Buying a health insurance policy is one of the most significant investments you can make. It alleviates financial stress during critical events such as medical emergencies. One key factor policyholders prioritize in health insurance plans is the claim settlement process of the insurance provider. Many insurers, such as Bajaj Allianz General Insurance, offer a 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 receive reimbursement in your account.

But what should you do if your insurer denies your claim? While insurance companies generally strive to settle claims, policyholders must be proactive to prevent claim denials.

What To Do If Your Health Insurance Claim is Denied

It is unfortunate when your claim is rejected or denied. However, there are specific methods to understand the reason behind the rejection and steps to appeal against the decision. One approach is utilizing the Grievance Redressal procedure outlined in your health insurance policy.

Common Reasons for Claim Denial

Insurance companies may reject a claim due to the following reasons:

1. The treatment received was not deemed medically necessary.
2. Administrative mistakes were made while completing the claim form.
3. The procedure was not included in your health insurance policy.

How to Deal with Denied Health Insurance Claims

Here are several strategies to handle denied health insurance claims:

1. Review the Denial Letter – When your insurer denies a claim, they send a denial letter to the network hospital (for cashless claims) or a repudiation letter (for reimbursement claims). Carefully review these letters to identify the reason for denial.
2. Gather Necessary Documents – Collect supporting documents, such as medical records, policy wording, and medical receipts, to assist in the appeal process.
3. Submit an Appeal – File an appeal regarding the claim denial decision through an arbitrator, lawyer, or ombudsman.
4. Maintain a Paper Trail – Ensure all communication with your insurer, doctor, or insurance agent is conducted via email or postal mail to preserve a record of your case.
5. Follow Up Regularly – Keep track of the appeal’s progress by staying in touch with your insurer or insurance agent.

You can appeal a denied claim multiple times, but it is essential to thoroughly understand the policy details, including exclusions and reasons for rejection. If the claim denial is justified, pursuing an appeal may result in unnecessary time, energy, and expenses.

At Bajaj Allianz, we take pride in having one of the highest claim settlement ratios among private insurance companies. Explore the features and benefits of our various health insurance plans on our website.