#nrimoneyclinic #healthinsuranceclaimrejected

WHY DOES A HEALTH INSURANCE COMPANY MAY REFUSE TO PAY A CLAIM ? HERE ARE THE 6 REASONS

CLAIM PROCEDURE

Cashless Claim Payment
Reimbursement Of Claimed Amount

NON DISCLOSURE
Previous Medical History
Congenital Problems

WAITING PERIOD
Medically Not Serious Conditions
Preexisting Health Issues

POLICY EXCLUSIONS
Pre Existing Issues
Congenital Problems
Dental Treatment
Alternative Treatment
Physiotherapy

DEDUCTIBLE AMOUNTS
First Deductible Amount
Co-Pay Conditions

LIMITS ON SUB HEADS
Ambulance Services
Room Rent
Limits Against Procedures
Dental Limits

NON SUBMISSION OF DOCUMENTS

Original Bills Not Submitted
Incomplete Set Of Documents

When a Hospital Says Claims Not Approved
What To Do ?
Check If It Is A Rejection Of A Cashless Claim?
Can The Claim Be Submitted On Refund Basis ?
Talk To Call Centre Of Company / Branch
Get A Letter From Company For Reasons Of Rejection

If A Company Rejects Claim Arbitrarily
What Can You Do?
You Have A Right To Appeal
Approach Ombudsman
Serve Legal Notice To Company
Send Complaint To Regulator – IRDA