On the 12th of May, my father was waiting to be discharged from hospital after battling for his life in the ICU. He had spent 3 of those days in a coma, and was still critically ill and frail. But he was cheered by the thought of going home. He washed and shaved and dressed by 10 am, it was the first time he was stepping out in days and he readied for the occasion.
My father had got himself medical insurance 14 years ago, at the insistence of Bajaj Allianz agent Sambhu Das (agent code 10008174). Persuaded by Das, my father also ensured that I got myself a policy from them. This was the Bajaj Allianz Health Guard policy. Not only this, he has been appearing for the every medical examination required by Bajaj Allianz, at pathology labs specified by Bajaj [the Calcutta Heart Research Institute] for the biological parameters mentioned by them. On the basis of these results, the company insured my father for a certain sum of money.
My mother had filled in the insurance form requirements with the person concerned at the hospital desk almost as soon as my father was admitted; she had also been following up on the progress. The requisite medical reports were duly sent by the hospital. The agent, Das, however, did not take or return my mother’s calls until two days before my father was released from hospital. The insurance company, Bajaj Allianz, said they were checking the reports. They expected payment to come in by the day of discharge, which also made sense given that the final bill would be drawn up then.
On 12 May, 10 am passed to lunch time. My father was given lunch by the nursing home. Tired by the wait, he was depressed by the delusion. They put him back to bed. He changed back to his hospital gown.
My mother, meanwhile, missed lunch running around following up frantically with Bajaj Allianz. The company nonchalantly informed the hospital that they had not received the requisite documents. My mother checked with the hospital and found they had long sent the requisite documents. She realised then that Bajaj Allianz was not going to pay up. These were excuses.
She was determined that my father should at least get home before tea. My mother and uncle cleared the bills, something which Bajaj Allianz had promised would be cashless and painless. They ate lunch at 4 pm. My father was home, his first thought was what is my illness costing my family?
The next day: the Bajaj agent calls and puts my mother on the phone with a certain Anjan Das.
“Madam, the hospital has not replied to our queries,” says Mr Das.
“Yes, it has,” my mother is certain. “I saw them sending the stuff.”
“Madam, those were the documents. We had certain queries which they didn’t answer,” Das says.
The next day, 14 May, my mother checks with the hospital, finds the document of answers they sent to the queries, makes a copy and feels confident. She takes it along to meet Mr Das.
She is made to wait for an hour by the security guard who refuses to let her enter.
“I have never spoken with you,” said Mr Das, when he finally made an appearance.
“But I spoke with a Mr Das yesterday on the phone when the agent called,” my mother says.
“Ah, you spoke,” he said, with the air of cracking a case. “But I didn’t.”
He then took a look at the documents my mother carried and said Bajaj could not pay for my father’s hospital bills because he had suffered hepatitis in1995. My father signed up for the policy 14 years ago. At the time, my father had recovered from the disease and not taking any medicines for it. The Bajaj-appointed agent made my father sign the policy documents and said he would take care of the rest. He said he would fill in the policy on my father’s behalf.
“Ah,” said Mr Das, “that’s the rub. You should have mentioned that he had once suffered from hepatitis.”
“But it is the agent who lied. Moreover, my husband appeared for every single test that you, Bajaj Allianz, prescribed,” my mother said. “At the labs you stipulated [Calcutta Heart Research Institute)]. And you renewed the policy every year, satisfied with the results.”
“The tests did not catch liver disease,” says Das.
“Surely that is your problem? You should check your policy holders thoroughly,” my mother says.
“You can’t expect us to cover every possibility,” says the unstoppable Mr Das.
No? What else is insurance for?
–wrote Sohini Chattopadhyay
6 replies on “An Encounter with Bajaj Allianz Health Insurance”
Like holes in Law.
holes in policy guidelines.
Healthcare cost is very high and people are trying for shortcuts ( either a policy holder or underwriter)
Bajaj alliance md,s balls should be chopped off in public
You should approach the grievance redressal for Bajaj Alliaz and then send the documents to the insurance ombudsman. There are very clear guidelines on insurance claim settlement and the insurer cannot cite pre-existing illness for a long running policy.
Next they will want a documentation of every cold and stomach ailment.
What a bunch of jokers.
I hope the family sues the living daylights out of them.
Complete nonsense and unacceptable. Even the clause of “pre-existing diseases” would have been over in the first four years of continuous insurance. Bajaj Allianz has no right to reject the claim. The party should approach consumer forum and all available media and internet sites to see that the insured in paid in full as per the claim. Some body should create a “hate-Bajaj Allianz” site to see that all other insured ones can justice from this nonsense company. They have no right to reject the claim.
1. Medical insurance in India is a joke
2. Medical expense is discretionary, don’t let anybody tell you otherwise
3. It will be your decision whether you want to first become a pauper and then die, or whether you want to die rich and leave something to your next of kin
4. Hospitals today can keep you alive till your money runs out, no matter what your disease. Your best option is to be dead before you reach the hospital
5. Give up your fear of disease, injury, or death. It liberates your mind and fattens your wallet.