How to complain if your Health Insurance Claim is denied

By vishal

You have just had surgery and are trying to recover when you hear that your Health Insurance company has denied your claim! Indian Health Insurance companies are denying (or partially paying) more and more claims. Here are some suggestions on how to deal with such a situation.

Things You'll Need

Copies of your Claim Forms and all Supporting Documents from the Hospital, Surgeon and other Medical Expenses
Negotiating Skills
Tenacity to fight for your rights

Steps

Write to your Insurance Company

If your Health Insurance claim is denied or partially paid by the Third Party Administrator (TPA) write to the Insurance company within 15 days. Provide them with copies of all documentation and claim forms submitted to the TPA. In your letter specify why in your opinion your claim should be honored, set a timeline and the next steps you will be taking if you don’t hear from the Insurance company. Please be polite in your message and request the Insurance company to address your grievance in a timely manner. Make sure you send your letter via registered post.

Post to a Consumer Forum on the Internet

You should also post your grievance on a Consumer Complaint Forum like the Indian Consumer Complaints Forum. Please be polite in your message and request the Insurance company to address your grievance in a timely manner. Insurance companies do not like bad publicity and since your complaint has the potential of discouraging future customers, there is a good chance that they will contact you and attempt to settle your dispute.

Contact the Insurance Ombudsman for your region

India's Insurance Regulatory and Development Authority has created the office of Insurance Ombudsman who can rule on Insurance Claim disputes for all Health Insurance companies operating in India. This is a quick way of addressing consumer complaints about Health Insurance, without having to go to court. While the decision of the Ombudsman is binding on the Insurance Carrier, the consumer still has the option to go to court if the Ombudsman’s decision is not acceptable to them. You can write a complaint to them 1 month after contacting your Insurance carrier. To find out the contact information for the Insurance Ombudsman for your region visit the IRDA website.

File a case in a Consumer Court

If you are not satisfied with the decision by the Insurance Ombudsman then you still have the option to file a case in a Consumer Court. You will need to consult a lawyer at this point to file a case.

Tips

Always have all communications in writing. Keep copies of all documents for your record and always use Registered Mail (with acknowledgement due) to ensure that you have proof that the other party has received your mail.

Caution

It is always better to negotiate hard with the TPA and the Insurance company to settle the claim instead of going the legal route.

Comments

Medicare supplement insurance

On May 21th, 2010 - Sheill said:

You need Medicare supplement insurance because you cannot predict what your medical bills will be. In some years, your costs may be low. In other years, you may have very high medical expenses. If you have Medicare supplement insurance, you will have peace of mind in knowing that you are protected from most of these costs.
http://medicaresupplementinsurances.com/

The nike shox always are the trend-guiders. Apart from the fashionable design, Nike emphasizes more on the performance. Shox shoes with small hollow columns that make up the midsole of the shoe, which gather the style and performance. Shox r4 shoes can provide an optimal environment for cushioning, a slower rate of impact loading and a responsive feel. The cheap nike shox that is newfangled and faddish. Nike shox is ideal blend of style and science, they deserve your favor. Shox shoes sale will be your favorite for the superior quality material with the original design. You can buy mens nike shox | womens nike shox | kids shox shoes | nike shox nz | shox r4 | shox tl | shox turbo shoes at low price now.

Vibram five fingers sale

On August 30th, 2010 - Vibram five fingers said:

Vibram Five Fingers is the emerging Running shoes that become the new celebrity Trend-Setters. Vibram Five Fingers sale aims to provide the most complicated variety of vibram shoes for customers all over the world. Vibram Five Fingers kso with panted rubber sole is remarkable for the durability. Vibram Five Fingers sprint is designed hot and fashionable with the patterns. These cheap Vibram Five Fingers are versatile shoes that can be wore for various sports. Vibram Five Fingers Bikila with mesh upper will make your feet drier and cosy with the extra moisture out. When come to outdoor activities, Vibram Five Fingers kso trek is the best choice that we highly recommend, they are produced with high-performance and comfort. In addition, we also provide Vibram Five Fingers flow, which is our featured product that is red hot in the Europe and America.

cheap kids ugg boots

On September 2th, 2010 - cheap kids ugg boots said:

For those who do not know what classic women's australia sheepskin ugg boots sale online store means. Today, you can know when your dealing with a genuine ugg sheepskin boots on sale newest style you will find that when you wear them in the winter your feet are warm and comfortable. However, you need some good pair of fashion and cheap kids ugg sale beautiful style for the delicate feet of your child in the harsh and rough winter, and you can buy kids ugg boots on sale at our wholesaler this season for your lovely baby. Owning these cheapest ugg kids bailey button black_ugg kids boots bailey grey_bailey button ugg kids pink_kids ugg bailey button sand about many color for classic winter. Message From: http://www.cheapugg2u.com/.

The How-To site for Indians World-wide

categories

More by This Author