Fibroid treatment claim rejected or cut?
Uterine fibroids are removed by myomectomy, or treated without open surgery by uterine artery embolisation (UAE) or high-intensity focused ultrasound (HIFU). If your insurer has rejected or cut the claim, these are the reasons that come up most for fibroid treatment (myomectomy, UAE or HIFU), the rules that apply, and what to do next.
Why fibroid treatment (myomectomy, UAE or HIFU) claims get rejected or cut
- “Waiting period not completed”: fibroids are often on the specific-disease list.
- A sub-limit on UAE or HIFU, which are on IRDAI’s modern treatment list.
- Pre-existing disease based on an earlier scan.
- Myomectomy in the first policy year refused because the earlier policy wasn’t accepted as continuous cover.
- Fibroids or heavy periods noted in older records, used to allege non-disclosure.
Rules that apply
- Waiting period: many policies put fibroid treatment on the specific-disease list, often for 24 months. The cap is 36 months of continuous cover, ported years count, and it never applies after an accident.
- Uterine artery embolisation and HIFU is on IRDAI’s list of modern treatments. Any sub-limit must be written in your policy wording.
What decided these disputes
- Whether the policy was fresh or a continuation often decided it. Claims failed where portability or earlier continuous cover couldn’t be shown.
- Earlier scans or doctors’ notes showing fibroids before the policy started weighed heavily against the claim.
- Where the fibroid was first found at the claimed admission, with no earlier treatment shown, the pre-existing disease ground did not hold.
Documents to keep ready
- The ultrasound or MRI report
- The gynaecologist’s advice
- The procedure notes
- The discharge summary, the itemised final bill and the rejection or settlement letter
How to challenge the decision
Write to the insurer’s Grievance Redressal Officer, who must reply within 14 days. If that fails, use Bima Bharosa or go to the Insurance Ombudsman within one year. The guides below have the letter format and the steps.
Questions people ask
Is HIFU for fibroids covered?
UAE and HIFU are on IRDAI’s list of modern treatments that insurers should endeavour to cover. Many policies cover them, sometimes with a sub-limit.
The fibroid was first found during my admission. Can the insurer call it pre-existing?
It counts as pre-existing only if it was diagnosed, or a doctor advised or gave treatment for it, within 36 months before the policy started. Ask the insurer to show the earlier record it relies on.
Does my previous policy count towards the fibroid waiting period?
Yes, if you ported or renewed without a break: waiting-period credit carries over. Keep the old policy schedules and the portability papers, because without them the policy may be treated as fresh.