Cost of inj. Trastuzumab is denied by United India Insurance co

[Rmyadav]

The treatment of breast cancer of my wife is going on in AIIMS, New Delhi and an Inj Trastuzumab is administered pre and post operation. The cost of five inj. In pre operation period paid but my TPA who is under UIIC is denying the reimbursement for post operation period. A huge conversation verbal and in writing has been done. My oncologist has also given a certificate that this inj. Is given for parenteral chemotherapy but no respond. I should go to consumer court or Ombudsman office. If there is another way, please advise.

Ram Mehar Yadav

[dhamecha]

It is very critical situation and we also facing same problem. I raised this issue to many govt institute and ngo several time in last 6 months but no one come forward. I mailed to NPPA, NCG, Cancer care india, AIDAN, Dr Harsh Vardhan health minister so many times but nobody help us in this regard. I suggest to you go head to insurance ombudsman meanwhile you buy this drug from direct pharmacy @23000/- against mrp of 58900.

[SjChowhan in reply to dhamecha]

Is your hospital allowing injection purchased from outside ??

[Sherna]

Try the ombudsman. In Mumbai he gave a ruling twice in my favour when United India denied two claims and I am preparing to go before him again for a third. United India has a horrible and ignorant TPA called Vipul, who denies or cuts down claims as it pleases either giving no explanation or giving absurd explanations. You can always go to the consumer court afterwards. Insurance companies rely on patients being too hassled to pursue their claims which is a horrible thing to do to sick people.

[sananc04 in reply to Sherna]

Similiar case of mine is pending under kolkata ombudsman. New India Assuarance TPA has denied all my claims stating the following reason that this drug ( trastuzumab) can be administered in OPD and daycare admission is not required. Can u guide me about your experience and how you defend your view in Ombudsman. My mail id is [e-mail]

Best regards... santanu

[Jsvs in reply to Sherna]

HiCan I please get the ruling given by ombudsman?

[UpperHand Administrator]

dhamecha , Sherna , thanks for your replies. Helpful info about approaching the ombudsman.

I don’t give chemo (am into Pharmaceuticals) so not much idea on what do patients do in this case. Will ask some doctors and get back.

It is indeed sad to see such genuine claims being taken for a ride by these insurance companies. They definitely have the right to reject false and untenable claims, but for such genuine claims especially in cancer, I wish they were more sensitive and pass. Since ombudsman twice passed in your favour, I was wondering why can’t they pass a ruling in that favour. Cancer is a different illness altogether and there should be a separate set of rules for insurance of cancer patients. Their claims should be settled within 7 to 14 working days of claim submission as there is always the next cost coming on the way.

[kanhaiya2]

try reading the post healthunlocked.com/breastca...