What to Do When Your Health Insurance Claim is Denied?

tech.hindustantimes.com:

Managing a medical condition can be difficult for the ill and their loved ones. Knowing that your health insurance will pay for the necessary treatments can be comforting. But what happens if your health insurance denies your claim? It could result in extreme stress.

Rejections of health insurance claims are real scenarios, and there are several reasons why insurers choose not to approve the claim. When insurance companies reject a claim, they usually notify the applicant and explain the reason. You shouldn't give up if the insurance company denies your claim. You have the option to reapply after appealing the denied claim application. So, let's discuss what to do if your health insurance claim is rejected:

You need to be aware of the precise reason for the claim denial before you can pursue an appeal. The insurance companies typically deny applications for claims for the following reasons:

The IRDA of India has given a recent circular that any insurance provider may raise questions about health insurance claims following a policyholder's average of five years of premium payments—a time known as the moratorium period.

For the others, you'll need to speak with your health insurance provider and inquire why your claim was turned down. If you understand why, you can reapply the claim by doing the following:

You can make the necessary corrections and resubmit after you know the reason. Nonetheless, the claim will never be approved if the denial was due to a "claim raised for expired policy" or other similar reasons. 

Speak with an ACKO executive to determine why you were rejected and how to address the situation. You can do the same thing via email or phone. In such communication, it is preferable to have a written mail.

An Ombudsman is a representative the insurance provider chooses to assist policyholders with grievances against them. The 1938 Insurance Act states that you can file a complaint with an ombudsperson regarding issues with claim settlement, premium