Cashless no more: Niva Bupa customers to pay at Max Hospitals, claim later

From August 16, Niva Bupa customers can no longer access cashless care at Max Hospitals. You must now pay upfront and request reimbursement afterward

In a significant blow to thousands of policyholders, Niva Bupa Health Insurance has suspended its cashless treatment facility at all Max Hospitals across India, effective from August 16, 2025.

 

Under this abrupt change, Niva Bupa customers will now need to pay out-of-pocket for hospitalization at Max Hospitals and then file for reimbursement instead of availing cashless coverage directly . The insurer cited an expired agreement since May 2025, with ongoing tariff renegotiations that fell through, according to a report in the Economic Times.Max Healthcare, on its part, said hospital tariffs have stagnated at 2022 levels and any further reduction would risk patient safety and quality of care .

 

" We would like to inform you that our cashless services at Max Hospitals are currently unavailable. Our agreement with Max expired in May 2025, 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," Dr. Bhabhtosh Mishra, Director & Chief Operating Officer at Niva Bupa Health Insurance told Economic Times.

 

What does this mean for policyholders? 

 

Niva Bupa policyholders can continue their ongoing treatments at any of the 22 Max hospitals across India but only on a reimbursement basis. This means that while Niva Bupa policyholders can avail of treatments at Max Hospitals, they will have to first pay the bills out of their pockets, and then file for reimbursement with Niva Bupa.

 

What you can do? 

 

Niva Bupa assures priority reimbursement for in-treatment cases at Max Hospitals, aiming to reduce delays for current patients 

 

If you prefer cashless convenience, consider going to one of the insurer’s 10,000+ other network hospitals 

 

Always keep a buffer—up to 3–6 months of healthcare reserves—to manage situations when cashless isn’t available.

 

The Bigger Lesson

 

This disruption highlights how fragile cashless access can be—even in top-tier hospitals—when insurer-provider agreements fall apart. As IRDAI continues to push for universal cashless coverage, policyholders must stay vigilant about network hospitals and claim processes.

 

What it means for your finances:

 

Immediate Cash Crunch: Expect to manage sizable hospital bills upfront—potentially draining emergency funds or requiring short-term loans.

 

Cash Flow Stress: Unless Niva Bupa expedites claims, reimbursement could be delayed—adding to financial strain, especially during critical care.

 

Choice Dilemma: Policyholders may need to opt for alternative network hospitals offering cashless service or pay upfront at Max and wait for reimbursement.

 

What Niva Bupa Is Offering Right Now

 

Priority Reimbursement Process:

 

• Customers getting treated at Max Hospitals must pay bills upfront.
• They can then file for reimbursement with Niva Bupa, which promises “quick” settlement.
• No exact timelines or guarantees are available yet.
• For chronic patients (long-term treatment), partners are asked to specifically inform them about this process.

 

Cashless Alternatives:

 

Niva Bupa has asked partners to guide customers toward its 10,000+ other network hospitals where cashless claims are still active.

 

This is their way of reducing disruption but also limiting Max Hospitals’ access under their plans

 

What the numbers say about Niva Bupa

 

Claim Settlement Ratio (CSR):

 

For FY 2023–24, Niva Bupa’s CSR was 92.02% → meaning 92 out of every 100 claims were approved.

 

On the surface, this looks reassuring.

 

Incurred Claims Ratio (ICR):

 

Their ICR is 59.92% → meaning for every ₹100 of claims filed, they only paid about ₹60.

 

This indicates stringent claim checks and relatively conservative payouts, which may leave customers covering more costs out-of-pocket.

 

Complaints Record:

 

Ranked among the top 5 insurers with the most complaints at the Council of Insurance Ombudsman (CIO) in FY 2023–24.

 

1,770 complaints were specifically related to claim rejections (full or partial).

 

This shows a pattern of customer dissatisfaction when it comes to getting claims settled.

 

Cashless Suspensions Are Growing

 

Earlier in 2025, CARE Health Insurance also suspended cashless ties with Max Hospitals (but only in Delhi-NCR).

 

Their reason: “unsustainable demands” from the hospital side.

 

This suggests a wider industry issue where insurers and hospitals are at odds over tariffs, putting policyholders in the middle.

 

Flashback: Bajaj Allianz’s Cashless Deal Suspended (Now Restored)

 

In late August, AHPI ordered the suspension of cashless benefits for Bajaj Allianz customers—affecting 15,000+ hospitals across North India, including Max, Medanta, and Fortis.

 

Reason: Hospitals cited outdated reimbursement rates, harassment via claim deductions, and delayed payouts—amid persistent medical inflation of 7–8%.

 

Resolution: After industry pressure—including from the General Insurance Council—cashless services were restored. Bajaj agreed to negotiate rates and protocols with AHPI, reversing the suspension in the interest of policyholders. Tapan Singhel, CEO of Bajaj, stated:

 

"Cashless access is the backbone of health insurance and should never be compromised."