Niva Bupa Halts Cashless Facility at Max Hospitals, Affects Thousands

Niva Bupa Health Insurance announced on September 1, 2025, the suspension of its cashless treatment facility at Max Hospitals across India. This decision leaves thousands of policyholders needing hospital care to pay their bills upfront and seek reimbursement later. The suspension comes after the company’s agreement with Max Hospitals expired in May 2025, and subsequent negotiations over premium revisions did not yield a resolution.

Dr. Bhabhtosh Mishra, Director and COO of Niva Bupa Health Insurance, confirmed the development in a statement to IANS. He noted that discussions regarding tariff revisions, an annual procedure, were ongoing but ultimately failed to reach a consensus. “We understand cashless is unavailable at Max Hospitals for Star Health and Care Health too for a variety of reasons,” he stated, highlighting the broader impact on multiple insurers.

The insurer emphasized that while cashless services at Max Hospitals are temporarily unavailable, policyholders can still access treatments on a reimbursement basis. Niva Bupa reassured its customers that cashless services remain operational at over 10,000 partner hospitals across the country, mitigating some of the disruption caused by this suspension.

The situation is not exclusive to Niva Bupa. Policyholders of Bajaj Allianz General Insurance and Care Health Insurance are also facing potential cashless access losses at various hospitals starting September 1, 2025. This follows concerns raised by the Association of Healthcare Providers (India) (AHPI) with online health insurers regarding the ongoing cashless service suspensions.

In a further twist, reports have emerged that AHPI issued an advisory to revoke the suspension of cashless services for certain policyholders, although there has been no official confirmation from the association. The General Insurance Council (GI Council), which represents insurers, criticized AHPI’s actions as unilateral, stating that such moves create confusion and risk eroding public trust in the health insurance sector.

The Council expressed concern that disruptions in cashless services directly impact citizens, forcing them into significant upfront payments, which could jeopardize lives in emergencies requiring immediate medical attention.

These developments arise at a critical time when the Insurance Regulatory and Development Authority of India (IRDAI) is advocating for 100 percent cashless treatment across the nation. While insurers are subject to IRDAI’s stringent guidelines, hospitals operate under different regulations, limiting the regulator’s capacity to intervene effectively.

With rising treatment costs posing a challenge in accessing quality healthcare, the ongoing disputes between insurers and hospitals threaten to exacerbate the situation for ordinary citizens. As the landscape of health insurance continues to evolve, the implications of these developments will be closely monitored by stakeholders across the industry.