{"id":3154,"date":"2023-08-03T14:04:57","date_gmt":"2023-08-03T08:34:57","guid":{"rendered":"https:\/\/www.insurancesamadhan.com\/blog\/?p=3154"},"modified":"2023-08-03T18:15:21","modified_gmt":"2023-08-03T12:45:21","slug":"what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7","status":"publish","type":"post","link":"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/","title":{"rendered":"What are the most common reasons for Health Claims Rejection: The Series: Part 7"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_76 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/#Admission_for_Diagnostic_Purposes\" >Admission for Diagnostic Purposes<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/#Case_Study\" >Case Study<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/#Dont_Be_Ignorant_%E2%80%93_Know_Your_Rights\" >Don\u2019t Be Ignorant &#8211; Know Your Rights<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/#How_to_Claim_Pre_and_Post-Hospitalization_Expenses\" >How to Claim Pre and Post-Hospitalization Expenses?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/#Documents_Required\" >Documents Required\u00a0<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/#Bottom_Line\" >Bottom Line\u00a0<\/a><\/li><\/ul><\/nav><\/div>\n<h3><span class=\"ez-toc-section\" id=\"Admission_for_Diagnostic_Purposes\"><\/span>Admission for Diagnostic Purposes<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Healthcare starts with and depends on diagnostics, whether it is diabetes, cancer, or any other health threats. Diagnostics are at the front and center. The purpose of diagnostics is to gather precise information to aid in early detection, prevention and monitoring of diseases. Moreover, diagnostics are vital in the creation and implementation of treatment plans. Thus, the importance of diagnostics cannot be undermined. However, what happens is that sometimes people visit clinics or hospitals for a diagnosis, but due to the severity of the problem, they are advised to get hospitalized.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The suffering person with pain has no option but to follow the doctor&#8217;s advice. However, when it comes to claiming health insurance for the medical expense incurred during hospitalization, the insurance companies reject the claim stating that the hospitalization was not warranted\/ required.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Today, we will talk about another major reason for rejecting health claims \u201c<\/span><b>patient admitted for diagnostic purposes but hospitalization was not required.\u201d\u00a0<\/b><\/p>\n<p><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Case_Study\"><\/span><span style=\"font-weight: 400;\">Case Study<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Insurance Samadhan is a platform where people register their insurance-related issues for expert assistance. Recently, we received a call from Mr. Rahul Pal, who was hospitalized at Neema Hospital for the treatment of Enteric Fever with chills, cold, vomiting, and related issues for which the doctor advised him to get hospitalized. Mr. Rahul had no other option but to listen to the doctor and got hospitalized.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">After being admitted to the hospital for two days, Mr. Rahul was discharged from the hospital with a huge medical bill, which he was not worried about since he had health insurance. To his surprise, the health insurance company rejected the claim stating that hospitalization was not required for the mentioned symptoms. He was shocked to see the company&#8217;s behavior as he never thought he had done something wrong. So, he decided to challenge the insurer.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">He contacted Insurance Samadhan, and we analyzed the case thoroughly. We saw that Mr. Rahul had all the relevant documents with the doctor\u2019s signature that stated admission was necessary as oral treatment was not improving the patient&#8217;s health.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When the Ombudsman heard the case with all the facts, it was decided that the insurer had wrongfully rejected the health claim. Thus, Mr. Rahul\u2019s case was settled, and he got back his hard-earned money but not the complete amount. And there is a reason: only a few expenses are covered under pre and post-hospitalization. We will talk about Pre and Post hospitalization expenses in detail later in the article.<\/span><\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-full wp-image-3159\" src=\"https:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/admitted-for-diagnostic-Purpose-creative.png\" alt=\"health claim rejected\" width=\"1920\" height=\"1080\" srcset=\"http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/admitted-for-diagnostic-Purpose-creative.png 1920w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/admitted-for-diagnostic-Purpose-creative-300x169.png 300w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/admitted-for-diagnostic-Purpose-creative-1024x576.png 1024w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/admitted-for-diagnostic-Purpose-creative-150x84.png 150w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/admitted-for-diagnostic-Purpose-creative-768x432.png 768w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/admitted-for-diagnostic-Purpose-creative-1536x864.png 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Dont_Be_Ignorant_%E2%80%93_Know_Your_Rights\"><\/span><span style=\"font-weight: 400;\">Don\u2019t Be Ignorant &#8211; Know Your Rights<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Don&#8217;t be ignorant about your rights as a policyholder. Understanding your rights is crucial when dealing with health insurance claims. Insurance companies may sometimes wrongfully reject claims, leaving policyholders confused. Knowing your rights empowers you to challenge claim denials with confidence. This series aims to educate you on policy terms, claim procedures to avoid misunderstandings with insurers.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In Mr. Rahul Pal&#8217;s case, he faced claim rejection after being hospitalized for diagnostic purposes. Unaware of his rights, he was shocked by the insurer&#8217;s behavior and questioned if he had done something wrong. Seeking help from Insurance Samadhan, he learned about his rights as a policyholder.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The above case is related to pre and post-hospitalization expenses, which are the medical costs incurred by a patient before and after their hospitalization for a specific medical condition or treatment. So, let us take a look at the subject and how you can easily make a claim.