6 Expert Tips For Avoiding Claim Rejection And Resolving Disputes In Health Insurance

New Delhi: Health insurance, considered a vital financial safety net, shields people and families from the escalating expenses of medical care. It's crucial to recognise that claim denials and disputes might happen, which puts consumers through needless worry and financial hardship. By following some key tips, one can maximise the chances of his or her health insurance claims being accepted and resolve any dispute that may arise.

Aftab Chaz, Associate Director and Business Head at Elephant.in discussed some of the essential points on claim denials and disputes related to health insurance with Reema Sharma of Zee Media.

“Navigating health insurance claim rejections and resolving disputes can be challenging, but by following the a few tips, one can increase the chances of a successful claim settlement. One should remember to provide accurate information, understand policy terms, maintain transparency, and submit all necessary documents on time. By being proactive and well-informed, consumers can protect their rights as policyholders and ensure smooth healthcare financing through their health insurance coverage,” added Aftab Chaz.

Chaz shares 6 Expert Tips for Avoiding Claim Rejection and Resolving Disputes in Health Insurance

Providing accurate information during policy purchase

When buying a health insurance policy, it is imperative to provide accurate and complete information. Consumers should disclose all pre-existing medical conditions, previous surgeries, medications, and any other relevant details. Failing to disclose the requisite information may lead to claim rejection or policy cancellation later.

Understanding policy terms and conditions

Consumers should thoroughly read and understand the terms and conditions of the health insurance policy. One should pay close attention to coverage limits, waiting periods, exclusions, and claim filing procedures. At times, consumers avoid reading policy documents because of the heavy information and terms and conditions mentioned. They realise they missed reading the important information during the time of claim settlements. By that time, it is too late to even make changes to the policy; as a result, many consumers have to pay out of their own pockets, which could have been taken care of by the insurance company. Thus, being well-informed about the policy will help one avoid surprises and make informed decisions.

Maintaining transparency during claim filing

During the claim filing process, consumers should ensure transparency by providing all necessary documents, medical reports, bills, and prescriptions. It is suggested that you double-check so that all information is accurate and up-to-date. Any inconsistencies or missing details may result in the claim being rejected.

Timely submission of claim documents

Consumers should submit claim documents within the scheduled time frame specified by the insurance provider. Late submissions can lead to delays or even rejection. Consumers should also keep track of deadlines and promptly provide the required paperwork to expedite the claim settlement process.

Seeking clarification from the insurer

If a consumer has any doubts or concerns regarding the claim process, policy coverage, or claim rejection reasons, he or she should reach out to the insurance provider. Consumers should not shy away from seeking clarification and guidance from their customer support team or a designated claims officer. Understanding the requirements and procedures will help them address any potential issues proactively.

Maintaining records and receipts

Another important parameter that consumers often overlook is maintaining a record of all medical reports, bills, and receipts and communicating the same with the insurance company. These records serve as evidence in the event of any dispute or claim rejection. Keeping organised documentation will not only strengthen the case but also facilitate a smoother resolution process.