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How to Appeal Against A Denied Health Insurance Claim?

In the current situation, all individuals must have a health insurance. With unsure health care, it is important to get insurance as it would reduce the financial burden. In health insurance, all the medical expenses, medical care cost, tests costs are covered. There is a lot of file authorization needed to claim insurance. Now you can get health insurance online​ and even claim it online which has made the process a lot simpler.

The process of getting health insurance could be cashless or the person could later get an NEFT transfer into their bank account. But there are cases when a health insurance claim can also get rejected. This could be due to various reasons like claim raised is not covered under the policy, fraud claims, some flaw in filing a claim, all the documents which were required may not have been submitted. In such cases, you will have to appeal against the rejected health claim. 

What should be done to claim against the rejected health insurance plan?


Reapply and Recheck: 


There could also be some mistakes in the documents while submitting and thus is common so one must recheck all their document and reapply for the claim. It is, however, important to note that if your health insurance expire in the given time when you reapply, the claim would not be eligible. In case of the rejection, the person sends a letter to the hospital too mentioning all the details for enquiry on why the claim would have been rejected. 

Medical Bills:​

Once your documents have been rejected collect all other documents such as medical records, policy papers and recheck them yourself. All these documents could help reapply for the claim. ​

Communication: 


It is important to keep a record of the conversation with the hospital as well as with the insurer. This could be all the formal writings and other documents which could be proof that you are eligible for the claim. Any communication made through the concerned person through email, letter, a message should be kept safely. 

Follow-up: 

Once the re-applying process is done it is important to follow back with your insurer at regular intervals.

Important things to keep in mind


  • It is better to go for the online mode of purchasing health insurance as it will decrease the chances of error in comparison to the offline mode.

  • Do not make a delay in premium settlements or filing against any dispute

  • Do not forget to mention all the necessary details like policy number, name, full address, and make sure all of these is same on all the documents.

  • What to do if the company is creating a problem?


    1. Talk to the insurer and find out the reason. The claim could also not be settled as there could be some problem from the hospital end’s as well.
    2. Consult a lawyer in the worst condition.
    3. Write an email to IRDAI if you are confident.

    Buy health insurance plan for your family now as this is the time when we all need some security against the spreading pandemic.