Can mediclaim get rejected due to Her2Fish positive?

Hi motiap - First of all see & study your policy in a very detailed manner. See if there is any clause of genetical disorder or anything like it. Then we can see if we get any technical help from anybody

HER 2 positive is not genetic disorder/disease. Does the FISH report specifically state it is a genetic disorder/disease. I am also HER 2 positive and all my claims have been settled. Get a letter from your oncologist that it is not a genetic disorder/disease and submit to insurance company. Public sector insurance companies are funny

pl go to higher up in insurance company and insurance ombudsman before going to court. The insurance company will have an escalation heirarchy. Usually some ignorant medical practitioners are sitting in the claims department. I think you will succeed if you go higher up.

Moitap - as informed by green bear go to higher authorities of the insurance agency

Motiap, greenbear said correctly her2 positive is not genetics disorder but u know these insurance companies tries to find out the way to escape from claim...so if u discuss higher authorities, your case will be settled...our wishes are with u.

Thanks motip greenbear for raising this issue. This is really a matter of concern for all .

Hi motiap,

I have the following to say:

1. This is ABSOLUTELY not a genetic disorder. This is a test for mutation in genes and is NOT a congenital genetic disorder

2. None of my patients (many of them from New India Assurance) have experienced this. All of the claims were passed.

Incidentally, two days back, for one of my young thyroid cancer patient, 15 years old, for whom I had done a BRAF mutation test, got a letter that her claim was rejected because of genetic test and blah blah blah, according to clause 4.4.16 (Genetic Disorders etc.). I wrote a letter yesterday and gave it to her father to submit it for the claim. And I am going to fight for her and ensure she gets the money which rightly belongs to her. Here is a copy of the letter for you to read:

l32i.imgup.net/hu3f6c.gif

The problem with these Mediclaim chaps is, they do not know the difference between 'congenital genetic disorders' and 'genetic tests'. They club both of them, though they are not similar. And there is so much corruption in these medi claim companies and their TPA's. TPA's are paid an amount by their Mediclaim companies to reject as many claims as possible. They reject even routine claims for no obvious reason and cause extreme levels of inconvenience to the applicant who has to run here and there, waste time and energy, running for the money they rightly deserve to be re imbursed. People who do not know a word on medicine and its implications, judge whether you can get your claim or not!! And to mention here, though not related, more than 90% of authorities in Health ministry of India and almost all who are invloved in planning and implementation of Medical Education in India are non medicos (and are pure politicians), who do not know what it takes to become a doctor. It is these non medico ministers and MLA's who decide the fate of doctors and medical education!! This is India.

You MUST fight for this, motiap. Ask your doc to write a letter to your mediclaim company. Thousands of women undergo HER2 testing daily. And all mediclaim companies re imburse cost for Herceptin as well, as long as the amount of mediclaim covers it.

If higher up authorities in insurance company fail to give positive response then there is an insurance ombudsman who is a representative of IRDA that is the insurance regulatory authority.Contact details should be available in your policy. Sad that you have to waste your time in all this when you should be concentrating on the treatment. You will need insurance as Herceptin is very costly.

Her2 Positive breast cancer is certainly not a genetic disorder but an acquired mutation driver in the 17 p chromosome. All what the test seeks to answer is that once the breast cancer has occured, is there an accelerated driver to this cancer or not.

It is pitiful, how ignorant are the mediclaim officers out there who probably have no clue to what this means. You should try and get this published in Times of India and of course appeal and go to higher authorities. You will now undergo treatment with HERCEPTIN, and there is a huge cost to this, and if they are going to cover HERCEPTIN costs, on what basis would they not cover the mere test which proves you are Her 2.

Please preserve all these documents and write and insist on written letters and information, and not verbal excuses from these babus.

I had logged grievance complain a week ago. Today I got reply stating they will do payment. Here is their reply:

"The matter has been discussed in view of grievance raised for the case during our visit to MD INDIA TPA office, BARODA , on 21.01.2015, the treating doctor has clarified that this can not be taken as Genetic Disease as this is a case of Breast Cancer. Therefore MD INDIA TPA is considering the case for the payment in favour of the insured. "

Thank you all for your support and help.

Great relief that you dont have to spend too much time battling to get this.

Thanks for the feedback as well.

(Glad to see quick and right justice done).

You can now concentrate and get back to the unfinished goal of finishing your mothers treatment with Herceptin.

All the best to your mom !

This is good news

If Fish report is positive means its a genetical Disorder

I am Deval Patel, a solicitor who has suffered the same misery at the hands of United India, my insurance company.

I have taken up this issue both with the Insurance Ombudsman and the IRDA.

Last week I have submitted a 200 page compilation, including opinions of Medical Oncologists, Articles on the criticality of Trastuzumab and Technical papers on the subject. I am waiting for their responses.

In the meantime, if you would like to receive updates on my crusade for the inclusion of Trastuzumab in insurance claims, please contact me by email with your case details on Deval1002@gmail.com.