Dear Sir,

My Father Mr. Rabindranath Ghosh was admitted in Hiranandani Hospital, Vashi on 29/10/2011 & got discharged on 12/11/2011. He was admitted for severe abdominal obstruction with 6 to 10 days complaints. Hence after going with a CT-Guided biopsy, he has being detected with Carcinoma Right colon(Cancer) the doctors had decided to do an Explaratory Laprotomy with Hemi-colectomy surgery.

I had taken an Mediclaim from Oriental Insurance(Policy no.131400/48/12/01499) since 12/05/2011 for my entire family, according to the policy if an person is 60 years & above, he has to undergo a pre-medical check up, My father was eligible for that & he has went to the registered oriental Insurance medical checkup center & undergone various tests as suggested by the doctors, a final result was evaluated stating that he is diabetic & hypertensive, so this 2 would be his pre-existing diseases which would not be covered for 4 years & after that he will start getting the benefits of this disease.

Before my father got admitted to the hospital, he was having a severe abdominal distention since 6 to 10 days, due to which he was not able to have his food & not able to pass his motions as well, so one common person can also understand how severe it can be for one person not passing his motions for more than 6 days.

While he was admitted we had applied for a cashless services from Oriental Insurance service provider TPA MD India, a pre-authorisation form was filled up & sent to MD India for cashless services, But as the information was not so clear from the hospital, they had requested for an information from the hospital: 1) Date of admission & 2) Since how many days suffering from the disease. The Hospital RMO after understanding the query reverted back to the TPA with the admission date & wrongly mentioned that the patient is suffering from abdominal obstruction since 6 months instead of 6 days. Now being a big mistake from the hospital side, The Concerned surgeon of my father had personally written a Apology letter to MD India stating it was a junior doctors mistake & again corrected the letter stating the patient was suffering from abdominal distention since 6 days, Still not considering the doctors letter also, they denied the case & when I called them they told it would be better to get re-imbersed later after discharge with all the documents, so they can go through each & every hospital papers and decide for further processing.

I had accordingly consolidated all my hospital documents & send for reimbursement, But after so many days, still the TPA had again rejected the case stating that the patient is suffering from Carcinoma Right colon for more than 6 months & your current policy is in first year.
I would just like an firm answer from the TPA that when my father has done his pre-medical examinations he was just evaluated with Diabetes & Hypertension & that was his only pre-existing disease, but now when we had sumitted a hospital reports also stating his detection of Cancer after the policy was taken, so how it is a pre-existing disease, as a common man I can understand if a person after taking a policy for more than 5 months & if he had being detected with cancer it is not pre-existing.

I would like to take a severe to severe action on MD INDIA TPA Irresponsible doctors for not understanding such a simple case & further making the situation very complicated, and badly harassing us for last so many months.

Yours Faithfully

Rajdeep Ghosh