Manipal Cigna rejecting robotic surgery for - “ROBOTIC CHARGE ARE NON JUSTIFIED , SHOULD COLECT FROM PATIENT PAYING AS PER CONVENTIONAL CHARGE” even though policy allows robotic without any riders
Hi! Uncle got robotic surgery done on doctor’s advice and at discharge my insurer has rejected the robotic component by saying -
ROBOTIC CHARGE ARE NON JUSTIFIED , SHOULD COLECT FROM PATIENT PAYING AS PER CONVENTIONAL CHARGE
The hospital has already submitted a letter for justification of robotic surgery during the pre-auth process (robotic was not okayed that time as well). Letter mentions the usuals -
“Robotic is more precise, less blood loss and early post-operative recovery. It has better hand -eye co-ordination,3D views, and depth perception and efficient alignment overcomes the limitation of human wrist and arm.it is ergonomically better and decreases the chances of error, hence medically recommended.”
My insurance policy says -
“Robotic and Cyber Knife Surgery – Covered up to full Sum Insured for treatment availed in India.”
And
Customer Information Sheet / Know Your Policy at Page 15, Clause D.II.10, which states:
“Robotic and Cyber Knife Surgery – Up to full Sum Insured, for treatment availed in India.”
My query is whether the insurance company is right to reject the claim based on the fact that the charges are not justified. What are my next steps? I've tried to raise an escalation with them but have not received any reply. Does this rejection mean that they are trying to say that robotic is not allowed as a whole, or are they trying to say that my hospital is charging too much for robotic? Please advise.