Denied health insurance claim: Here’s your appeal plan

Considering the skyrocketing costs of healthcare services, health insurance has become a necessity now. This is the reason the market is now loaded with several health insurance plans. You can claim any number of claims throughout the limit of the sum assured amount. But it depends on the insurance provider to grant it or not as per the plan terms. Denied claims in healthcare are common. If any health insurance claim is denied, what next? Read this exclusive article to find out.

Know more about health insurance claims denied

Normally it is found that the insurance providers have very strong reason(s) for a denied health insurance claim. It is usually communicated during the rejection of the concerned claim application. As a policyholder, if you do not receive it, you have to request the same for clarification. If possible, you can reapply after making the necessary alterations.

The claims team initiates the process of receiving a claim by checking the details of the concerned policyholder. All the major details like the plan terms, inclusions, exclusions, etc. are verified. Some of the popular reasons for claim rejection include:

1. Any claim raised for an issue that is excluded under the policy terms

2. Any claim raised for an expired plan

3. Claim application misses relevant details causing incomplete claim application

4. Relevant supporting documents are missing

5. The claim being raised for such an individual who is not covered by the concerned plan

What to do if medical claims are denied?

If your claim application is rejected, you can undertake the following steps for undertaking the reapplication procedure:

1. Rectifying and reapplication

If you know the exact reason for claim rejection, if possible you can rectify and reapply. However, if your claim rejection happens for a lapsed plan or for someone who isn’t covered by the plan, stands no further chance.

2. Approach the ombudsman

Health insurance ombudsmen are created for claim and complaint settlements for the policyholders. You can approach your concerned Ombudsman regarding your issue and raise a complaint against your insurance provider. However, your complaint issues must be concerning to the Insurance Act of 1938.

The Ombudsman acts as a middleman or mediator between the policyholder and the insurance company to ensure a fair recommendation.

3. Proactive approach

As a policyholder, you must maintain a proactive approach during claim settlement. If you are well aware of all the relevant terms and conditions of the concerned plan before buying, renewing or claiming, you can easily avoid misunderstandings.

4. Online health insurance plan

Previously offline was the only method for acquiring any health plan. However, technological advancement has immensely popularised the online method. This has significantly reduced the chances of any misinterpretation of personal details. You can also be well aware of the policy’s inclusions and exclusions.

Conclusion

Now that you are aware of these necessary steps you may consider it before reapplying for your rejected health insurance claim.

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