u/awkwardlycurious

My mother was diagnosed with MOG-associated myelitis after two weeks' of hospitalization on 8th May. The insurance covered approx 87% of the total hospitalization expenses.

She had to re-admitted today for second dose of rituximab, which the doctor adviced to be administered over a two-day period of in patient treatment.

However, my cashless claim was rejected on the following ground:

Rejection reason:

As per submitted documents member got admitted for management of MOG associated myelitis . However, the

proposed line of treatment is clinically not indicated and Unproven. Hence, we regret to inform you that the

cashless facility has been denied

Clause:

Unproven/Experimental treatment means the treatment

including drug experimental therapy which is

not based on established medical practice in India, is

treatment experimental or unproven..

What are the chances of my reimbursement? And what steps should I undertake next?

Mother was hospitalized for urinary retention but it became a two week hospitalization after she started showing symptoms of transverse myelitis. Every time the insurer has asked for doctors note and case summary, they have sent the continuation notes.

I have mailed the insurance desk at the hospital. What following steps should I be taking? My mother will be discharged tomorrow.