Health Insurance Plans

pays for your hospital bills for diagnostics, surgery etc.

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Health Insurance Claim Denials

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Majority of us opt for a Health Insurance simply to overcome financial stress during health emergencies. It is considered as a legal contract between the insurance company and the Insured individual where the Insurer pays back medical expenses of the insured individual in exchange to the yearly premiums. Health insurance covers the medical expenses of the insured individual like the Hospitalization charges, pre and post hospitalization expenses and physician fees for a particular period of time. Therefore, an insured individual remains in peace and financial comfort even after going through an emergency.

But even before finalizing a health Policy one should look for the coverages offered in the health plan and also check out the sub limits and exclusions. Because of the improper understanding of these issues in few cases, insurance Claim of the individuals is found denied by the insurance companies pushing them into distress.

Common claim Denials

A health claim denial letter can leave the insured individual in a shock. But even before understanding a way to come out of such a situation, let us take a look at some of the common reasons behind a Mediclaim rejection.

A claim rejection is common in cases where mediclaim request for Coverage is filed on the excluded medication procedures in the health plan.

Late submission and improper or delayed notification of the emergency to the insurance company can also lead to claim rejection.

Also, some hidden Pre-existing health issues of the insured individual can lead to a claim denial.

Health claims for performing medical procedures in order to identify the illness shall be denied by most of the insurance companies

Clerical errors in documentations can also lead to claim rejection i.e. documents and proofs provided by the insured individual for the health claim should be apt and complete. Any mistake in the address, billing details, diagnostic procedures, policy number and certifications from the medical officers or any other irrelevant proofs can lead to claim rejection.

Above all overlooking the medical policy and claiming for Exclusions leads to a confirmed rejection.

Fighting claim denials

A rejection can be appealed and one can also fight over it to retain their rightful demands. Only if your protests are true you may find justice and get atleast a partial payment for your policy claims from the insurer. Here are a few ways to overcome these denials and get your financial demands fulfilled.

Aware yourself:

Firstly, read every bit of your policy to overcome a claim denial. Get yourself aware of the coverages and exclusions offered in the policy and thus prevent the claim denial. If you still face a rejection then here is what you are supposed to do.

Speak in Peace:

If you face a rejection even after going according to your health policy, speak to the customer care representative in peace to avoid a fight.

Make a Formal Appeal:

If the talks fail do all the necessary paper work, keep your documents and other supporting proofs ready and then make a formal appeal to the higher authorities explaining them in detail.

Get ready and stay Organized

Most probably a formal appeal solves the issues. But still if there is a necessity case a file as per the rules.

Generally, following the rules and the policy will not leave us into rejections. Therefore, stay aware of what you have before you opt to claim.