What to Do If Your Health Insurance Claim is Denied

In a country like India, having a health insurance policy for separate individuals and special family health insurance plans are of a necessity. A health insurance plan is a safety measure that is undertaken by the buyer of the plan.

This safety measure gives financial aid at the time of a health crisis through payment of medical bills, buying medicines and hospitalization fees to all members who are insured under the same policy. Health insurance plans can also be termed as medical insurance plans.

There are a variety of best health insurance plans that arepresent in India. These plans are divided on the type of health insurance that a person is looking for, the length of the health insurance as well as the inclusions and exclusions of each health insurance plan.

The Many Health Insurance Plans in India

Each and every company in India that provides insurance plans to individuals have their own versions of health insurances that they have to offer. The different types of health insurance plans that are offered popularly to the masses are as follows:

·         An Individual Health Insurance Plan is a health insurance plan that is meant only for covering the health requirements and expenses of one individual.

·         Family Health Insurance Plans are plans that not only cover the individual but also their entire families as well. The health insurance plan varies depending on the number of individuals who are covered under the plan itself.

·         Critical Illness Plans are special plans that are made for individuals who already have a critical illness and who are seeking to get insured for the same. This plan covers nearly all critical illnesses, there are also some plans that cover all critical illnesses after a wait period of some time.

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          Depending on the age group, there are also health insurance plans that are specially tailored for children, adults and senior citizens as well from different companies.

Why Must You Buy A Health Insurance Plan?

In the 21^st century, there are a number of new diseases and health problems that are affecting the common masses. It doesn’t take long for an individual to realize that the expenses of fixing one’s health is gradually rising. There is also the risk of sudden health deterioration occurring for which huge funding is necessary for treatment. At a time when all these problems are being faced, the wisest decision is to take a health insurance policy.

Now those who are insured under a health insurance plan do not have to worry about the expenses of the treatment that they need to go to. The traditional method of borrowing loans from the bank for fixing one’s health is over. Health insurance plans cover everything health-related of a person. This may be the hospitalization fee, the fee for surgery/treatment of even the fee for buying the different medicines, everything is included in the same plan.

Health and Medical Insurance Claim

Once a health or a medical insurance plan has been given to a person, there are two ways in which the medical insurance claim can be made by a person. A health insurance plan can either be claimed at the time that there is a medical emergency and money is needed by the policyholder from the company, or the claim can be made after the event.

The cashless medical insurance claims policy is when the insured does not have to pay for any expenses that are incurred at the time of a medical emergency. All the expenses are taken care of by the insurance company itself. This is mainly applicable when the insurance holder avails treatment from the hospital which is affiliated with the insurance company as well.

The reimbursement process is when the insurance holder or a member related to the insurance holder pays for the hospitalization fees and other bills. This is later reimbursed from the company. The process is a short one and does not require much effort for the same. The method of reimbursement involves:

·         Informing the company that you want to make a claim,

·         Submitting all the bills and necessary documents that are required for the claiming process from the insurance company.

·         Get the reimbursed medical insurance claim amount.

Steps to Take When Your Medical Insurance Claim is Denied

There are rare occasions when the reimbursement of claim from the insurance company may be denied. In this case, there are several reasons why the insurance claim may be denied and there are several ways of re-claiming one’s medical insurance claim.

At the time that a claim has been denied from the company, the insured individual can ask the reasons why the company has denied their medical insurance claim. Reconsideration of claim can also be suggested to the insurance company in question. A third party may also review the insurance claim that has been made and help in finding out the faults in the claims process and ways to re-claim the money.

All individuals whose claim has been denied from a health insurance company have the right to appeal. An internal appeal is when the insurer appeals to someone from the insurance company itself to go through the claims process and reconsider the claims amount. Depending on the urgency with which the insured wants the claims to be settled, the insurance company also has to speed up the process as well. The third-party review is known as external review.