Re: Mediclaim-cashless facility .TPA med assist

Respected sir ,

Since long , I am suffering from obstructive sleep apponea . For this I am using Cpap machine for over one year . It costs me over 70, 000/- which is not admissible in Mediclaim .It gave me lot of comfort in breathing in sleep . But, for the past few months I am having breathing problem even in day time . I approached yoshoda hospital , secunderabad ENT DOCTOR .After detailed examination ,CT scan of neck and nose and endoscopy of neck and nose , It was diagnosed as 1) Development of crude mass in both nasal pathways 2) enlargement of PALATINE UVULA (CHIRU NALAKA )  3)enlargement of tonsils 4) over size of tongue .
   These can be corrected by major operation . But  being a 1) diabetic 2) BP patient 3) cardiac patient having undergone ANGIOPLASTY twice , this surgery for me  was completely ruled out . But my breathing problem is  aggravated regularly .
  Hence it was decided to perform a surgery using latest technology with the help of radio frequency to rectify my nasal block in the presence of cardiologist .This is more advanced than item no 13 in annexure 3 ( without hospitalisation for 24 hours ) - TURBINECTOMY/Turbinnoplasty . But due to my health condition , I was suggested for one day hospitalisation .

THE PROPOSAL FOR TOTAL EXPENDITUR OF RS 49000/- ONLY BY HOSPITAL TO TPA . THE SURGERY IS PLANED ON 23 .02 .2016 .THE TPA HAS NOT AGREED AND SUGGESTED ME TO PAY CASH AND UNDERGO PROCEDURE  AND LET HOSPITAL CLAIM AMOUNT AFTER WARD .WHAT EVER SETTLED BY TPA WILL BE PAID TO ME BY HOSPITAL REST IS TO BORNE BY ME .

This is completely unreasonable and exploitation . What is the use of TPA and cashless facility?

I don't have any information about whom to approach higher up in the hierarchy . The CRM NO GIVEN IN BOND IS OF NO USE ,ONLY CLERICAL STAFF ARE MANNING IT . The TPA wants to be non committal. We should take this up with New India Assurance Company.

CAN YOU PLEASE GUIDE ME IN THIS REGARD . THIS EXPERIENCE WILL HELP US FOR OTHERS IN FUTURE .

WITH RESPECTFUL REGARDS .

YOURS FAITHFULLY
K.PANDURANGA  RAO
SR Number: 516906