Niva Bupa Denies Viral Claims on Cashless Treatment Denial in Mumbai

By siliconindia  |  Tuesday, 02 September 2025, 12:24 IST

Niva Bupa Denies Viral Claims on Cashless Treatment Denial in Mumbai
  • The insurer says the reported denial of a Rs 61 lakh cashless claim for a Mumbai patient is 'baseless', with Rs 25 lakh already approved.
  • Chandra Kumar Jain, battling Myeloid Leukaemia, holds a Rs 2.40 crore policy and has successfully availed multiple claims in 2025.
  • Cashless services were suspended after the contract expired and tariff talks failed; Max continues helping patients via reimbursements.
Niva Bupa Health Insurance clarified that a viral social media post claiming the denial of cashless treatment for a policyholder in Mumbai is 'baseless'. 
The post on professional networking site LinkedIn, shared by health insurance and investments advisor Avigyan Mitra, described the case of Chandra Kumar Jain, a patient with Myeloid Leukaemia in urgent need of a Bone Marrow Transplant (BMT) at Sir HN Reliance Foundation Hospital. The post claimed that Jain, holding a policy worth Rs 2.40 crore, was allegedly denied a Rs 61 lakh cashless claim for the life-saving procedure.
In response, Niva Bupa called the claims 'baseless' and warned against 'fear-mongering narratives' around the case. The company stated that Jain has been a policyholder since November 18, 2021, and this was the third claim he availed in 2025.
“In the last two instances, an amount of Rs 22.72 lakh has already been paid”, the company said. For the current treatment, Niva Bupa approved Rs 25 lakh pre-authorisation cashless requests along with an additional charge of Rs 77,000.
However, the insurer did not approve the hospital’s request to increase the pre-authorisation from Rs 25 lakh to Rs 61 lakh, based on an interim bill claiming escalating treatment costs, which reached Rs 80 lakh as of September 1. Niva Bupa emphasized that the originally approved Rs 25 lakh pre-authorisation remains valid.
“Labeling the health insurance sector as a ‘scam’ is highly irresponsible and misleading. Health insurance plays a vital role in protecting families against unforeseen medical expenses", the company added.
The clarification comes a day after Niva Bupa suspended the cashless treatment facility at Max Hospitals across India. According to Dr. Bhabhtosh Mishra, Director and COO of Niva Bupa, the company’s agreement with Max Hospitals expired in May 2025, and ongoing discussions over premium revisions failed to reach a consensus, prompting the suspension.
Max Hospitals, however, stated that it continued providing cashless services to Niva Bupa policyholders even after the contract expired. “Niva Bupa requested further tariff reductions, already pegged at 2022 levels, which are unviable and could compromise patient safety and quality of care”, said a spokesperson.
To support patients, Max Hospitals has set up an express desk to assist policyholders in claiming reimbursements without making upfront payments. 
The incident highlights the ongoing complexities in health insurance and hospital agreements, and underscores the importance of understanding policy coverage and pre-authorisation limits before availing critical treatments.

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