Get <strong>₹5 Lac</strong> Health Insurance starts <strong>@ ₹315/<span>month*</span></strong>
Get ₹5 Lac Health Insurance starts @ ₹315/month*
Get ₹5 Lac Health Insurance starts @ ₹315/month*
250+ Plans 18 Insurance Companies
₹ 5 Lakh Coverage @ ₹ 10/day
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Things to Do after Your Health Insurance Claim Is Rejected

Worried about why your health insurance claim got rejected? This can be extra stressful during the ongoing COVID-19 pandemic. However, there can be numerous reasons behind this, and the first thing you need to do is look for the errors in your claim form that you have submitted. Even a small mistake or ignorance can lead to non-payment of claims at the time of a medical emergency. Sometimes the reason for claim rejection is knowingly or unknowingly submitting incomplete and inaccurate information to the Health Insurance Company. You can also avail of the help of TPA or the Third-party

Administrator to help you submit the right documents and get the information corrected in the claim documents. The first thing that you need to be aware of is the accuracy and authenticity of the information provided and the documents submitted to ensure hassle-free claim settlement.

Reasons for Health Insurance Claim Rejection

Before any action is taken, let us first consider the reasons that generally lead to the rejection of health insurance claims in India. It applies to individual health plans, family health plans, coronavirus health insurance plans, senior citizen health plans, etc. Having prior knowledge would help you avoid making the same mistakes and you will be able to benefit from your mediclaim policy at the time of a medical emergency.

Providing Wrong Information  

Most of the medical insurance claims get rejected when the policyholder has furnished incorrect or wrong information. Some applicants do not furnish all the information correctly at the time of purchase so that they have to pay a lesser premium. This is one of the biggest blunders that they end up doing and should be avoided especially during the time of COVID-19. Insurers usually find out such discrepancies sooner or later, therefore, avoid providing any incorrect details in your form.

Improper Documentation

If you have purchased the policy in a hurry or a non-registered agent has duped you into submitting fewer documents then you can end up losing your claim amount. Without proper documents, health insurance companies in India do not settle claims. Missing documents are one of the major reasons for medical insurance claim rejection In India. Even when you port a health insurance policy, make sure that you complete the paperwork as required.

Lapsed Policy

And if you have not renewed your medical insurance policy on time and it has got lapsed then you also your health insurance claim will not be entertained by your health insurer.

Limitations

If you file a claim for any treatment or illness that is not covered by the insurance company or a waiting period applies to it, then your claim will not be initiated. For example, if someone is treated for injuries resulting due to adventure sports, and is mentioned in the list of exclusions in the policy wording the insurer holds the right to reject it.

Insurer Doesn’t Find Your Claim Request to be Deemed Fit

If the insurer finds that hospitalization was not required for your treatment or the insurer feels that you have made an unjustified claim, then your claim request will not be taken forward and intimation will be provided to you by the Insurer.

Steps to be taken in Case your Policy Gets Rejected

In a recent circular, the Insurance Regulatory and Development Authority of India (IRDAI) announced that health insurance claims can be questioned by insurance providers after a policyholder has paid the premium regularly for 8 continuous years, and this period is called as the moratorium period.

For others, you need to negotiate with your health insurance company and try to know the reason for denying your claim. In case you get the reason then you can take the following actions to amend it:

File the Claim Again with Correct Data

Inform your insurer about reinitiating the claim. Gather the data and understand where you went wrong. When filling the claim form again you can seek help online from our experts and make sure that there is no error in the data provided. It will ensure that your claim gets accepted the second time.

Proper Documentation

In case the reason why your claim did not get processed was a missing document, then make sure that you provide it this time. Losing your claim amount for this is the last thing that you would want to happen.

Submit all the Medical Documents/Papers

For smooth claim settlement, the health insurance company would require original hospital bills, medical practitioner’s certificates, hospital discharge summary, etc. And if the hospital doesn’t cooperate, then you would need to follow up and submit the entire required document to support your insurance claim request.

Prove that Hospitalization was Recommended

If your medical insurance company rejected your policy claim because hospitalization was not required then you can submit your doctor’s medical prescription suggesting hospitalization. Show the diagnostic reports before hospitalization. If you can convince your Insurer or TPA that it was essential to undergo the treatment and stay in a hospital for more than 24 hours and your claim request must be accepted.

You can try using any of the above-mentioned methods when your mediclaim gets rejected. Be truthful and furnish correct information and leave no scope for errors. If you avoid making the above mistakes then surely your claims will never be rejected.

Written By: PolicyBazaar - Updated: 29 October 2020
Search
Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

You May Also Want to Know About

Top Maternity Insurance Plans

Top Maternity Insurance Plans

Maternity or pregnancy is an important phase of life, and one needs to prepare in advance to embrace parenthood. Though rearing a child is an expensive affair and may require good financial backup to meet the requirements of a growing baby. From ho...
Health Insurance for Parents

Health Insurance for Parents

Are you planning to buy health insurance for your parents? Well, the Indian Insurance market is currently flooded with healthcare plans specifically designed for senior citizens or elderly parents above 60 years. And many insurance providers also o...
Health Insurance Claims Ratio- Things You Should Look Before Buying Health Insurance

Health Insurance Claims Ratio- Things You Should Look Before Buying Health Insurance

There has always been a doubt in customers mind about whether the private company will keep its side of the bargain i.e. it will settle the claim or not. A customer spends premium annually which will cover his medical expenses but there’s always ...
Best Health Insurance Plans for Senior Citizens in 2020

Best Health Insurance Plans for Senior Citizens in 2020

Considering the increasing percentage of medical inflation in India, it has become an absolute necessity to buy adequate health insurance for your loved ones. And if they are your elderly parents, then it is all the more imperative to get them medi...
Here’s the Difference between Health Insurance and Mediclaim

Here’s the Difference between Health Insurance and Mediclaim

Imagine you’re looking for a job change. You get an interview call for a job. What will be your plan of action? Will you get your resume ready and prepare for the interview or you will try to extract all the possible information about the job pro...
Close
Download the Policybazaar app
to manage all your insurance needs.
INSTALL