Both diagnosis are different and they should not have rejected your fibroid operation unless the exclusion is for whole reproductive system.

When the TPA rejected your GL request, didn't they give you a copy of the rejection letter?

With that you can certainly file an appeal citing the reason of not the same diagnosis to the Claims Dept.

If their Claims Dept. refuse to honour the hospital charges, next alternative is to lodge your case with Ombudsman for Financial Services.

I would think you would get a decision in your favour.

The Insurance co cannot simply impose a new exclusion if you have not made a claims against them.

However they can change or impose any new terms & conditions if you have made a claim and it is a yearly renewal policy.

[quote=River,Jun 21 2019, 11:30 AM]
Haven't claim anything from them because of the rejected GL request. I'm hoping if there is a new TnC, they should send me a copy and highlights the changes.

[QUOTE = lifebalance,Jun 20 2019, 10:40 AM]Question is, where is your agent ? shouldn't you be asking for his/her assistance ?[/QUOTE]

He did follow up, received mssg from him on the rejection and an apology about it. But I feel he also was subjected to the Claim Dept's final decision. I have no idea what else he can do. He thinks it was rejected because the diagnosis might be related to my pre-existing condition.

So far no reply yet from them, but I just want to settle this confusion for future peace of mind.

Thank you so much for your advice.

[/quote]

Rejecting a GL because of the diagnosis might be related to Pre-Ex is really an amateur claims job. You have a strong case because both diagnosis and procedure are not the same.

Since you have already used your other cashless card, you would not be able to claim unless you want to transfer the cost from the other insurer.