u/Ducati781

Sharing an update on my original post -https://www.reddit.com/r/InsuranceTroubleIndia/comments/1we8ajd/how_to_escalate_to_niva_bupa/

TL;DR: Niva Bupa was a pain to deal with, but they came through in the end.

Longer version:

After they canceled the cashless pre-authorisation and mentioned that I should proceed with the surgery and they would provide reimbursement later, I decided not to proceed with the surgery until the issue was sorted.

I postponed the surgery, escalated it to Ditto (bought the insurance through them), and also emailed the CEO, COO, and the grievance team at Niva Bupa.

After all the above steps, a lot of stress, and sleepless nights, finally, after 3 days, Niva Bupa came through and said the cashless pre-auth was approved for ₹3.8L (estimate was ₹4.5L), but their diagnosis was still incorrect (frozen shoulder instead of muscle tear).

I spoke with Ditto and the hospital. Both said it was alright, but I wasn’t convinced because the approval letter specifically mentioned that if the final diagnosis doesn’t match the approval letter, the cashless claim is null and void.

And the hospital was definitely going to inflate the bill because it’s insurance, and I didn’t want to be stuck with a ₹5L bill on the day of discharge.

Ditto escalated it to the Niva Bupa team, and they shared the revised approval letter within a few hours.

I scheduled the surgery, and my mom had to stay in the hospital for 2 nights.

Moment of truth - I was honestly tense about what would get approved/disapproved in the cashless claim, given the crap experience I had so far with Niva Bupa.

Actual bill shared by the hospital - ₹4.54L
Discounts applied - ₹13k
Total bill - ₹4.41L

Niva Bupa approved ₹4.05L initially and asked me to pay the remaining ₹36k as they were consumables, and I didn’t opt for the consumables add-on when I took the insurance (will opt for it during renewal).

In the list of consumables, there was Fibertape (₹13k) and “Others” (₹6k). I spoke to the hospital, and they mentioned that Fibertape was used in the surgery, so it should be a part of the procedure.

I escalated both items to Ditto.

I tried calling all publicly available phone numbers of Niva Bupa, and none of them were working (excellent customer service!!). Even in an emergency, you cannot reach them via call.

We waited for 2 hours for a response and finally received an email from Niva Bupa saying that they would pay for the “Others” line item (₹6k) and we should pay ₹30k at the hospital.

Moral of the story - don’t give up and constantly escalate if something isn’t right.

Overall, it was a terrible and extremely stressful experience dealing with Niva Bupa. I will never recommend them to anyone.

A special mention to Ditto for being there throughout this terrible journey (btw, they were the ones who recommended this insurance 3 years back).

Their service was so much better than my experience with Policy Bazaar last month for my surgery (pathetic would be an understatement).