[Resolved]  United India Insurance - Tpa Ttk Health Care — my dads eye treatment claim denied and rejected

Address:

Bangalore, Karnataka

Hi,

I work with a giant organisation. My company has made it mandatory to take United india insurance as mediclaim corporate policy and i have taken it for sum assured of Rs 2 lakhs for my wife, dad and mom.
Now recently my dad had a chorod in left eye and doctor has suggested us for photo dyanamic theraphy along with 2 injection called as avastine and somethine else. I had send a cashless claim for this treatment and it was denied and rejected initially. reason is this particular eye treatment and injection is not covered under the policy. secondly my doc otr has suggested for betterment of this treatment that my dad has to remain in hospital for 48hrs in dark room after this photo dyanamic treatment. so second time i send the claim again the TPA rejected saying it is a OPD and doesnt require hospitalisation and completely rejected my claim and my internal organisation HR has put a complaint against me saying i have asked doctor to put the statement as my dad needs to be hospoitalised for more than 24 hrs so that i can claim the insurance money.

Sir, i need help with few clarification
1. for the above treatment can a insurance company deny flattly that it is not covered in a policy?
2. for this treatment whether it is OPD or 48 hrs hospitalisation , does insurance company can reject my claim if my dad is hospitalised for more than 24 hrs.
3. Does IRDA has any where mentioned that this particular treatment is not covered.
4. Does any insurance company has the rights to remove any illness as and when they feel like?
5. how should i proceed with this case.