Rejection of claim for daycare rituximab cancer treatment by United India Insurance Co

[munjalbom8]

I had stage IV mantle cell Non hodgkins lymphoma. Got chemotherapy treatment at mumbai . Now under full remission but i am taking rituximab inj in day care every 2 months.All my earlier chemo costs were paid by United India Insurance under their gold policy. I am 61 yrs old male. I have coverage of 6.5 lakhs + 10 lakhs top up mediclaim policy with them. They paid for my 3 rituximab daycare tratment but now refusing saying that rituximab is a monoclonal antibody hence cannot be given. Though nothing mentioned in their policy terms . Their grievence cell has rejected to pay furtther. Need help & guidance to go further

[sumeet_shah Administrator]

The only person who can help you here is your Medical Oncologist. He needs to write a detailed reply to the insurance company justifying it as standard treatment as per world guidelines and requesting to sanction the amount for same.

[maria_87]

Were you able to get a resolution for this? My mother is recovering from non-Hodgkin's lymphoma and the insurance company has rejected the claim to use Rituximab.

[MsLockYourPosts TeamBCI in reply to maria_87]

You don't say which non-Hodgkins lymphoma or what her treatment has been so far. Is your mother being seen by a hematologist or lymphoma specialist? Rituxan maintenance is the standard of care for some NHLs. This group is focused on breast cancer. Feel free to send me a chat. I, and several family members, deal with NHLs. I don't know the system in India, but may be able to offer some help.

[Pakhare]

Some insurance companies reject the claims. In my wife's case, her2+, Out of 13 Herceptin maintenance dose they approved 2 injections, and rejected remaining. Even grievance cell keeps the same decision. In many cases if you go to ombudsman, it is approved. I have also approached to ombudsman, and complaint is registered. Waiting for the award.