Admissibility of medicine for claim
02 Apr, 2022 by R Lalittha
Ujvira (T-DM1) or trastusumab-emtansine to treat Her2 + CA Breast in adjuvant treatment is prescribed as protocol by treating doctor. Insurer rejects claim on grounds that it is "mono clonal antibody" and hence exceeded sublimits. whereas , its a conjugate biosimilar of the two medicines mentioned above. Can you please clarify?
Monoconol Anitibody is classified under Modern Treatment. Many plans have a limit defined for such treatments. Kindly cross check your plan for sub limits towards modern treatment. Currently it seems the limit has been reached and hence the claim is not paid.