Bharathi, had fibroids in her Uterus and she was suffering from bleeding episodes. She went to her Gynaecologist Dr. Sudha Rajaram. She suggested Hysterectomy for her. She was admitted at Adarsha Hospital and underwent the said operation. When pre-authorization was requested it was unduly delayed because her age was only 39. Yashaswini Rules say that if the woman's age is less than 50, then for Hysterctomy one has to take special permission from a panel of doctors. The panels permission was not forth coming. Yashaswini did not grant authorization nor rejected it. It kept it under suspended animation. Doctor went ahead with the requisite surgery. Hospital sent the claim bills to Yashaswini but to no avail. Yashaswini kept saying that how did you operate when authorization was not given? You have flouted the rules. Therefore the scheme will absolve itself from honouring the claim. Bharathi approached the Consumer Court.

The Judgment is here (open the attachment). The complaint was allowed. Court held that pre authorization was unnecessary in emergent cases. Doctor in charge will decide about the time and need for surgery. Waiting for preauthorization is meaningless. The peculiar rule framed by Yashaswini, meant only to harass its members, that age >50 does not need special permission and age <50 needs ultra special authorization is baseless and can not be applied.

The TPA who is the real villain in this whole episode who never bothered to give the authorization in time preferred to be exparte. And the court did not draw any adverse inference on his behaviour. It has been exparte in not only this case but also in several other cases. It is usual for this TPA, FHPL to remain exparte shamelessly.

Court awarded full bill plus Rs. 5000/- compensation plus Rs.1000/- cost jointly and severally on FHPL and Yashaswini.