How to Deal with Health Insurance Claim Rejection?

Q: How to reapply for a health insurance claim?

1. Carefully read the claim rejection document given by your health insurer 2. Contact your insurance company and hospital 3. Collect proper proofs (Collect the proofs and documents which were missing from the earlier claim) 4. Reapply for the claim (Write a formal email to your insurance company. Include a statement wherein you must mention the correct policy number, claim details and the reason for the claim)

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Was your health insurance claim rejected? Was your claim genuine? If yes, then there is no need to get worried. You can ask your health insurer to reconsider it.

How to reapply for a health insurance claim?

Carefully read the claim rejection document given by your health insurer: When an insurer rejects a claim, he gives a document which contains the reasons for the claim rejection. Read that document carefully and understand why your claim was rejected.
Contact your insurance company and hospital: After understanding the reason for the rejection, if you feel that you have a reason to reapply for the claim, then approach your insurance company. It is better to contact your insurer by email as it will be a written proof of your communication. Also, contact the hospital where you were admitted to get the required details from them.
Collect proper proofs: Collect the proofs and documents which were missing from the earlier claim. Furthermore, if you made any errors in your claim form, rectify them. Also, if the claim was rejected because your insurer felt that a hospitalization or any medical procedure was unnecessary, you must obtain your doctor’s prescription and reports to convince him.
Reapply for the claim: Write a formal email to your insurance company. Include a statement wherein you must mention the correct policy number, claim details and the reason for the claim. Furthermore, attach appropriate documents and proofs to support your claim. Remember, you can make multiple appeals for the claim.

Also Read: Not Wearing A Seat Belt May Affect Your Insurance Claim

If you do not get a response within a reasonable time period, you can contact the Grievance Cell of IRDAI.

A case of health insurance claim rejection resolved by Insurance Samadhan:

Mr. Jadhav’s wife suffered from high fever, chills, headache and vomiting. She was treated at her home. However, she was advised by the doctor to get admitted to the hospital. Later, he sent a claim notice to the insurance company, but was rejected as the company did not find her hospitalization justified. He stated that he contacted his insurance company, but didn’t get a proper response from them. On April 30, 2022, the customer approached Insurance Samadhan. We guided him and helped him to get his claim money. By July 05, 2022, his case was resolved and he received his claim amount.

We have helped 14,500+ people in resolving insurance-related cases. Contact us to get samadhan for your insurance-related issues. We are always available to help you out.