Things to Do After Your Health Insurance Claim is Rejected

Worried about why your health insurance claim got rejected? There can be numerous reasons behind this, right from errors in your claim form to non-disclosure of a health condition. Even a small mistake or ignorance can lead to non-payment of claims at the time of a medical emergency. In case your health insurance claim has been rejected, read on to know what you can do.

Read More

Policybazaar exclusive benefits
  • 30 minutes claim support*
  • 50,000 claims approved in last 15 months*
  • Schedule home visit with our advisors
  • Get a plan based on your medical needs

*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

Back
All health plans cover Covid-19 treatment
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    Continue
    By clicking on “CONTINUE”, you agree to our Privacy Policy and Terms of use
    Previous step
    Continue

      Popular Cities

      Previous step
      Continue
      Previous step
      Continue

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      What is your existing illness?

      Select all that apply

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step

      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.

      Search
      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      Health insurance articles

      Recent Articles
      Popular Articles
      Monkeypox: Dos and Don’ts of the Disease That You Should Know

      15 Sep 2022

      Monkeypox has slowly and steadily spread to more than 85 countries...
      Read more
      Why is It Important to Disclose Pre-existing Diseases to Your Insurer?

      06 Sep 2022

      As we grow old, the chances of developing a disease or a medical...
      Read more
      Benefits of Multi-Year Health Insurance Plans

      25 Aug 2022

      Ever since COVID-19 entered our lives, health insurance has come...
      Read more
      Does Health Insurance Cover Monkeypox?

      25 Jul 2022

      Monkeypox is the latest disease to make its way to India while we...
      Read more
      List of Diseases Covered by Bajaj Allianz Health Insurance Plans

      05 Jul 2022

      Barely any person has remained unaffected due to rising health...
      Read more
      PMJAY Scheme: Ayushman Bharat Yojana Eligibility & Registration Online
      Prime Minister Shri Narendra Modi announced the launch of (PMJAY) Ayushman Bharat Yojana in his Independence...
      Read more
      Best Health Insurance Plans in India 2022
      Finding the best health insurance plan from so many different health insurance companies can get confusing for many...
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal...
      Read more
      Best Maternity Insurance Plans
      Maternity insurance offers comprehensive coverage for medical expenses incurred during pregnancy, including the cost...
      Read more
      Best Health Insurance Plans for Senior Citizens in 2022
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance...
      Read more

      top
      Close
      Download the Policybazaar app
      to manage all your insurance needs.
      INSTALL