In India, over time, the living expenses have steadily increased. Economic factors, technological factors, social factors, and much more influence these expenses. The sudden increase in medical expenses has created a burden on the shoulders of middle and lower-class families. Hence, to avoid carrying the burden of huge medical costs, health insurance has been in high demand by the population of India. Besides providing financial security, Health Insurance Plans promote preventive measures and permit access to quality healthcare services. Therefore, health insurance massively uplifts the entire country’s healthcare system.
In many instances, like incomplete or incorrect information provision, hiding medical history, and delay in notifying about the necessity to the insurer, your insurance claim can be denied. What to do in such cases? To learn about the procedure, keep reading.
All You Need to Know About the Health Insurance Claim Procedure
The claim procedure is quite simple and can be performed steadily without being overwhelmed by technical issues. Here are the guided steps for claiming an insurance policy:
- Notifying the insurance company: First, the policyholder’s family must notify the insurance company immediately. Any delay in this step might create unwanted troubles for the insured individual.
- Documents: In such situations, documents play a vital role as they act as evidence for the policyholder to claim the insurance. Hence, each piece of the document must be carefully observed. Here is the list of some important documents that are required for the claim procedure:
- Claim form issued by the insurance company
- The entire history of medical records for the particular accident or illness.
- The discharge bill from the hospital
- Other documents that the insurance company may specify.
- Justifiability of the claim: Once the documents get submitted, the insurance company will verify and assess the need for the claim.
- Judgement from the insurance company: After document verification, the insurance company will either give their approval or rejection. If the claim gets approved, the insurance company will proceed with the settlement process. In contrast, if the claim gets rejected, the insurance company will provide justifiable reasons for such action.
- Settlement of the claim: Depending upon the situation, the insurance company could either provide cashless settlement or reimbursement. In the case of cashless settlement, the insurance company directly pays the desired amount to the hospital. While in reimbursement, the company will settle the amount with the insured person.
If there are any additional delays to the claim process, the family members should contact the insurance company. Before being insured by any company, do not forget to read the terms and conditions of the policy, as they contain vital details regarding the claim for the health insurance policy.
Necessary Steps You Must Take When Health Insurance Claim Gets Denied
Not all claims requests get approval from the insurance company. Sometimes, a genuine claim has to face rejection from the insurance company. In such case scenarios, one should follow the given steps:
- Examine: Carefully examine the rejection letter to check whether the reasons provided by the insurance company resonate with the conditions of the insurance.
- Collecting: Assemble each document that might have a possible connection with the claim process.
- Justification: Directly contact the insurance company and request a proper reasoning behind the rejection of the claim.
- Legal procedure: If the insurance company provides absurd reasons for rejecting the claim, then the insured person could file a case of appeal against the insurance company.
- Documents and Communication: Provide every document that might support the appeal against the company. Also, keep a proper record of all communications with the insurance company. This might act as a shred of strong evidence during the appeal process.
- Proper Guidance: If the appeal consists of complex matters, it is recommended to get assistance from an advocate.
- Other options: You can consider taking such matters to the higher authorities if all other efforts prove futile.
Conclusion
As medical expenses are rapidly increasing, health insurance proves to be a crucial tool that not only secures the family from carrying the financial costs but also provides a huge variety of advanced healthcare options. Interestingly, an insurance policy promotes an individual’s positive mental health stability.
Being one of the fastest-growing insurance brokers in India, CoverYou has completely revolutionized the concept of an insurance policy. Not only have they reduced the time for claim settlement, but they have also introduced hassle-free procedures for getting insurance. Due to their innovative approach, CoverYou has successfully created a loyal consumer base.
Here are some of the fascinating features of CoverYou that set them apart from the rest of the competitors in the healthcare industry:
- CoverYou identifies the needs of an individual and accordingly suggests the best-suited insurance for the individual.
- Their 24/7 assistance reduces the time taken for a claim settlement.
- We are the leading insurance broker for doctors’ health insurance, and over 1.5 lac doctors are successfully registered.
- In case of any inconvenience, the management team is ready at your service.
