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Dr Karthiyayini

Dr Karthiyayini Mahadevan  |885 Answers  |Ask -

General Physician - Answered on Jun 12, 2024

Dr Karthiyayini Mahadevan has been practising for 30 years.
She specialises in general medicine, child development and senior citizen care.
A graduate from Madurai Medical College, she has DNB training in paediatrics and a postgraduate degree in developmental neurology.
She has trained in Tai chi, eurythmy, Bothmer gymnastics, spacial dynamics and yoga.
She works with children with development difficulties at Sparrc Institute and is the head of wellness for senior citizens at Columbia Pacific Communities.... more
Asked by Anonymous - Dec 30, 2023Hindi
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The routine blood-test report of my wife done from a pan-India reputed lab on 13/12/23 under a test package showed a TSH value of 10.6 μIU/ml, which her Doctors thought as pretty high and was about to prescribe some medicine for that when based on my previous experience I decided to carry out a confirmatory test. A few years back my report from the same lab showed a low level of Hemoglobin which when tested in another reputed lab in my city was found to be quite normal. So based on that experience she got her blood tested once again for TSH with one of the most reputed lab in our city on 16/12/23 which came as 4.33 μIU/ml. We are now totally at a loss as to which part of the reports from that lab can be relied upon and took up our grievance with the first mentioned lab and demanded complete refund of fees as we need to do all the tests once again with a different lab to check the veracity of the report. But the said lab states that the tests were done correctly following correct protocols and refuses to refund and states further that, at best, they can do the test once again. That, we find rather ridiculous. So our question is how can we resolve and recover our money.

Ans: NABL certified lab should be able to explain why is there a difference. If there is a wide difference, then we, need to check about their daily calibration run through. In any case it is always better to doubly sure about the readings, if they are high
DISCLAIMER: The answer provided by rediffGURUS is for informational and general awareness purposes only. It is not a substitute for professional medical diagnosis or treatment.
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Ramalingam

Ramalingam Kalirajan  |4605 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 05, 2024

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My father is 89 years old and has recurring abdominal pain from last few months. In Apr'23 he was admitted in one private hospital at our locality and admitted for 7 days due to the pain issue. Various tests were conducted including blood tests, CT scan, fibroscopy and endoscopy, no major issues observed except some liver irregularities and discharged after providing certain oral medication. The cashless benefits are obtained through corporate TPA (EWA). However after certain weeks intermittently severe pain recur for almost a week and this time, on first week of July, my father was taken to Kolkata at a hospital specific to liver and digestive treatment. As advised by doctor he was admitted and again various tests are conducted including blood and stool culture, LFT, CT scan and colonoscopy..But this time also no major issues observed and he was discharged after certain medications, which differs from earlier hospital medicines. But this time claim is denied by TPA (EWA) stating that the admission is done only for investigation and observations and no line of treatment was done.. although new medicines are prescribed in the discharge summary and along with that IV fluid and some other medicines were regularly given during his stay in hospital. As TPA has denied the claim, I have to pay the entire amount in spite of paying a hefty amount of premium for my father. Can you pls suggest, why the claim is denied and whether there is any possibility of reimbursement of the claim by any means?
Ans: I'm sorry to hear about your father's health issues and the challenges you're facing with the insurance claim. The denial of the claim by the TPA (Third Party Administrator) could be due to several reasons, including discrepancies in documentation, interpretation of policy terms, or classification of the treatment as investigational rather than therapeutic.

To address this issue and explore the possibility of reimbursement, here are some steps you can take:

Review Policy Documents: Carefully review the terms and conditions of your father's health insurance policy to understand the coverage and exclusions. Pay attention to the criteria for claim eligibility and the definition of covered treatments.

Seek Clarification: Contact the TPA or the insurance provider to seek clarification on why the claim was denied. Request detailed information on the specific reasons for denial and ask for clarification on any policy terms that are unclear.

Gather Documentation: Gather all relevant medical records, including discharge summaries, prescription details, invoices, and receipts for medications and treatments provided during the hospital stay. Ensure that the documentation clearly demonstrates the medical necessity and therapeutic nature of the treatment received.

Appeal the Decision: If you believe that the denial was incorrect or unjustified, consider filing an appeal with the insurance company. Provide supporting documentation and any additional information that may strengthen your case for claim reimbursement. Follow the appeal process outlined by the insurance provider and submit the appeal within the specified timeframe.

Consult an Expert: If necessary, consider seeking assistance from a healthcare advocate or insurance specialist who can help navigate the appeals process and advocate on your behalf. They may offer valuable insights and assistance in presenting your case effectively.

Explore Legal Options: If all attempts to resolve the issue through the appeals process are unsuccessful, you may consider seeking legal advice to explore further options, such as mediation or legal action, to resolve the dispute.

It's important to remain persistent and proactive in pursuing reimbursement for legitimate medical expenses. Keep thorough records of all communications and documentation related to the claim, and continue to advocate for your father's rights as a policyholder.

