My wife has grade 4 HER positive metastatic breast cancer.
The doctor has tried various medicines/ combinations and now she is on Herclon + Tykerb. I have a group mediclaim policy of Oriental Insurance through my office. The insurance company has declined claim on following grounds:
1. Infusion of Herclon is not Chemotherapy.
2 Patient is HER positive so it is genetic disorder which is excluded from cover.
3. Herclon is an advanced treatment. Medicine is expensive. So not covered. As per doctor no other less costly medicine is working now.
I would contest if my claim is just and fair. If the reply of TPA of insurance company is correct then I will have no option but to give up.
Please suggest reply to insurance company.