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Health insurance provides great financial support to the insured. All the medical expenses are covered by the health insurance companies subjected to the terms and conditions of the insurance company. 

Whenever you get a major medical treatment you need to apply for the claim with all your documents. But sometimes it happens that the insurance company rejects your claim for some of the reasons. Generally, people get worried and do not know how to tackle the situation. The situation can be handled with ease and you can get your claim in case of any discrepancy from the side of the insurance company.

The health insurance claim can be rejected because of the following reason:

What Should You Do In Case Of Claim Rejection?

Cross-check Claim Application

In case your claim gets rejected the first thing that is to be done is that cross-verify the whole application process to get confirmed that there is no mistake committed on your behalf. If you find any blunder then thereafter you know what you have to rectify.

Resolve Rejection Reason

A letter is sent by the health insurance company to the network hospital. The letter mentions the reasons for the rejection of the claim. Try to know the reason. If you get to know the reason for the claim rejection then it will be easier to tackle the situation.

If Not Treated At Network Hospital

There can be two cases under hospital selection at the time of getting the treatment:

  • Get treatment at one of the network hospitals
  • Get treatment at any of the hospitals.

In case the hospital does not fall in the network hospitals of the health insurance company then you can get the claim into your account by showing all the medical expenses and hospital documents. But in this case, you need to pay for the treatment before you get the claim amount.

Important: Learn About Exclusions In Health Insurance Policy

Appeal Formally

A lawyer or ombudsman is needed to be hired by you to handle the legal situation. It will be more convenient as the lawyer will act as your representative as well as a conveyer between the health insurance company and you. The lawyer will be able to understand the terms in a better way.

Legal Documentation

Paperwork and documentation should be prepared with the help of the lawyer who can advise a guide in a better way. An experienced person will be more helpful in guiding under such a condition and a lawyer or ombudsman is the best option.

Store Medical Bills

The documents are to stored very carefully. The moment you get to know that the claim has been rejected a list should be prepared to recall the medical treatments taken at the particular hospital, and along with that all the bills relating the treatment should be procured. This is to be done so that under the claim process appeal all the documents can be presented in front of the law.

Keep Track Of Verbal Conversation

The communications taking place between the insured and the insurer needs to be procured. The insured can generate those communications in the form of proof in time of need. The communications should be in written form whether in the form of mail, letter, messages, etc. calls are not considered safe in such a situation but under critical circumstances, you can record the call as nowadays all the android mobile comes with call recording facility.

Health insurance is of no use if it does not pay you benefits at the time of requirement. Be careful and never let your claim get rejected. If in case it gets rejected then take action against the claim rejection as it is the right of the insured. In case you find any mistake in document submission then rectify that and if the insurance company is guilty, then never give up.

Read This: How To File A Complaint Against Health Insurance Claim?

Naval Goel is the founder of He is an Associate Member of the Indian Institute of Insurance`, Pune. He has been authorized by IRDA to act as a Principal Officer of Insurance Web Aggregator.
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