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Dr Karthiyayini

Dr Karthiyayini Mahadevan  |885 Answers  |Ask -

General Physician - Answered on Jun 26, 2024

Asked by Anonymous - May 09, 2024Hindi
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I am 54 years M ,having Diabetes and High BP (HTN) since the past 13 years. At times it has been in poor control also like in May 2021 the HbA1c was 10.10 which gradually went down to 7.70 and then remained constant between 7.90 and 8.10 with the medications and 'not so strict' diet regime. Plus the body weight was also increasing and i gained around 10 kgs (101.2 Kgs) in a span of around 06 months. Recently in March 2024, the test reports indicated it as 8.70 causing me some concern and in April 2024 the reports showed a value of 9.20, which made me think about the reliablity of Lab report as well as made me change the doctor. My medicines were changed from Glimepiride (2 mg),Metformin (500 mg) Pioglitazone (15 mg) and METFORMIN-500MG + VILDAGLIPTIN-50MG twice daily ( taking for about 20 months) to GLIMEPIRIDE-2MG + METFORMIN-500MG + VOGLIBOSE-0.2MG and Dapagliflozin 5 mg+Metformin 500 mg twice daily recently in Mid April 2024. I was asked by the doctor to report after a month with Fasting and PP readings. However after few days,I started realising that my blood sugar was approaching higher and then I experienced needle like sensations in feet and hands plus sticky urine with a heavy head and hot face. I again went for a checkup three days back and the randomn sugar was 291 mg/dl. The medications have again been changed to Dapagliflozin (10mg) + Metformin (500mg) + Sitagliptin (100mg) + Saroglitazar (4mg) in the morning and METFORMIN-500MG + VILDAGLIPTIN-50MG since yesterday (08.05.2024) and I have been asked to take daily readings and report after 10 days. All this has lead to a panicky feeling in me, resulting in increased HTN. I am worried that how this hit and trial or permutations and combinations will help me in achieving a perfect set of medicines to lower my blood sugar to normal levels. Kindly advice. I shall be highly obliged.
Ans: Medicines alone cannot work in these Lifestyle diseases.
Lifestyle modification plays a vital role
So start with your dietary discipline. Strict no to Sugars and refined carbohydrates.
Have less portion of Carbohydrate in a complex form
Timely meals with early dinner before 7 pm

..Read more

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Maxim

Maxim Emmanuel  |288 Answers  |Ask -

Soft Skills Trainer - Answered on Jul 12, 2024

Asked by Anonymous - Apr 23, 2024Hindi
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Hello sir my name is Santu Chakraborty.I am 34 year old now unmarried. My qualification is Bsc botany honours with 2nd class +diploma in mechanical engineering with distinction +btech in mechanical engineering from government engineering college west Bengal with 7.5 dgpa.I have 6 years of teaching experience in private diploma engineering college and now I working as a vocational teacher in automobile engineering department in gov high school.In my early phase of life I am going through lots of Misguide,seveare Anxiety issue. Nobody can help me on that phase.I recover mostly by my own after various dillema.I want to work in mechanical r and d company, Mechanical design basis company and also upgrade my teaching carrier. How can I start my journey at this age ?what is the risk factor also? Please tell me. I am very enthusiastic dedicated person. I have no guide in my home. My father is vegetable seller.
Ans: Hi Santu Chakraborty,

This is a really exhaustive query.

The journey thru' your acquisition of qualifications has been vast!

In the course of your life you are now suffering from SNIOP (SUSCEPTIBLE NEGATIVE INFLUENCE OTHER PEOPLE) this happens when you let others control your life.

I have this poem.. Especially for one's like you!

The Guy in the Glass

When you get what you want in your struggle for pelf,
And the world makes you King for a day,
Then go to the mirror and look at yourself,
And see what that guy has to say.
For it isn't your Father, or Mother, or Wife,
Who judgement upon you must pass.
The feller whose verdict counts most in your life
Is the guy staring back from the glass.
He's the feller to please, never mind all the rest,
For he's with you clear up to the end,
And you've passed your most dangerous, difficult test
If the guy in the glass is your friend.
You may be like Jack Horner and "chisel" a plum,
And think you're a wonderful guy,
But the man in the glass says you're only a bum
If you can't look him straight in the eye.
You can fool the whole world down the pathway of years,
And get pats on the back as you pass,
But your final reward will be heartaches and tears
If you've cheated the guy in the glass.

Dale Wimbrow (c) 1934

Get the enthusiasm going, don't get embroiled in what life has been before!

Take a stranglehold of your life and make it BIG!

The opportunities are.. Miracles waiting to happen, what are you waiting for.. You are the catalyst!?
Maxim Emmanuel.

Pick up yourself don't be a victim of self pity.

If you do need further professional advice happy to assist
https://m.me/maxim.emmanuel.2024

...Read more

Nayagam P

Nayagam P P  |1830 Answers  |Ask -

Career Counsellor - Answered on Jul 12, 2024

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