Max Bupa — Refusal of cashless admission

Dear Officer,
It is a surprise that The above claim has been rejected based on the reason which cannot be admissible by us.
Even there is no solid reason to deny the claim. Without seeking a report from hospital.

“As per Permanent Exclusion clause 6.15 Hospitalization not justified (as per received
documents vital and oxygen saturation is wnl and it can be manage in home isolation)
Admission solely for the purpose of evaluation, investigations, diagnosis or observation
services or not consistent with standard treatment guidelines (as defined by Clinical
Establishments (Registration and Regulation) Act 2010 and amendments thereafter) or
Evidence Based Clinical Practices.”

My first point, how oxygen saturation can be managed at home, without observing the decline in oxygen level. Please note that RT PCR is Negative taken by hospital in emergency ward.
Let me Narrate the whole sequence
1. Chanchal got fever around 11.30 in morning of 23rd April and temperature was 98.6 F with mild cough
2. On doctor advise over phone taken paracetamol 650 mg and gargling suggested
3. Oxygen level measured by oxymeter it was 97
4. Again at 5.30 oxygen checked it was 98
5. At 7.30 again it has been checked after giving her juice of Pomagranate and result was 97
6. At 8Pm she complained about stomachache and fainted. Oxygen Was 96
7. At 8.03 by sprinkling water she got little senses and oxygen was 98
8. Immediately she fainted and Oxygen was 83
9. Then again by sprinkling water she got senses ant it shot up to 98
10. Again she fainted and oxygen was down to 64
11. We were sprinkling water and keeping her awake and she was breathing thru mouth.
12. We have visited 2 hospital for an emergency treatment, but they shown Inability to take her even to Emergency thinking it might be covid and they didn’t have covid beds available.
13. After at 9.38 AMRI taken her into emergency but warning if RT PCR will positive, we have to search for another hospital for bed. But if non covid they can provide the treatment in ward
14. At 11.40 RT PCR got negative, In the meanwhile AMRI emergency was supporting her to keep her level of xygen.
15. As per Doctor advise from Emergency immediately she was admitted to HDCU, as monitoring and oxygen was necessary.
16. At around 12.03 she got her admission paper ready and further tests were on . Finally she was in HDCU at around 2.00 am of 24th.
WITH ABOVE< HOW IT IS ARRIVED THAT SHE COULD HAVE CURED IN HOME ISOLATION.
SHE IS STILL IN HDCU
You are requested to Kindly Approve the same ASAP.
Regards
Vikas Kumar Choudhary
Uncle of Chanchal Kumari
CG-159, Ground Floor Secor –II,
Salt Lake, Bidhan nagar- 700091
[protected], [protected]
From: [protected]@maxbupa.com [mailto:[protected]@maxbupa.com]
Sent: Saturday, April 24, 2021 3:55 PM
To: [protected]@GMAIL.COM
Subject: Max Bupa: Non-approval of Claim ID [protected]
Was this information helpful?
No (0)
Yes (2)
Max Bupa customer support has been notified about the posted complaint.
Complaint comments 
Share
Tweet

Post your Comment

    I want to submit Complaint Positive Review Neutral Comment
    code
    By clicking Submit you agree to our Terms of Use
    Submit
    Max Bupa
    customer care contact
    Customer satisfaction rating Customer satisfaction rating is a complex algorithm that helps our users determine how good a company is at responding and resolving complaints by granting from 1 to 5 stars for each complaint and then ultimately combining them all for an overall score.
    Read more
    24%
    Complaints
    229
    Pending
    0
    Resolved
    54
    Max Bupa Phone
    +91 11 3090 2000
    +91 11 3090 2120
    +91 40 3325 1300
    Max Bupa Address
    B-1/I-2, Mohan Cooperative Industrial Estate, Mathura Road, New Delhi, Delhi, India - 110044
    View all Max Bupa contact information