Cashless Claim Rejected by Manipal Cigna for DBS Surgery

Dear Members

1. My father  was diagnosed with Parkinson disease in November  2020 by the Medical Doctor . My Father was having symptoms like rigidity, tremors, and slowness from October 2020. Hence we approached Doctor Consultation on 23.11.2020. The doctor observed the person and declared he is a Parkinson Patient.

2. In the 1st consultation paper the Doctor expressed her doubt about the possibility of Non -Motor Symptoms which was not related to treatment of Parkinson Disease . ( Note- This is only her doubt and not any opinion/ declaration ) She wrote in the consultation paper as "PD ? 1-2 yeras." She kept Question Mark (?) in the consultation paper. The doctor did not mention these points in the clinical points and she wrote separately as they were just doubts expressed by the Doctor.

3. The cashless approval team took 1-2 years of doubt (?) expressed by the doctor in the consultation paper as the Opinion and rejected the Claim for Deep Brain Stimulation (DBS) Surgery. The symptoms started in October 2020 and how could we know about the non motor symptoms and the disease where there were no symptoms before? The Claim was 14 Lakhs. It is very difficult to incur expenses first and go under Reimursement process.

The Points in My Favour

1. Pre Medical tests taken before isssuance of policy by the companay.
2. The consulation paper based on which which they rejected already submitted to the company in 2020 immediately after Diagnosis. They accepted and sent a mail saying that it will not be an issue for future claim as the disease is daignosed post issuance of policy.
3. The uderwriting team team accepted the diagnosis and issued endorsement letter for Parkinson Disease
4. The disease is printed in the policy copy in 2021 for Post issuace helath disclousure.
5. The present treating Doctor gave certificate about the 1-2 years doubt expressed in the 1st consultation paper and clarified the issue to the insurance company.
6. The Doctor diagnosed the disease in 2020 and she expressed her doubt (?) 1-2 yeras of Non-Motor PD.The expression of doubt will not come under defination of PED as the disease was not diangnosed before 2020 and no treatment was taken before.

The company rejected the cashless claim eventhough i have above mentioned strong points in my favour.

So, kindly inform anyone how to fight with the company and get cashless approval.

If anyone needs documents and supproting proofs. Kindly send your mail ids. I will send detailed reports.