Disputes with Mediclaim Providers: How to Resolve Claim Rejection Issues
Mediclaim policies safeguard policyholders against growing medical inflation and unforeseen medical emergencies. Unfortunately, there is a chance that your medical claim can be rejected at the very last moment. This causes unnecessary stress to any policyholder and puts an unwarranted financial burden on them.
Sometimes, insurance claims are rejected even by some of India’s best health insurance companies. There are many reasons why they may have denied your claim. However, policyholders can also appeal against these rejections to get them overturned and the necessary coverage.
Why Are Claims Rejected?
Medical emergencies are an incredibly stressful time for any individual, and having your insurance claim rejected only adds to that stress. It not only affects that individual’s finances, but it also puts doubt in them the next time they might have to deal with any such situation. In this situation, people must keep calm and understand why their claim was rejected.
The first thing to do when a claim is to understand why it was rejected. Even the best health insurance plans in India have exclusions. Insurance companies only reject Mediclaim insurance claims when they think or feel they have a valid reason to do so. Therefore, before reapplying for medical expense reimbursement, you must read your insurance policy and the fine print.
Some of the reasons insurance companies reject insurance claims are:
- The claim is raised for a medical illness or treatment not covered under the insurance policy.
- The claim is raised for an expired mediclaim insurance policy.
- The policyholder has made a fraudulent insurance claim.
- The policyholder did not send the documents required to support the insurance claim.
- The policyholder has not followed the due process to raise a claim correctly.
- The claim is raised for a person not covered by the insurance policy.
Appealing Against a Rejected Claim
After understanding exactly why your insurance claim has been rejected, you can appeal against that rejected claim using the steps below.
Inspect Your Claim Form
If the insurance provider states or provides evidence of something wrong with your form, you should review and correct those errors to apply again. Ensure that you thoroughly go through every aspect of your insurance policy. Also, note whether your insurance company specifies any time limit on reapplying.
Providing Documents
It is essential to read through the terms and conditions of your current mediclaim insurance policy. This is to understand exactly why your insurance claim was denied. Once you know the insurance company’s company or they are rejecting your claim, you can start documenting evidence to prove otherwise. If, for example, the insurance company denies your claim because you have not provided enough evidence to support your claim amount, You should collect all the documents and bills supporting your claim to show them as evidence when you appeal against the rejection.
Track Your Communication
When you appeal against your claim denial, keep records of your communication with your insurer. This includes email or messages, where clear evidence can be recorded. This communication acts as a record of everything said between you and the insurer. This could act as proof of your claim. Make sure to keep records of your communication at all times because it can be used as evidence to decide in your favor for any claim disputes.
Final Thoughts
Having an insurance claim rejected is quite disheartening for any policyholder. However, there are still many options available to address the claim rejection. It is a distinct reality that rejected claims can be overturned, and the insurance company can pay your claim amount in full. Understanding the process of how claim rejection works is essential. After that, knowing what you must do to approve your rightful claim is vital information for any policyholder.
Some of India’s best insurance companies, like Niva Bupa, ensure no claim isn’t rejected. They do this by allowing people to apply for their policies online. They also put all the terms and conditions of their policies online. This ensures that people can make informed decisions when looking for a policy for themselves and their loved ones.
