized font of terms and conditions. You realise it only after you face such experiences and then you also realise that you can't actually do anything because you yourself signed the docs showing faith in someone's words.

Finally, I would advise not to go for health insurance policies without checking each and everything on your own. Go for a lower cover because you won't be able to get such high cover even if you are entitled to. This way, you would be paying a lower premium amount. And most importantly never ever trust people like Jayant. They are there to just sell and earn salaries or commissions.

Hope my answer saves you from such nightmares!