Community › Forums › Legal Advice India › Health insurance claim for recurring prostate cancer treatment without hospitalization
- This topic has 7 replies, 3 voices, and was last updated 1 year, 2 months ago by
Indianrekha4021.
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IIndianrekha4021
PARTICIPANT
April 15, 2025 at 12:18 pmHello,My father was diagnosed with the prostate cancer last year. As part of the diagnosis he underwent biopsy, was hospitalized and some other tests and the health insurance covered the cost for same.
Based on the diagnosis, it was advised by the doctors to follow the harmone therapy treatment which includes injection every 3 months and daily oral tablets and this will continue for two years.
The costs for these medications were also reimbursed by the health insurance for 6 months as it was under the post hospitalized period. However now the post hospitalization period is completed and the health insurance company denied the reimbursement.
However the hormone therapy treatment is going to be continued for atleast one and halfo years more and this does not require any hospitalization. The injection is administered at the hospital every three months.
Has anyone been in the similar situation? I am not sure how to proceed further as these treatment is very expensive. Can this claimed under day care procedure? Any help would be much appreciated.
The heath insurance provider is HDFC ERGO and the policy is optima restore family floater plan.
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BBravedevika7220
PARTICIPANT
April 15, 2025 at 12:48 pmOPD is not covered. It’s not a day care procedure either. I’m an insurance advisor.-
IIndianrekha4021
OP
April 15, 2025 at 1:13 pmSo is there any way to get this reimbursed? Because it feels like we are being forced to go under hospitalization-
BBravedevika7220
PARTICIPANT
April 15, 2025 at 2:00 pmAsk if the treating doctor can give a letter as oral chemotherapy and list the medicine names in it. They are different treatments and insurer may still reject it. But you can try.
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RRakhieagle417
PARTICIPANT
April 16, 2025 at 5:06 amPlease also ensure next time you renew the policy that _domiciliary_ treatment is covered. Check your existing policy for it too.-
IIndianrekha4021
OP
April 16, 2025 at 5:08 amDomiciliary treatment is covered in my current policy.-
RRakhieagle417
PARTICIPANT
April 16, 2025 at 5:20 amI reread your initial post. A lot of care will pass for domiciliary but they require 72 hours of dedicated care to approve. A singular injection may not be approved.I’ll ask around on this and get back to you about your extremely specific use case.
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IIndianrekha4021
OP
April 16, 2025 at 5:25 amThank you very much.
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