'Biggest Scam Business In India': Rs 61 Lakh Health Insurance Claim Denied By Niva Bupa Sparks Outrage
A viral post on LinkedIn has drawn questions on the reliability of health insurance, after a patient with a Rs 2.40 crore policy was allegedly denied a Rs 61 lakh cashless claim.
A viral post on LinkedIn has drawn questions on the reliability of health insurance, after a patient with a Rs 2.40 crore policy was allegedly denied a Rs 61 lakh cashless claim for a life-saving procedure.
The LinkedIn post, from health insurance and investments advisor Avigyan Mitra, details the case of a patient named Chandra Kumar Jain, who is battling Myeloid Leukaemia and urgently needs a Bone Marrow Transplant (BMT) at Sir HN Reliance Foundation Hospital in Mumbai.
According to Mitra, despite the patient holding a substantial health policy with Niva Bupa, which included a Rs 1 crore base cover and a Rs 1.4 crore no-claim bonus, the insurer "suddenly denied cashless approval, citing 'liability cannot be established.'"
This move came after the company had initially provided a written pre-authorisation for a Rs 25 lakh BMT package. Mitra said the action is a "systemic betrayal," arguing that with the "same patient. Same treatment. Same procedure. Same policy," the family was being forced to arrange a significant sum of cash during a medical emergency.
"Health insurance cannot become a game of wordplay and escape clauses. When lives are at stake, dignity, compassion, and fairness must come first. This fight is not just for Mr. Jain. It’s about ensuring that no family in India ever has to beg their insurer during the darkest hour of their life," said the post.
Angel investor Udit Goenka also shared the post on X saying "Insurance is the biggest scam business in India".
Insurer's Response
In response to the post, Niva Bupa provided a four-part statement on X. The company’s representative, Aarav, confirmed they were "acutely aware of Mr. Jain’s case" and noted that an initial pre-authorisation of Rs 25 Lakh was provided.
They claimed "a variation in the costs presented" led to an escalation in the matter. The insurer stated that according to the standard cashless process, final approval is sought at the time of discharge, and since the patient had not been discharged, they would process the final request within stipulated timelines.
They also added that they are committed to working with all stakeholders to provide support to the patient and his family.
