I was examined by a neurologist at a contracted institution with complaints of pain and burning in the upper part of my head that has been going on for three days without interruption; pain in my neck, upper back and shoulders; a strange feeling like an internal tremor in the back of my eyes when their focus changes, inside my head, upper part of my mouth, throat and even upper part of my chest. The doctor requested a Neck X-ray and "Routine EEG" diagnoses. However, Mapfre refused to cover the Routine EEG procedure by citing 2 items that were unrelated to my complaints and were not included in the subject mentioned as a special condition in my Supplementary Health Insurance policy. Although I insisted on explaining the issue in detail and explaining that there was no relationship, the company did not cover the procedure. The ordeal I had already gone through while explaining the issue to customer service was already on my toes. The alleged policy special condition clauses are as follows: The clause put forward when the first request was rejected: "39. Snoring treatment, sleep disorders, sleep apnea examination (polysomnography, sleep EEG) and treatments and all kinds of apparatus used for sleep apnea treatment," After explaining that this was not a Sleep EEG, the issue was not a sleep problem, there was constant burning and pain in the upper part of the head, and that what would be done was a Routine EEG, the clause put forward was: "23. Dementia resulting from old age and Alzheimer's, Parkinson's, epilepsy diagnosis and treatments, antipsychotic, anxiolytic, anticonvulsant and all psychotropic drugs used in the treatment of these diseases," Here too, the epilepsy clause was taken as a basis and rejected. However, the issue again has nothing to do with the alleged issue, that is, epilepsy. The reason for the request for a Routine EEG procedure is not epilepsy or a symptom related to it, but the constant pain and burning sensation in the head. It is clear from the articles and my situation that this diagnostic method is not outside the scope of my policy. The company has only taken an unbecoming stance here, victimizing me and not covering a diagnostic procedure within the scope of the policy. I am quite sure that those who made the rejection decision are also very clear that this is the case. I demand that my victimization be immediately remedied, and that my material expenses and moral damages be covered.
Comments