Claim denied by TPA after pre authorization approval – India Consumer Forum
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Claim denied by TPA after pre authorization approval

I have taken pre authorization before admission in hospital where I have clearly spoke to hospital for colonoscopy. Doctor prescription also suggest for doing colonoscopy for evaluation purpose and pre authorization form also attached for your ready reference where also clearly mentioned for the same.

On that document basis TPA given pre authorization of Rs.20000.(Approval attached.) and I go for invention on behalf of approval but at a time of bill finalization TPA Denial of Enhancement as saying Cashless facility can not be extended admission only for investigation and evaluation purpose with out line of management hence denied My issue is that all provided documents showing that admission is only for investigation and evaluation purpose then why TPA given pre authorization approval.
I am not able to bear expenses that is more than 18000. If TPA rejected pre authorization same time then I didn’t go for investigation and evaluation due to financial constant.

Now hospital continuously follow up and force me to pay hospital bill and threatening for legal action and my financial condition not allow me to pay this large amount.

Please help me for this as earliest possible for approval of claim by TPA.

Ashish Saxena
Bhopal 462042, Madhya Pradesh

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