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Health insurance claim denial can derail your finances and cause stress. But instead of panicking, you can raise an appeal. Let's explore the intricacies of claim denials and how to appeal effectively for better medical coverage.
Health is indeed a wealth in today's fast-forward lifestyle. We have a full-fledged routine, from healthy eating habits to workouts to maintain a healthy lifestyle. But occasionally, there comes a scenario where we come across health issues. Dealing with health or medical emergencies can be overwhelming for anyone.
In such a case, health insurance works as a support system. But when the health insurance claim gets rejected, it brings a lot of stress.
Health insurance claim rejections happen for various reasons, but instead of panicking, you can appeal against health insurance denial. In this blog, we will clarify about health insurance claim denial and how to appeal it.
How to Handle Health Insurance Claim Rejection?
Medical emergencies can be devastating events in an individual's life, and getting a health insurance claim rejection is like an insult to injury. Not only does it affect a person's finances, but it also makes him think twice before getting quality care. However, health insurance claim rejection is nothing to worry about; individuals need to rectify their mistakes and reapply for medical expense reimbursement.
Here is a detailed structure that needs to be followed in the health insurance claim denial process.
Know the Reasons
The first thing to do when you get the claim rejected is to learn about the reasons for health insurance denial. Insurance companies only reject claims when there is a solid reason. That's why, before reapplying, it is best to check the policy conditions and all. Below are the list of health insurance denial reasons by insurance company:
If the health insurance claim is raised on the medical condition or treatment not covered under the policy.
Further, if the claim has been raised after the expiration of the policy.
In addition, policyholders forget to provide sufficient supporting documents when raising the claim.
Besides this, necessary details are missing in the insurance claim application form.
Lastly, if the claim is raised for someone out of policy purview.
Rectify or Reapply
After knowing the exact health insurance claim denial reasons, make the necessary changes and reapply for a health insurance claim again. If you have any queries regarding the claim rejection, it is better to reach out to the representatives of insurance companies. Further, if the reason for insurance claim rejection is an expired policy, then the insurance provider won't accept any such obligations.
Request for Ombudsman
Further, to help policyholders with insurance claim settlement, the government has appointed an Insurance ombudsman. These individuals help policyholders with complaints against insurance companies, such as premium disputes, delays in claim settlement, etc.
As per the Insurance Act of 1938, policyholders can approach an ombudsman for complaints against insurance companies. The hired ombudsman works to settle disputes between insurance companies and insurers. While hiring an ombudsman, ensure all your policy documents and medical bills are intact to support your case.
Write an Appeal Letter
Another way to get the rejected health insurance claim settled is to write an appeal letter to insurance companies. The letter should mention all the points and facts with supporting documents to strengthen your case.
It should be a detailed letter explaining why you have taken the medical insurance policy and your medical condition. Further, it should also clarify the treatment you are getting with medical prescriptions and bills. The detailed letter with supporting documents will help the insurance company about your medical condition and help in reconsidering the appeal of the rejected claim.
Wait For An Answer
The last step is waiting for an insurance provider's decision on the denial of a health insurance claim. The process might take some time since insurance providers have to verify all the documents and fact-check everything before making a proper decision.
Conclusion
Individuals generally buy health insurance plans to save their financial assets in emergencies. Also, under Section 80D of ITA, individuals will get tax deduction benefits for expenses related to health insurance premiums, medical expenses, etc.
There can be many reasons for buying health insurance, but one thing is financial security at the hour of need. So, if your health insurance claim gets rejected, there is no need to worry. One can reapply for a health insurance claim after rectifying the reasons for claim rejection.
