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How to Deal With a Denied Claim from Your Individual Health Insurance Provider?

When someone is dealing with a health issue, it can be a difficult and overwhelming experience not just for them, but for their loved ones as well. This is where having individual health insurance can be a huge relief, as it can help cover the cost of medical treatment.

by Henry James
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When someone is dealing with a health issue, it can be a difficult and overwhelming experience not just for them, but for their loved ones as well. This is where having individual health insurance can be a huge relief, as it can help cover the cost of medical treatment. 

However, it can be extremely stressful if your insurance claim is rejected. It’s important to understand that health insurance claim rejections happen quite frequently, and there can be various reasons for it. In most cases, the insurance company will inform you of the reason behind the rejection. If this happens, it’s essential not to lose hope. You can always appeal the decision and try to reapply for the claim.

Denied Claim for Health Insurance Plan for Individuals

  • Know the Reason

If your health insurance claim has been denied, it can be frustrating and overwhelming. However, before you file an appeal, it’s crucial to understand why your claim was rejected. Insurance companies typically reject claims for several reasons, such as:

  • The disease or treatment option you’re claiming for is not covered by your policy.
  • The policy has expired, and you didn’t renew it on time.
  • You didn’t provide enough information to support your claim on the application form.
  • You didn’t submit enough proof or documents to support your claim.
  • You filed a claim for someone who is not covered under your policy.

Knowing the specific reason behind the rejection can help you better understand how to proceed with the appeal.

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  • Reapply and rectify the issue

Once you’ve identified the reason for the rejection of your claim, it’s important to make any necessary changes and resubmit the claim. For instance, if the insurance company rejected your claim due to incomplete details or insufficient documents, you should provide the required information and documents and submit the claim again.

Before re-submitting your claim, it’s advisable to contact the insurance company to confirm if the additional information and documents you’ve provided are sufficient. This can help ensure that your claim is not rejected again due to the same reason.

  • Reach Ombudsman

If you have a complaint against your insurance company, an Ombudsman can be appointed to assist you. As per the Insurance Act, 1938, policyholders can approach an Ombudsman to resolve issues related to claim settlement, premium charges, policy term violations, or unclear policy terms.

The Ombudsman acts as a neutral party between the policyholder and the insurance company, facilitating the dispute resolution process. They will review the facts and provide a fair recommendation to help both parties settle the dispute. When approaching an Ombudsman, it’s important to have all relevant bills and documents that support your claim. It’s recommended to have copies of policy documents, payment receipts, and KYC documents. This can help ensure a smoother and more efficient resolution process.

  • Letter of appeal

One of the best ways to appeal a rejected health insurance claim is to write a letter or email to the insurance company with relevant facts. The communication should include all necessary details, such as the purpose of the message.

When drafting the letter or email, it’s essential to mention why you opted for the policy and provide details about your medical condition. It’s also important to include information about the treatment plan recommended by your doctor and provide proof of medical prescriptions. This can help the insurer better understand your situation and reconsider your appeal against the rejected claim. Click here to read more

Conclusion

It’s common for health insurance claims to be rejected, but there’s no need to worry if your claim is denied. The first step is to understand the reason for the rejection and take necessary corrective measures before reapplying. If your claim is valid and legitimate, the insurer will consider your appeal and approve your claim. Make sure to read the best health insurance plans for individuals before you ask for its claim!

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