When Your

Health Insurance Claim Gets Rejected!

By buying a health insurance plan for you and your family, you may have made one of the

smartest decisions of your life. Being the responsible person you are, it is accepted to feel

a sense of pride with a mediclaim policy in your name. However, don’t drift away with the

possession as getting a health insurance is just half the work done. The real challenge

arises when you want to make a claim against any medical expenses you may have

incurred. Some of the experienced people with mediclaim policies may tell you about the

bad experiences they might have had with the company, especially with rejection of

claims.

If you are facing the same dilemma, then we give you a brief insight on how to make

things work in your favour:

It is not always a good idea to blame the company for your claims getting rejected.

As the insurance provider very subtly tells us to “Read the offer documents

carefully”, it is our fault if we do not adhere to the same.

So, we basically need to understand the reason behind the rejection of the claim.

Did you make the claim timely? Did you disclose all the information about any pre-

existing diseases? Did you make all the mandatory documents available? Or

whatever the reason behind your claim getting rejected may be.

In case if you’re having a hard time figuring out the exact reason, do not hesitate

to call the insurer in order to better understand the clause.

Once that is sorted, then you may act upon it according to the situation:

If the reason behind the rejection was incomplete information, then mail

the insurer to correct the errors. Also, it is advisable to keep a record of all

the correspondence between you and the insurer.

If the documents were a problem, then approach the insurance company

within the stipulated time period with the proper documents.

If the company finds that a medical treatment was unnecessary, then prove

your case to them with accurate medical data.

You can file multiple appeals with the company, once you find out the reason for

rejection. Enclose the doctor’s opinion along with other necessary documents. In case of

repeated arguments between you and your insurer, you may approach Ombudsman for

resolution of the case.