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Oct 12, 2018

Health Insurance Claim Denied? Here's How You Deal With It

Bajaj Allianz Health Insurance

Buying a health insurance policy is one of your most important investments. It relieves you of your financial burden during critical situations, like medical emergencies. The one aspect which the policyholders look for in a health insurance policy is the claim settlement process of the insurance company.

Many insurers, like Bajaj Allianz General Insurance, offer cashless claim facility at network hospitals. However, if you are admitted to a non-network hospital, you can register your claim with your insurer and get the amount reimbursed in your account. But what if your claim is denied by your insurer?

Insurance companies always try to settle your claim, but as a policyholder, you should be proactive enough and avoid the denial of your health insurance claim.

What to do if your health insurance claim is denied?

It is very unfortunate if your claim gets rejected/denied by your insurer. But there are certain ways which give you an opportunity to understand why the claim was denied and what next steps you should take to appeal against the denied claim. One thing that you can do is take recourse under the Grievance Redressal procedure stated under your health insurance policy.

There are usually three major reasons based on which your insurance company might reject your claim:

  • The treatment you received was not medically necessary
  • There were administrative errors while filling out the claim form
  • The procedure was not covered in your health insurance policy

Here are some ways to deal with denied health insurance claims:

  • When your insurer denies/rejects your claim, they send a denial letter to the network hospital (in case of cashless claims) or a repudiation letter (in case of reimbursement claim settlement process). You should go through each and every detail mentioned in the respective letters to find out the cause of claim denial.
  • Once you find out the reason for denial, you should begin collecting documents such as your medical records, policy wordings, medical receipts etc. which can be useful in the process of appealing against the denied health insurance claim.
  • Make an appeal against a decision about health insurance claim denial through an arbitrator, lawyer or ombudsman.
  • Make sure to have all the communication with your insurer, doctor, insurance agent either via mail or post. This will help you to maintain the paper trail and track the case until the claim is settled.
  • Do not forget to follow up with your insurer/ insurance agent about the proceedings of the appeal.

You can appeal the denied insurance claim multiple times, but we recommend that you understand the complete details of your insurance policy and the reasons provided by your insurer for the rejection of your claim. If you are appealing against a right decision of claim denial, then you might be losing a significant amount of time, energy and money from out of your pocket.

We at Bajaj Allianz have the highest claim settlement ratio among private insurers. Check out the features and benefits of our various health insurance products on our website.


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