Trastuzumab inj claim rejected by Insu... - Breast Cancer India

Breast Cancer India

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Trastuzumab inj claim rejected by Insurance company.

Please provide me with orders of Insurance Ombudsman or Consumers Court regarding payment of claim in respect of Trastuzumab inj given to the CA Breast patients.

7 Replies

Trastuzumab - was this inj given separately or along with other chemo drugs, if given separately then claim may get rejected, if given with other drugs then you are eligible for claim, just get a letter from your oncologist and submit along with the claim form, United India Insurance approved my spouse's claim for 5 injections along with chemo

in reply to Sidduram

Thank you very much.

roxboxfox profile image
roxboxfoxRadiationOncologist

The Insurance company letter and their brochure of Terms and Conditions have mandatory obligation, inncase you are not happy with their decision, you can Complaint to the Ombudsman and details should be provided by the company.

in reply to roxboxfox

Thanks sir.

Ours was a stand-alone injection which was rejected. Ombudsman passed 50% of claim amount, took about 6 months. Definitely go ahead and complain to Ombudsman.

Yes I have seen the order of Ombudsman of Maharashtra in case of one Attorney who herself was undergoing the treatment. She has appealed to the Ombudsman and in that order it is stated as 50%. But she replied to me stating that she got entire amount as thete was sufficient amount in the policy. Thanks sir.

Is there any way to get Claim of trastuzumab injection alone no other chemo medicine with trastuzumab .as insurance company rejected my claim with comment as per clause 3.9 trastuzumab stand alone can’t be come under reimbursement.

Any other way to get in this matter can doctor help as chemo is finished ..can he add any medicine to help me out to get my claim.

Pls guide

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