Earlier, health insurance claim denial was a widespread problem- in India and globally. Trust me, when a health insurance claim is denied, it turns out to be a very stressful and frustrating experience. However, you need to understand that you have all the right to appeal against this decision. Before filing a complaint against your insurer, you need to know why they denied your claim.
n this article, we will discuss what are the key reasons for your health insurance claim rejection, how to appeal against a denied claim and many more.
Key Takeaways
Review the denial letter carefully and take note of the specific reasons provided. This information will help you build a strong case for your appeal. Some common reasons for health insurance denied coverage are:
Your claim will definitely get rejected if you have not submitted enough documents while filing a claim. However, you can ask for the claim again after submitting all the documents that are requested by your insurer.
If you are going for multiple claims then you may not have an adequate sum insured to raise another claim request. This can result in a rejection of your claim.
If you are raising the claim for the service which is not included, then your claim will get rejected. Check for the exclusions before making a claim. You can also call us to discuss the situation in detail and our in-house health insurance advisors are at your service 24X7.
Your claim will be automatically rejected if you raise it during the waiting period. Usually, 30 days is the initial waiting period for the health insurance policy. In case of critical illness or maternity requirements, the waiting period may vary on the policy.
Your health insurance policy should be active. It will not provide the benefits if it is expired. In such case, either you need to renew your health insurance policy or you need to buy a new one.
If you go for the treatment at the blacklisted hospital, then your claim will be rejected unless it is an emergency case.
POV, check out the policy documents/wordings carefully when you are applying for a claim.
As I said before, you can still appeal for the denied health insurance claims.
You need to make sure of a few things before going to the ombudsman court for claim rejection.
Health insurance claim denial is an unwanted situation for anyone, especially when you are already dealing with a tough time in a medical situation. However, understanding the reasons for denial and taking the necessary steps to appeal can significantly improve your chances of success. By carefully reviewing your policy, gathering supporting documentation, and following the proper appeal procedures, you can increase your chances of receiving the coverage you deserve.
If you are also in this situation, then fight insurance denials. Get Help Now. Call us.
The appeal process can vary in length depending on the complexity of the case and the insurance company’s procedures. However, it’s generally recommended to submit your appeal within the specified timeframe to avoid delays.
In some cases, it may be possible to appeal a denied claim after the deadline has passed, but it’s important to contact your insurance company to discuss the options.
You need to carefully review all the notifications regarding the claim, and be persistent about the process. And do now delay, submit and resubmit the claims promptly.
You need to visit IRDAI’s online portal Bima Bharosa System to file a complaint against the health insurance company.
Know More About Health Insurance Companies
0
Rated by 0 customers
Select Your Rating
Let us know about your experience or any feedback that might help us serve you better in future.
An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Traveling and writing is her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and solves the reader’s query seamlessly.
Do you have any thoughts you’d like to share?