• How to Deal with a Health Insurance Claim Rejection?

    We often do not take wise decisions, by simply being ignorant to details and believing that some cosmic power will take care of us at all times. These circumstances lead us to a hell-hole such as the claim rejection of our health insurance. It might sound dramatic to people who are reading this as a safety measure but for those who have already experienced it and are seeking help, realize the real-life drama in the situation. So, it is important to understand the circumstances under which a claim can be rejected but at the same time it is also important that one understands the preventive measures. This is more important than the curative measures that can be taken for obvious reasons.

    Claim Rejection Circumstances:

    • Particular ailment against which the claim is being made is not covered under your medical insurance policy.
    • The form for the claim has not been filled properly.
    • The procedure was not required by the insured, medically.
    • The claim has not been filed in the correct time-frame, mentioned as per the policy.

    Prevention of Health Insurance Claim Rejection:

    Keep the following in mind about your health insurance policy to never have to deal with this again:

    • Always make copies of all the documents that you submit with the claim form for your insurance policy, to the TPA as measure of future reference.
    • Make sure that you go through the policy wordings along with terms and conditions, especially exclusions, deductibles and claim process more than anything else along with the benefits of the policy.
    • Make sure that you submit the claim request before 30 days from the date of hospitalization.
    • You must send all the medical records to the TPA. In the case of post hospitalization costs incurred the details and submission must be done within ninety days from the date of hospitalization.
    • Always double-check the insurance claim form for accuracy. (Keep multiple forms in hand incase you need to fill it again before submission)
    • Also gather enough information and proof such as doctor’s prescriptions, etc. and submit or post it to the TPA.

    What Needs to Be Done?

    Even after a claim rejection, an insurance company may reconsider your claim keeping in mind that you are able to convince the insurer that your claim is genuine. But you first need to know why it was rejected, since you need to take the next steps, accordingly. But once you know the reason, here is what you have to do:

    • See through your medical insurance claim form, submitted to the insurance company. The most important things here are the names and your policy number. If there are errors in reporting these, the TPA has to be informed to reopen the case as well as the insurer has to be clearly made aware of the error.
    • Some claims are rejected due to errors in the system caused by insufficient information provided by the claimant. The TPA representative can help you out with the solution then and there also making sure that you record details about this conversation as well as document it if possible.
    • You must check the documents sent with the claim form and whether any mistakes have been made in the form of insufficient or incorrect documentation or even lack of attestation.
    • If you figure out what is the problem it can be cleared by providing sufficient documents with correct details and attestation.
    • If the reason for rejection is medical procedure deemed unneccessary, get sufficient opinion of licensed medical practitioners to prove your claim.
    • Once you have all the documents ready supporting your claim:
      • Write and send a formal letter with the statement that includes reason for claim being genuine or valid.
      • Attach appropriate documents along with medical opinion of the licenced medical practitioner for claim substantiation.
      • Note, that multiple appeals for the claim validation can be made.
      • If the insurer does not respond to your claim in 30 days you can approach Ombudsman. This organization allows you to submit a written complaint at the Office of insurance Ombudsman within thirty days from the health insurer's response.

    The office of Ombudsman is your last resort to get your claim validated. Beyond that you might need legal aid which will cost you more than your medical bill in most cases. Hence, make sure you have a valid claim and have sufficient supporting documents.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Health Insurance Claim Rejection Reviews

