Radiotherapy claim rejected or cut?
Radiotherapy treats cancer with targeted radiation, usually as a course of daily day care sessions over several weeks. If your insurer has rejected or cut the claim, these are the reasons that come up most for radiotherapy, the rules that apply, and what to do next.
Why radiotherapy claims get rejected or cut
- Each session treated as OPD because there is no overnight stay.
- Advanced techniques (such as stereotactic radiosurgery) capped by a modern-treatment sub-limit.
- Pre-existing disease or non-disclosure arguments.
- The planning CT or simulation scan done before the sessions start refused as diagnostics without hospitalisation.
- Later sessions refused once the sum insured or a cancer sub-limit runs out, even though the course is one treatment plan.
Rules that apply
- Pre-existing disease: a condition counts only if it was diagnosed or treated within 36 months before the policy started. After 60 months of continuous cover, a claim can’t be contested for non-disclosure except for established fraud.
- Under 24 hours in hospital: check your policy’s day care list. If radiotherapy is on it, a short stay is no reason to reject.
- Stereotactic radiosurgery is on IRDAI’s list of modern treatments. Any sub-limit must be written in your policy wording.
Documents to keep ready
- The radiation oncologist’s treatment plan
- The biopsy report with its date
- The session-wise bill
- 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 radiotherapy covered without hospital admission?
Usually, yes. Radiotherapy is normally on the day care list, so an overnight stay isn’t needed.
Is each radiotherapy session a separate claim?
It depends on the hospital and the policy. Some claims cover the whole course, others are made session by session. Keep the radiation oncologist’s plan showing the total number of sessions, so every bill links to the same treatment.
Are scans and medicines between radiotherapy sessions covered?
Many policies pay pre- and post-hospitalisation expenses for a set number of days around a covered treatment, if they relate to the same illness. Check those day limits in your policy, and keep each bill linked to the oncologist’s plan.