Key Points

It means policyholders can no longer avail cashless hospitalisation at Max hospitals and will have to pay bills themselves before filing for reimbursement.

In a statement to IANS, Dr. Bhabhtosh Mishra, Director and COO of Niva Bupa Health Insurance, said the company’s agreement with Max expired in May 2025.

Talks over premium revisions did not reach an agreement, leading to the suspension of cashless services.

“We understand cashless is unavailable at Max Hospitals for Star Health and Care Health too for variety of reasons. We would like to inform you that our cashless services at Max Hospitals are currently unavailable,” Mishra stated.

He added that insurers such as Star Health and Care Health also face similar issues with Max Hospitals.

“Our agreement with Max expired in May, and while discussions on tariff revision -- an annual process -- have been ongoing, we were unable to reach a mutual agreement. As a result, cashless services at Max Hospitals are temporarily suspended,” Mishra mentioned.

In its notification, Niva Bupa said the step was taken after “exhausting all other options” and cited administrative and process-related challenges in its arrangement with Max Group of Hospitals.

It assured policyholders that treatments at Max Hospitals will continue but only on a reimbursement basis.

At the same time, the insurer reminded customers that cashless services are still available at its 10,000-plus partner hospitals across the country.

Max Hospitals was yet to comment.

The issue is not limited to Niva Bupa. Policyholders of Bajaj Allianz General Insurance and Care Health Insurance may also lose cashless access at several hospitals from September 1, after the Association of Healthcare Providers (India) or AHPI raised strong concerns with online health insurers over the suspension of cashless services at several hospitals.

There were also reports that AHPI has issued an advisory revoking the suspension of cashless services for these policyholders. However, there was no official word from the association.

The General Insurance Council (GI Council), the apex body representing insurers, criticised the association’s move, calling it a sudden and unilateral action that creates confusion and risks undermining public trust in health insurance.

The Council warned that disruptions in cashless services hurt citizens directly by forcing them into heavy upfront payments and could even endanger lives in critical medical cases requiring immediate treatment.

The developments come at a time when the insurance regulator IRDAI is pushing for 100 per cent cashless treatment across India.

While insurers operate under IRDAI’s strict rules, hospitals are not regulated in the same way, limiting the regulator’s ability to intervene.

With hospital treatment costs rising sharply in recent years, such disputes threaten to make quality healthcare even more difficult to access for ordinary citizens.

- IANS