Articles 930 views August 31, 2019

What To Do Now If My Health Insurance Claim Is Rejected

Kunal bought a comprehensive family health insurance plan to keep himself as well as his wife and kids safe. Sadly, his son had to undergo an appendectomy, for which Kunal got him admitted to the topmost hospital in the city. Everything went smoothly and the child recovered, but at the time of the hospital discharge, Kunal’s health insurance claim was rejected. He was shocked and distraught. Left with no other option, he paid the bill with his own pocket and took his son home. Health insurance claim rejections are common. What does one do at such a time? Let’s find out.

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Why Does Health Insurance Claim Gets Rejected – Major Reasons

Before we look at the actions, let us understand the reasons why health insurance claims are commonly rejected. Once you know about these reasons, you can avoid making the mistakes yourself and stay assured of getting the insurance claim honoured when there is a need:-

Incorrect Information

One of the main reasons for a health insurance claim rejection is incorrect information. Many people lie when buying health insurance. They do this to get a better cover at a better rate. Do not make this mistake, as if you do so, your insurance provider will find out and your claim will get rejected in all likelihood.

Insufficient Paperwork

You may be in a hurry to get the insurance claim amount in your hands. In this hurry, you may end up submitting only a few documents. An insurer will never honour your health insurance claim unless all the proper documents are in place. Improper documentation is again a major reason why health insurance claims are rejected.

Not Deemed Fit For The Claim

Many a time, an insurance company may say that the medical procedure for which you need the claim, was not required to be done. If your health insurance provider feels you made an unjustified claim, they will not compensate you for the expenses incurred.

Lapsed Policy

And finally, you simply cannot make a health insurance claim on a lapsed policy. Even if your insurance policy lies in a lapsed state for one day and you need to make the claim on that very day, it will not be entertained by your medical insurance company.

Exclusion

If you get hospitalized for anything that is mentioned in the list of exclusions in your health insurance policy , your claim will not be honoured. For instance, if someone is treated for attempted suicide, a health insurance claim cannot be initiated.

Things To Do When an Insurance Claim Is Rejected In India

You need to negotiate with your insurance provider and try to get the claim honoured at all costs. Do not give up without trying. Speak to your insurer constantly and try to understand the exact reason why the health insurance claim was rejected in the first place. If you find a reason look at the following actions:-

Submit The Proper Documents

If there was a document missing, check again and include it in the submission. You should not have a health insurance claim rejection due to this simple reason.

Reinitiate The Claim With The Correct Data

Gather the data and see where you went wrong. Tell your insurance provider that you are reinitiating the claim. Seek their assistance when filing the health insurance claim and make sure the process is completed in an error-free manner. This will surely help you to get the claim, the second time around.

Submit The Medical Papers

The medical papers, including the original hospital bills, the doctors’ certificates, the discharge summary, etc. At the time, the hospital doesn’t cooperate, so you need to follow up properly and get every possible document to support your claim.

Prove Hospitalization Was Needed

If your insurance provider rejected your medical insurance claim saying the hospitalisation was unnecessary, get all the proof you can gather to show it was necessary. Get additional certificates and declarations from your doctor. Show the pre-hospitalisation diagnostic reports. If you can convince your health insurance company that you very rightfully hospitalised, the claim may get honoured.

Try these methods when your health insurance claim gets rejected. Be cautious and minimize the margin of errors. Be disciplined and honest and your health insurance claim will surely be honoured.

Rectification About List of Things to Do Once Your Health Insurance Claim Get Rejected in India

If you cannot get your claim honoured at all, don’t lose faith in medical insurance. You still need to carry on with your health care cover, because there will be other needs in the future. Just be very careful from now on. If you made any mistakes, voluntary or involuntary, when buying health insurance, make sure you rectify them. Also, pay your insurance premium on time and keep the policy in a working and valid state. These steps will ensure your next health insurance claim will get honoured.

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