Dear Sirs,
This is my 2nd letter on the same issue.
I have Group Insurance Policy provided by my company. This is from National Insurance Co. Limited & managed by TPA- M/s E-Meditek TPA Ltd.
My wife is a patient of breast cancer,most of treatment completed but mainenance Trastuzumab is continue. Doctors advised her to admit in hospital either on regular hospitalization or on day-care basis to take this treatment.
Every time I request for pre-authorization of cashless treatment from my GMC policy. But,all the requests (Cashless or Reimbursement) has been rejected by E-Meditek saying that " Hospitalization is not justified only for taking Trastuzumab Injection''. If it will be day care admission, the wording in denial letter wll be -"Hospitalization is not justified only for taking Trastuzumab Injection as it is not included in day-care list''.
Although,as suggested by all of you, further options are open to go to superior authorities but I want to know that- "Can TPA or Insurance Agency justify the need of hospitalization for any treatment?"
The answer will help me in further course of action.
Regards,
Shashi Shekhar Mishra
Wardha,Maharashtra