What to Do When Your Group Medical Policy Claim is Denied?

group medical policy

If you’re feeling concerned about your group medical policy claim being rejected, it’s important to understand that there could be a variety of reasons for this outcome. From mistakes on your claim form to failing to disclose a medical condition, even a minor oversight can result in your claim being denied when you need it the most. 

It’s crucial to ensure that all the information provided and documents submitted are accurate and authentic to ensure a smooth and hassle-free claim settlement. Remember, taking proactive steps can help ensure that you receive the coverage you need when you need it most.

To begin with, it’s important to take a step back and consider the common reasons that often result in rejection of
group health insurance in India. This applies to various types of plans including individual health plans, family health plans, coronavirus health insurance plans, and senior citizen health plans. 

Reasons For Rejection

  • One of the primary reasons why medical insurance claims are rejected is due to the policyholder providing inaccurate or incorrect information. Oftentimes, applicants may not disclose all the necessary information at the time of purchasing the policy in order to secure a lower premium.

  • Improper documentation is another common reason why health insurance claims may be rejected. If you’ve rushed through the policy purchase process or been misled by an unregistered agent into submitting incomplete documentation, you run the risk of losing out on your claim amount. In India, health insurance companies require proper documentation to settle claims, and missing documents can be a major reason for claim rejection.

  • If you allow your medical insurance policy to lapse by failing to renew it on time, your health insurance claim will not be considered by your insurer. It’s essential to keep your policy current by renewing it before it expires, as a lapsed policy can leave you without coverage when you need it the most.

How to Claim Group Medical Insurance?

The Insurance Regulatory and Development Authority of India (IRDAI) recently issued a circular stating that insurance providers can question health insurance claims after a policyholder has paid premiums consistently for a period of 8 years, known as the moratorium period. If your policy falls within this time frame, you may be subject to further questioning regarding your claim. For those whose policies fall outside of this period, it’s important to engage in a dialogue with your health insurance company to understand the reason for the claim denial.

  • If your health insurance claim has been rejected due to incorrect information, one option is to file the claim again with accurate data. Begin by informing your insurer that you plan to reinitiate the claim, and take some time to review the original claim and identify any errors or discrepancies. With the help of online experts or customer support, fill out the claim form again, making sure that all the information provided is accurate and up-to-date. By taking these steps, you can increase the likelihood that your claim will be accepted upon resubmission.

  • If your health insurance claim was rejected due to missing documentation, it’s essential to ensure that you provide all the required documents when submitting the claim. Failure to do so could result in a loss of coverage and benefits that you’re entitled to under your policy. Be sure to review the original claim and identify any missing documentation, then gather the necessary paperwork and provide it to your insurer when submitting the claim. By taking these steps, you can help ensure that your claim is processed and that you receive the benefits you need when faced with a medical emergency.

  • To ensure a smooth claim settlement process, it’s important to submit all relevant medical documents and papers to your health insurance provider. This may include original hospital bills, certificates from your medical practitioners, and a discharge summary from the hospital. If the hospital is uncooperative, it’s important to follow up with them and obtain all the necessary documents to support your insurance claim request. By providing all the required documentation, you can help ensure that your claim is processed quickly and that you receive the coverage and benefits you’re entitled to under your policy.

  • If your best health insurance claim was denied because your insurer claims that hospitalisation wasn’t necessary, it’s important to provide evidence to support your case. This could include submitting your doctor’s medical prescription recommending hospitalisation, as well as any diagnostic reports that were conducted before you were hospitalised. By providing this information to your insurer or TPA, you can help demonstrate that hospitalisation was essential to your treatment and that your claim request should be accepted. Ultimately, providing clear and compelling evidence can help ensure that your claim is processed and that you receive the coverage and benefits you need when faced with a medical emergency.

Try out these methods, and we assure you group medical policy claims will not get rejected! For more information, you can consult the experts at Niva Bupa and get the answers to your questions.

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