Manipal Cigna Cashless Denial. Help!
Hello all,
My friend's father has admitted in the hospital and the dcotors have deiced to go with bypass surgery.
Manipal is rejecting the cashless with below reason. Can anyone suggest or help on what's the next step?
Denial Reason: We have received claim documents of <name redacted> admitted at Yashoda Super Speciality Hospital since 30-09 with CAD unstable angina. Claimant is covered under Manipal Cigna health insurance since 18-08 Based on the information available at this stage, we're unable to determine the medical history and assess the claim. liability. Additional verification or investigation may be required to confirm the admissibility of the claim. Hence, we're unable to approve the request on a cashless basis. We regret our inability to admit this liability under the present policy conditions, We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.
Denial Remark: We have received claim documents of <name redacted> admitted at Yashoda Super Speciality Hospital since 30-09 with CAD unstable angina, Claimant is covered under Manipal Cigna health insurance since 18-08-2024 Based on the information available at this stage, we're unable to determine the medical history and assess the claim liability. Additional verification or investigation may be required to confirm the admissibility of the claim. Hence, we're unable to approve the request on a cashless basis. We regret our inability to admit this liability under the present policy conditions. We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.
I did spoke spoke to the claims representative regarding shat documents they need that will help for investigation and there is no information received.
They say it has been decided by their panel of doctors that this needs more investigation, like a broken record.
Every question is replied with the same answer.
Has anyone faced this before from Manipal Cigna. Can you please give any suggestions. We have already paid 4L+ to the hospital and are in serious need of help and suggestions.