\u00a0<\/span><\/p>\n<p><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/p>\n<h2><span class=\"ez-toc-section\" id=\"How_to_Claim_Pre_and_Post-Hospitalization_Expenses\"><\/span><span style=\"font-weight: 400;\">How to Claim Pre and Post-Hospitalization Expenses?<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><b>Step 1:<\/b><span style=\"font-weight: 400;\"> Ensure the health claim is for treatment of the same condition the patient was admitted for.<\/span><\/p>\n<p><b>Step 2: <\/b><span style=\"font-weight: 400;\">Complete the required claim form and attach hospital bills and relevant documents\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">(diagnosis confirmation, prescriptions, discharge summary, etc). Submit to your insurer and TPA.<\/span><\/p>\n<p><b>Step 3: <\/b><span style=\"font-weight: 400;\">Submit the claim within the specified time period (usually 30-60 days after hospitalization, check with your insurer).<\/span><\/p>\n<p><b>Step 4: <\/b><span style=\"font-weight: 400;\">The insurer will verify the documents. The claim will be accepted if expenses are related to the admitted condition.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Usually, we miss a few things that might lead to claim rejection, but if you follow the above points, it will likely happen.\u00a0<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Documents_Required\"><\/span><span style=\"font-weight: 400;\">Documents Required\u00a0<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><b>Claim Form: <\/b><span style=\"font-weight: 400;\">Complete and sign the claim form your health insurance company provided. Make sure all details are accurate.<\/span><\/p>\n<p><b>Hospital Bills: <\/b><span style=\"font-weight: 400;\">Attach the original bills or receipts from the hospital for the pre and post-hospitalization expenses. The bills should clearly mention the treatments, consultations, medications, and other services availed.<\/span><\/p>\n<p><b>Diagnosis Confirmation:<\/b><span style=\"font-weight: 400;\"> Include documents confirming the medical condition diagnosis for which the patient was admitted to the hospital.\u00a0<\/span><\/p>\n<p><b>Discharge Summary:<\/b><span style=\"font-weight: 400;\"> Obtain the discharge summary from the hospital detailing the treatment received during the hospitalization.<\/span><\/p>\n<p><b>Prescriptions:<\/b><span style=\"font-weight: 400;\"> Provide copies of prescriptions issued by the treating doctor, which show the medications prescribed during the pre and post-hospitalization period.<\/span><\/p>\n<p><b>Follow-up Reports:<\/b><span style=\"font-weight: 400;\"> If there were any follow-up consultations or medical check-ups after hospital discharge, include the relevant reports and bills.<\/span><\/p>\n<p><b>Relevant Medical Reports: <\/b><span style=\"font-weight: 400;\">Submit any other relevant medical reports or documents related to the pre and post-hospitalization treatments.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Providing the insurance company with all necessary documents will facilitate a streamlined and expedited claim processing experience.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Bottom_Line\"><\/span><span style=\"font-weight: 400;\">Bottom Line\u00a0<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In today\u2019s blog, we have covered the common reasons for the rejection of health claims, focusing on &#8220;patient admitted for diagnostic purposes, but hospitalization was not required.&#8221; Understanding your rights as a policyholder and being aware of the claim process is crucial to avoid misunderstandings with insurers. The case study of Mr. Rahul Pal serves as a reminder that if stuck, you can always ask for help from Insurance Samadhan, as we will be really happy to help people whose claims have been wrongfully rejected. Additionally, we provided a step-by-step guide on claiming pre and post-hospitalization expenses, emphasizing the importance of submitting the required documents within the specified time frame. Stay informed and confidently navigate the health insurance journey.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">That is all from our side today. Hope this article helped you gain enough clarity. Stay tuned for next week, where we will be covering \u201c<\/span><b>Discrepancy in Documents\/ Fraud.\u201d <\/b><span style=\"font-weight: 400;\">It is another very important reason for claim rejection.<\/span><\/p>\n<p><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=organic&amp;utm_medium=blog&amp;utm_campaign=blog_post&amp;utm_term=blog_term\"><strong>Click here<\/strong><\/a>\u00a0to register your complaint with Insurance Samadhan<\/p>\n<p>You can also<\/p>\n<p>Visit our website:\u00a0<a href=\"https:\/\/www.insurancesamadhan.com\/\">insurancesamadhan.com<\/a><\/p>\n<p>Call us on +91 9513631312<\/p>\n<p>WhatsApp:\u00a0<a href=\"https:\/\/api.whatsapp.com\/send?phone=+919910998252&amp;text=Hi\">\u00a09910998252<\/a><\/p>\n<p>Mail us at\u00a0<a href=\"mailto:corporate@insurancesamadhan.com\">corporate@insurancesamadhan.com<\/a><\/p>\n<p><script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\/\",\n  \"@type\": \"Article\",\n  \"mainEntityOfPage\": {\n    \"@type\": \"WebPage\",\n    \"@id\": \"https:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/\"\n  },\n  \"headline\": \"Learn your rights as a policyholder and claim pre\/post-hospitalization expenses with ease. 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Diagnostics are at the front and center. The purpose of diagnostics is to gather precise information to aid in&hellip; <a href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-7\/\" class=\"more-link\">Continue Reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":12,"featured_media":3158,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[301,3,313,315,311],"tags":[],"class_list":["post-3154","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-case-study","category-health-insurance","category-health-insurance-claim","category-health-insurance-claim-rejection","category-insurance-claim-rejection"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>What are the most common reasons for Health Claims Rejection: The Series: Part 7 - Insurance Samadhan<\/title>\n<meta name=\"description\" content=\"Learn your rights as a policyholder and claim pre\/post-hospitalization expenses with ease. 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