My wife admitted in hospital and gone through a major surgery. She admitted for 25 days and bills of hospital and medicines are 268000 approx. When she admitted TPA help desk of hospital denied for cashless facility but after 5 day they told that Medi assist TPA is on our panel but you dont avail cash less facility due to your treatment is started now. After discharge I submitted all the paper in TPA’s office in original. TPA investigate our file at hospital and also gave statement of my treating doctor. After 3 months when I remind and send mails many times to TPA, they denied my claim due to cause that your ailment is in clause 3 and consider as pre existing but when I bought policy they do not give me any catalog regarding clauses. The catalog which I received from Insurance co. clearly shows the diseases which not covered but our ailment is not in the list.
TPA not reconsider my claim. as a lehman how can I know about clause 3 .
Please help me