When your insurance claim gets rejected, you ought to search for errors within the form you submitted. You will get your form rectified with the support of a third-party representative (TPA) with accurate documents. We often don’t make wise decisions, by simply being ignorant to details and believing that some cosmic power will look out folks in the least times. These circumstances lead us to a hell-hole like a claim rejection of our insurance. It sounds dramatic to people that are reading this as a security measure except for those that have already experienced it and are seeking help, realize the real-life drama within the situation. So, it’s important to know the circumstances under which a claim are often rejected but at an equivalent time it’s also important that one understands the preventive measures, this is often more important than the curative measures which will be taken for obvious reasons.
REASONS FOR REJECTIONS
- Wrong Information
If the policyholders provide wrong or incorrect information, in that case, there can be rejection, so it is advised to check before providing information. It should be duly verified by the policyholder and also no wrong information is entrained so correct and accurate information needs to be provided.
- Improper Documentation
The documentation part is really crucial thing in the insurance policy as if any of the documents is missing or the full documents are not submitted, this also becomes a reason for rejection of the claim. Therefore it is advised to verify this before it is too late.
If the claim of the treatment is not covered in the insurance policy, the claim will not be initiated, it is advised to check the exceptions of the policy before buying it.
- Lapsed Policy
There is always a time duration of a policy and if it is not renewed at the right time, becomes a reason for rejection.
Claim Rejection Circumstances:
- Particular ailment against which the claim is being made isn’t covered under yours.
- The form for the claim has not been filed properly.
- The procedure wasn’t required by the insured, medically.
- The claim has not been filed within the correct time frame, mentioned as per the policy.
Score Prevention of insurance Claim Rejection:
Keep subsequent in mind about your insurance policy to never need to affect this again:
- Always make copies of all the documents that you simply submit with the form for your policy, to the TPA as a measure of future reference.
- Make sure that you simply undergo the policy wordings alongside terms and conditions, especially exclusions, deductibles and claim process quite anything alongside the advantages of the policy.
- Make sure that you simply submit the claim request before 30 days from the date of hospitalization.
- You must send all the medical records to the TPA. within the case of post-hospitalization costs incurred the small print and submission must be done within ninety days from the date of hospitalization.
- Always double-check the claim form for accuracy. (Keep multiple forms in hand in case you would like to fill it again before submission)
- Also gather enough information and proof-like doctor’s prescriptions, etc. and submit or post it to the TPA.
What Must Be Done?
Even after a claim rejection, an insurance firm may reconsider your claim keeping in mind that you simply are ready to convince the insurer that your claim is genuine. But you initially got to know why it had been rejected, since you would like to require subsequent steps, accordingly. But once you recognize the rationale, here is what you’ve got to do:
- See-through your medical claim form submitted to the insurance firm. the foremost important things here are the names and your policy number. If there are errors in reporting these, the TPA has got to be told to reopen the case also because the insurer has got to be clearly made conscious of the error.
- Some claims are rejected thanks to errors within the system caused by insufficient information provided by the claimant. The TPA representative can assist you out with the answer then and there also ensuring that you simply record details about this conversation also as document it if possible.
- You must check the documents sent with the form and whether any mistakes are made within the sort of insufficient or incorrect documentation or maybe lack of attestation.
- If you work out what’s the matter it is often cleared by providing sufficient documents with correct details and attestation.
- Once you’ve got all the documents ready supporting your claim:
- Write and send a proper letter with the statement that has a reason for the claim being genuine or valid.
- Attach appropriate documents alongside the medical opinion of the licensed medical man for claim substantiation.
- Note, that multiple appeals for the claim validation are often made.
- If the insurer doesn’t answer your claim in 30 days you’ll approach Ombudsman. This organization allows you to submit a written complaint at the Office of insurance Ombudsman within thirty days from the health insurer’s response.
The office of the Ombudsman is the last option to get your claim validated. Beyond that, you simply might need legal aid which can cost you quite your doctor’s bill in most cases. Hence, confirm you’ve got a legitimate claim and have sufficient supporting documents.
It is advised to check details of the policy before buying it, the policyholder should provide correct information and also renew the policy according to the time span, in case the claim gets rejected, you can check the above-mentioned ways that whom to approach and how. Therefore, it is advised to follow the proper process and procedure, avoid mistakes then for sure your claim will never get rejected.