How To File An Appeal Against Health Insurance Claim Rejection
Updated On Oct 21, 2020
Getting insured and choosing the best insurance policy is a worth of money deal in life. Insurance is a handy way to protect you and your family from unforeseen circumstances and incidents.
What if you recently have applied for the health policy and due to some problems and document work your insurer is not paying you? Fret not, we will cover it all and discuss how to appeal against a rejected health plan?
Rejection of a policy claim could be extremely disappointing, but one can easily appeal against the denial and get the sum assured easily.
Rejection Reasons For a Health Insurance Claim
Generally, insurance companies communicate the reason while rejecting any health policy. There is a strong reason behind and if there are no remarks stated the policyholder can appeal for the same. There could be many reasons including:
- The claim is raised for the problem which is not covered in the policy.
- Policy has expired
- If any supporting documents are missing.
The above-mentioned reasons are sometimes responsible for the cancellation of the health insurance policy.
What To Do When A Health Insurance Claim Gets Rejected?
You can do the following if your health insurance claim gets rejected by your insurance company:
- Rectify And Reapply - One can rectify the mistakes in the documents provided if the insurer has provided the reason for the cancellation. It is always advised to assess the reason carefully and then reapply after discussing the issue with the insurance company executive. However, one can't reapply for the policy which has already expired.
- Discuss It With The Ombudsman- An Ombudsman is the official person appointed by the organization to deal with the individual matters and complaints against the company. According to the Insurance act 1938 complaint can only be made on the following issues :
- Claim settlement issues
- Premium dispute issues
- Terms and conditions are not cleared
One can write his/her issue to their respective ombudsman according to the location.
- Keep All Bills Intact - Now that you know the reason for the cancellation of the policy, the next step is to collect your medical documents such as medical records, wordings of the policy, and all the necessary receipts that will help to appeal against the policy cancellation.
- General Documents To Carry- A set of general documents is required and submitted to authorities:
- A duplicate copy of the policy
- Copy of payment receipt(last)
- KYC documents or any other address proof.
- Write An Appeal Letter To The Company - Writing an appeal letter means communicating your problem with proper information and facts in written mail. It is the easiest way to file a complaint against a rejected health insurance claim. What an ideal appeal letter should include :
- Opening Statement- Includes the purpose of writing a letter and what service or therapy was denied with its reason for a better understanding of the reader.
- Explanation- One must explain why he/she needs this policy and the medical conditions he is going through.
- List Information From Your Doctor- Include your current treatment plan and medical prescription. It will help the company to reconsider your appeal against rejected insurance.
It is important to send your appeal within the stipulated time and go through all the instructions on the company's website before appealing.
There is no need to worry if your claim is rejected. Act smartly, assess the conditions, and most importantly understand your coverage and reason for the cancellation. The insurance company will definitely consider your request if it's legitimate and you will receive the insured sum.
You May Also Like To Read:
Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.