Viral social media post on cashless denial of policyholder ‘baseless’: Niva Bupa

Niva Bupa Health Insurance issued a statement on Tuesday refuting claims made in a viral LinkedIn post concerning the denial of a cashless claim for a Mumbai policyholder, identified as Chandra Kumar Jain, who is undergoing treatment for Myeloid Leukaemia. Jain’s situation, detailed by insurance advisor Avigyan Mitra, alleged that a cashless claim of Rs 61 lakh for a Bone Marrow Transplant at Sir HN Reliance Foundation Hospital was denied, despite having a policy worth Rs 2.40 crore.

Niva Bupa characterized these claims as “baseless” and noted that Jain, who has held the policy since November 18, 2021, has successfully availed claims two times prior, amounting to Rs 22.72 lakh. The insurer clarified that they approved a pre-authorisation cashless request of Rs 25 lakh for Jain’s current treatment but did not sanction an increase to Rs 61 lakh as requested by the hospital, citing escalating costs. The company maintained that the originally approved amount remains valid.

This statement coincides with Niva Bupa’s recent announcement regarding the suspension of cashless treatment services at Max Hospitals due to expired agreements and unsuccessful negotiations over premium revisions. Max Healthcare clarified that they continued to offer cashless services despite the expired contract, asserting that any further tariff reductions were not feasible without compromising care quality.