Herclon(Trastuzumab) not paid by Insurance Company by saying that"Hospitalization is not Required to take this injection,hence not paid"

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

2 Replies

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  • Ohh - lets see if anybody can guide you further from our family

  • It's unfortunate, I know. My colleagues see this issue time and again. The only person who can actually help you out by probably justifying all this is your Oncologist. You should definitely be getting your re inbursement.

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