[Resolved]  Tpa: M/s Genins India Ltd. (United India Insurance Co. Ltd.) — [protected]@ Shyamal Banerjee: Reimbursement of bills for prostatomegaly

Address:

West Bengal

25 January 2012
To
Shyamal Banerjee
Officer-in-charge
Health Insurance Section
Consumer Forum
2 Brabourne Road
Calcutta 700001

Policy No.: 031000/48/11/20/[protected]
Subject: Reimbursement of bills for prostatomegally.

Dear Mr. Banerjee,

I had suffered from prostatomegally as diagnosed by the Urologist Dr. R. K. Gopala Krishna of the FORTIS Hospital. As per his advise, I was hospitalized in FORTIS Hospital on 30 August 2011, operated (using Laser TURP) on 31 August 2011 and discharged on 6 September 2011. Subsequently, post hospitalized complications developed, such as obstructive micturition with pain in urinary tract, high fever, haematuria and swelling of the right testis in home. Dr. Gopala Krishna had advised me to wash my urinary bladder which was carried out for several times by recommended nurse of Dr. Gopala Krishna. Simultaneously, antibiotics (Netspan and Genticyn injections and tablets such as Percin, Diclogesin and Niftran etc.) were administered as per sensitivity test o[censored]rine culture. Despite such a longtime treatment with several types of antibiotics, my post hospitalized complications like pain in the urinary tract, fever, haematuria and weight loss continued. Surgeon Dr. R.K. Gopala Krishna advised me over telephone to consult physician for correction of my complications. Later I decided to move to CMC Vellore for further treatment which I had informed to United India Insurance (TPA: Genins India Ltd.) on 20 October 2011, before I left. I registered my name online with the name of doctor for consultation. Subsequently, CMC, Vellore informed me the name of Dr. N. S. Kekre, the urologist with date (25 October 2011) and time (at 8 AM) for consultation. When I arrived at CMC, Vellore, the reception counter, they could not find any record of my booking. Meanwhile, I came to know that Doctor went to Sri Lanka, which was not informed to us. So, I had to move to APOLLO, Hyderabad and consulted Dr. V. Rajagopal, an eminent urologist for further treatment. After performing of all the required tests, Dr. Raja Gopal advised me for exotic antibiotic (Tygacil) o[censored]SA by I.V. for five days. After reviewing Dr. Rajagopal allowed me to return home. So, I left the Apollo and arrived home on 11 November 2011 and submitted the bills to TPA for reimbursement.

Subsequently, I came to know that the bills are reimbursed upto 60 days of post hospitalization treatments. But my treatment had to continue even after 60 days of post hospitalization. It means that the stipulated time is important for reimbursement, not the curing of the disease of the patient, for which premium is paid for medical insurance for financial relief. Therefore, the very objective and spirit of medical insurance is totally lost. Time limit can not be the prime factor for reimbursement. Curing of the disease should be the essential factor to be considered for reimbursement of bills actually incurred for the treatment. My case is not very common as Dr. Rajagopal pointed out it to me. So, you need to consider case by case depending upon the actual requirement of the duration of treatment. Such cases should be considered as a special one, like mine.

Under the circumstances, I request you to kindly consider my case for reimbursement of all the actual bills incurred for the treatment of prostatomegally. I am a 74 yrs old patient of prostatomegally, retired from the post of Professor of Zoology, University of Calcutta without enjoying the benefit of the sixth pay commission of the UGC (GOI). Consequently, I have been suffering from acute pecuniary hardship. I have submitted the actual bills incurred for my treatment for reimbursement. You can never encourage me to manipulate the bills for time period of treatment for reimbursement.

In fact I am still under the treatment of Dr. V. Rajagopal and Dr. K. Pradahan for recovery of the disease, because my doctor had advised me to take Bactrim DS. as per urine culture report (Urine and blood test of 25.11.2011) and after that currently I am taking so many medicines under treatment of Dr. Pradhan, bills for which are yet to be submitted for reimbursement.

Under the circumstances, I request you to kindly consider my case for inclusion of all the bills incurred for my recovery of the disease. Please do not hesitate to contact me, if you need further information / document available to me.

Regards.

Thanking you.

Yours faithfully,

Dr. Biswaranjan Maiti (Retd. Professor)
Office address:
Department of Zoology
University of Calcutta
35 B.C. Road
Kolkata 700019
Residential address:
206/1/E, Bidhan Sarani
Suite No. 3
Calcutta 700006