  • Page 1 of 50 1 2 3 4 5
    • ICICI Lombard Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with ICICI lombard from last 2 years and it is a good insurance policy to use. My premium of this policy gets auto deducted from the salary account. My claim experience was not up to the mark. I have a coverage of Rs 1.5 lakhs for accident and Rs 1 lakh for health. I am happy with the coverage and benefits of this policy.
      Was this review helpful? 0
      , ghaziabad
      Reviewed on Feb 23, 2018
    • United India Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I got the UNITED INDIA INSURANCE health insurance policy around 4 months ago. This policy covers 2 members in my family. I have got the medical coverage up to Rs,3,00,000 from this UNITED INDIA INSURANCE health insurance policy. I never got any claim experience with this policy .
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 20, 2018
    • Max Bupa Health Insurance
      "Good Protection for Health"
      0.5 4.0/5 "Great!"
      Max Bupa gives the medical cover around Rs. 2 lakhs its covers only for me. I paid around Rs. 2500 as premium amount for one year. They do have tie up with good hospital. I hope Max Bupa is providing tax benefits and no claim bonus on the health policy.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 20, 2018
    • Star Health Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I have paid Rs,8000 to get the health insurance policy from the STAR HEALTH & ALLIED INSURANCE company. This policy covers 3 members in my family and it gives the medical coverage of Rs,3,00,000 and I never had any claim experience so far and I have got this policy around 5 months ago.
      Was this review helpful? 0
      , new delhi
      Reviewed on Feb 20, 2018
    • Royal Sundaram Health Insurance
      "Best insurance policy"
      0.5 5.0/5 "Blown Away!"
      I have taken Health Insurance with Royal sundaram.The premium amount is is 2500,the policy coverage is five lakhs,24 hours hospitalization. for any kind of claims.The payments is done online.I have no claim experience and cashless treatment is covered 95%.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 20, 2018
    • Bajaj Allianz Health Insurance
      "Best insurance policy"
      0.5 5.0/5 "Blown Away!"
      I have taken Health insurance with Bajaj allianz,the premium amount is not paid my me as its offered by the company.The policy coverage is six lakhs including the family members.This is covered mediclaim as well as health insurance.The policy was taken two years back and no claim experience.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 20, 2018
    • United India Health Insurance
      "Good policy"
      0.5 3.0/5 "Satisfactory"
      I have taken a health insurance from UNITED INDIA INSURANCE. They provide cashless facility. And i dont have any previous claim experience. Yearly i have to renew the policy. This policy cover my family and myself. They provide cashless facility.
      Was this review helpful? 0
      , secunderabad
      Reviewed on Feb 19, 2018
    • National Insurance Health Insurance
      "Good"
      0.5 3.0/5 "Satisfactory"
      I am having the health insurance policy with the National Insurance company. I used to talk with them very often and the claim went in easy manner. Everything went in the good aspects with them till now.
      Was this review helpful? 0
      , kolkata
      Reviewed on Feb 17, 2018
    • Bajaj Allianz Health Insurance
      "Good Insurance"
      0.5 5.0/5 "Blown Away!"
      I have taken a Mediclaim plan with Bajaj. I have had a good claim experience with them. They gave the amount pretty easily. Even in case of my relatives experience Baja readily payed about Rs.75000 for the treatment. The number of network hospital in it are pretty good.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 16, 2018
    • Religare Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I hold a health insurance with Religare from last 2 years and it is a good insurance policy. This policy has to be renewed every year and i pay a premium of Rs 11000 for this insurance. I do not have claim experience and i have not taken any cashless treatment. I have a coverage of Rs 5 lakhs which is satisfactory.
      Was this review helpful? 0
      , faridabad
      Reviewed on Feb 14, 2018
    • HDFC Ergo Health Insurance
      "Fantastic"
      0.5 5.0/5 "Blown Away!"
      Taken a medical insurance policy with HDFC ERGO GENERAL INSURANCE. Still now I have not taken any claim with my medical insurance. The plan and benefits are really good. I have been paying a premium of rs 5,000 per year. The customer service and response is good.
      Was this review helpful? 0
      , coimbatore
      Reviewed on Feb 14, 2018
    • National Insurance Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance with national insurance from last 2 months and it is a good insurance policy. I pay a premium of Rs 170 on monthly basis. I do not have claim experience so far and i have not taken any cashless treatment. I have a coverage of Rs 3 lakhs which is satisfactory.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 13, 2018
    • HDFC Ergo Health Insurance
      "Best policy to use"
      0.5 5.0/5 "Blown Away!"
      I hold a health insurance with HDFC ERGO from last 7-8 years and it is a good insurance policy to use. This policy has to be renewed every year and i pay a premium of Rs 15000 for this insurance. I have taken a cashless treatment and my claim experience was very good with this insurance. I have a coverage of Rs 3 lakhs which is satisfactory.
      Was this review helpful? 0
      , pune
      Reviewed on Feb 13, 2018
    • Apollo Munich Health Insurance
      "Excellent"
      0.5 5.0/5 "Blown Away!"
      I took a health insurance from Apollo Munich through an advisor. Its been 3 years. The cash facilities are really good. The customer service was pretty good. I haven't gone for claim. The medical coverage was 5L. I used to pay around 13,000 rupees yearly.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 12, 2018
    • review Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I hold a health insurance with Birla General insurance from last 6-7 years and it is one of the good insurance policy to use. This policy has to be renewed once in 3 years and i pay a premium of Rs 3500. I do not have claim experience so far with this insurance and i have not taken any cashless treatment. I have a coverage of Rs 3 lakhs which is satisfactory.
      Was this review helpful? 0
      , panipat
      Reviewed on Feb 12, 2018
    • National Insurance Health Insurance
      "Good service"
      0.5 3.0/5 "Satisfactory"
      For the past 2 years I have the health insurance policy from the NATIONAL INSURANCE. The customer support service is average with the NATIONAL INSURANCE company. This policy covers 3 members in my family and the medical coverage is good with this policy , I can claim up to 4lakhs for the hospitalization.
      Was this review helpful? 0
      , gorakhpur
      Reviewed on Feb 12, 2018
    • United India Health Insurance
      "Good Insurance provider"
      0.5 5.0/5 "Blown Away!"
      I have a corporate insurance with United India Insurance for the sum assured of Rs.10 lakhs including my family members. I did a claim, when I met with the accident, I got cashless hospitalization service, totally I was admitted for 10 days, they took care of everything. The process was good, I claimed to Medi assist whose got tie up with them.
      Was this review helpful? 0
      , chennai
      Reviewed on Feb 12, 2018
    • HDFC Ergo Health Insurance
      "Good insurance policy"
      0.5 4.0/5 "Great!"
      I hold a health insurance policy with HDFC ERGO from last 5-6 years and it is one of the good insurance policy to use. I pay a premium of Rs 202 every month for this insurance. I have not taken any cashless treatment and i do not have claim experience so far. I have a health coverage of Rs 5 lakhs and the accidental coverage of Rs 15 lakhs which is satisfactory.
      Was this review helpful? 0
      , surat
      Reviewed on Feb 12, 2018
    • Reliance General Health Insurance
      "Good insurance policy"
      0.5 4.0/5 "Great!"
      I am having a health insurance policy with Reliance general from last 7 years and it is a good insurance policy to use.This policy has to be renewed every year and i pay a premium of Rs 12000-13000 for this insurance. I have not taken any cashless treatment and i do not have claim experience with this insurance. I have a coverage of Rs 6 lakhs which is satisfactory.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 12, 2018
    • HDFC Ergo Health Insurance
      "Excellent insurance "
      0.5 5.0/5 "Blown Away!"
      I have taken Health Insurance with HDFC Ergo,the premium amount is 1153,The policy coverage amount is three lakhs including family members.I have no claim experience as its taken six months ago.The process is too simple, and easy they had finished within a day.
      Was this review helpful? 0
      , chennai
      Reviewed on Feb 10, 2018
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