How to Appeal Against Rejected Health Insurance Claim?

If you are suffering from any health issue and need hospitalisation, it can be daunting not just for you but also for the family members. In such a scenario, a health insurance can provide you the much needed financial support. But, if the claim gets rejected, it can lead to both mental and financial hardship.Many times, insurance companies reject the claim application due to the following reasons:

• The claim raised for the treatment is not covered under the policy
• The individual has made a fraudulent claim
• The policyholder did not furbish required documents to support the claim
• The policyholder has not followed the filing process correctly

If your health insurance claim is rejected , you still have a second chance to get the compensation; you can appeal against the denied claim.

• Check your claim form and apply again If your insurer rejects the claim, you should go through the denial letter and know the reason for rejection. If the insurer states a discrepancy in the claim form, you must review the application again and rectify the mistakes (if any) and apply again. Make sure that you carefully go through the policy terms and conditions and re-apply within the specified period.
• Approach an ombudsman The ombudsman helps the policyholders in settling issues that they may have relating to their claim rejection. Ombudsman is an official who investigates complaints lodged by private citizens against public entities and officials. In health insurance, they act as a bridge between the insurance company and the policyholder. Individuals can formally appeal in writing to the ombudsman to help you get the claim settled.
• Provide sufficient documents Suppose the reason for claim denial is insufficient proof to support the claim amount. In that case, you must collect all the bills and other related documents and provide as evidence when you file an appeal against the rejection.
• Keep track of the communication When you appeal against the denied health insurance claim, you must keep a record of the communication through email or messages you may have had with the TPA and the insurer. This may act as proof to support your claim. So, make sure that you always keep the records safe to be used during critical situations.
• Follow up diligently When you appeal against the rejected claim, you must diligently follow up with your insurance agent or the TPA about the appeal's status.

Now that you are aware of how to appeal against the rejected claim make sure that you follow the steps carefully and abide by the claim filing rules.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.