My father was admitted to Fortis Hospital Mulund for a disease of Distal Penile Stricture and Proximal Short Segment Bulbar stricture for which the Barbaglis Urethroplasty and EIU cystoscopy surgery was done on 27/03/2019 and the total cost incurred was Rs. 2, 46, 301. I am the Cigna TTK Prohealth Plus policyholder for past 2years which went Claim free, but now when i applied for the cashless before getting my father admitted, they denied the claim a day before saying its a pre existing disease,however the medical tests were done at the time of policy purchase which was initiated by the insurer and no existing diseases were disclosed except Diabetes(which we already disclosed). Post hospitalization, we had provided clarification from our surgeon/doctor as well that patient was unaware about any existing disease and it was only when he diagnosed, the disease was established after seeing certain reports which was done 4days before the surgery.
The Policy inception date is 08/04/2017, and my father suffered with fever and chill which was later suspected to be a UTI infection when we consulted the local doctor on 21/08/2017 (four months after policy purchase and this UTI could be symptom of many another disease so we cannot confidently say that it's related to the disease for which surgery was done).
We had to arrange the money and pay the money to the hospital somehow and then we contacted a few concerned people from Cigna TTK and they assured us to apply for Reimbursement and it will get processed.
But, now when I applied for reimbursement by sharing all possible required documents from hospital as well as doctor's clarification note, the TPA has again repudiated the claim(possibly the same reason of preexisting disease).
Please help me get my money back as its a very big amount and the patient was unaware about any disease at the time of policy purchase so he did not falsely suppresed the fact.
I looked into the regulation of IRDA for pre-existing disease and it says -If insured had been even otherwise living normal and healthy life and attending to his duties and daily chores like any other person and is not declared as a diseased person as referred above he cannot be held guilty for concealment of any disease.
Please help me fight this case and suggest the ways to get my money back.