When your Health Insurance Claim gets Rejected - BAGI

1. When Your Health Insurance Claim Gets Rejected! By buying a health insurance plan for you and your family, you may have made one of the smartest decisions of your life. Being the responsible person you are, it is accepted to feel a sense of pride with a mediclaim policy in your name. However, don’t drift away with the possession as getting a health insurance is just half the work done. The real challenge arises when you want to make a claim against any medical expenses you may have incurred. Some of the experienced people with mediclaim policies may tell you about the bad experiences they might have had with the company, especially with rejection of claims. If you are facing the same dilemma, then we give you a brief insight on how to make things work in your favour: It is not always a good idea to blame the company for your claims getting rejected. As the insurance provider very subtly tells us to “Read the offer documents carefully”, it is our fault if we do not adhere to the same.

2. So, we basically need to understand the reason behind the rejection of the claim. Did you make the claim timely? Did you disclose all the information about any pre- existing diseases? Did you make all the mandatory documents available? Or whatever the reason behind your claim getting rejected may be. In case if you’re having a hard time figuring out the exact reason, do not hesitate to call the insurer in order to better understand the clause. Once that is sorted, then you may act upon it according to the situation: If the reason behind the rejection was incomplete information, then mail the insurer to correct the errors. Also, it is advisable to keep a record of all the correspondence between you and the insurer. If the documents were a problem, then approach the insurance company within the stipulated time period with the proper documents. If the company finds that a medical treatment was unnecessary, then prove your case to them with accurate medical data. You can file multiple appeals with the company, once you find out the reason for rejection. Enclose the doctor’s opinion along with other necessary documents. In case of repeated arguments between you and your insurer, you may approach Ombudsman for resolution of the case.