{"id":3200,"date":"2023-08-18T18:14:47","date_gmt":"2023-08-18T12:44:47","guid":{"rendered":"https:\/\/www.insurancesamadhan.com\/blog\/?p=3200"},"modified":"2024-02-26T11:14:42","modified_gmt":"2024-02-26T05:44:42","slug":"what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-8","status":"publish","type":"post","link":"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-8\/","title":{"rendered":"What are the most common reasons for Health Claims Rejection: The Series: Part 8"},"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 ' ><li class='ez-toc-page-1 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-8\/#TREATMENT_AT_A_BLACKLISTED_HOSPITAL_Major_Facts_to_keep_in_mind_before_Hospitalization_and_insurance_Claim\" >TREATMENT AT A BLACKLISTED HOSPITAL: Major Facts to keep in mind before Hospitalization and insurance Claim!\u00a0<\/a><\/li><\/ul><\/nav><\/div>\n<h3><\/h3>\n<h3><span class=\"ez-toc-section\" id=\"TREATMENT_AT_A_BLACKLISTED_HOSPITAL_Major_Facts_to_keep_in_mind_before_Hospitalization_and_insurance_Claim\"><\/span><b>TREATMENT AT A BLACKLISTED HOSPITAL: Major Facts to keep in mind before Hospitalization and insurance Claim!\u00a0<\/b><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Harsh met with an accident. Someone from the public took him to a nearby hospital. The insurer rejected the claim stating that the hospital was blacklisted. What can Harsh do?<\/span><\/p>\n<p><span style=\"font-weight: 400;\">One of the most common reasons for health claim rejection is that the insured went to a blacklisted hospital.<\/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\"><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/a><\/p>\n<p><span style=\"font-weight: 400;\">So let us first understand what is a blacklisted hospital and things that you should keep in mind:<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A blacklisted or excluded hospital in the context of a health insurance policy refers to a healthcare facility that has been marked and claims pertaining to the same are rejected. The following are the common reasons for a hospital being marked as blacklisted:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><strong>Fraudulent claims<\/strong>: If an insurer comes across instances where a hospital colludes with the client to provide fake documents and bills, to curb these activities, insurers blacklist such hospitals.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><strong>Non-cooperation<\/strong>: There are cases in which hospitals do not support the investigations and provide required documents to the insurers. As this makes it difficult for insurers to process claims, a hospital might get marked as blacklisted due to this.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><strong>Exorbitant Unjustified Charges<\/strong>: Certain hospitals are blacklisted for charging unjustified high prices from their customers, especially in the case of insurance owners.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">As we can understand the scenarios above, it is clear that we should totally avoid getting admitted to a blacklisted hospital. The best way is to always admit at a Network hospital and take a CASHLESS claim.<\/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\"><img decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/stage.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Insurance Samadhan\" width=\"500\" height=\"70\" border=\"0\" \/><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Coming now to the pressing issue, which is what you should do if after an accidental injury you are admitted to a blacklisted hospital.\u00a0<\/span><\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-full wp-image-3201\" src=\"https:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/Treatment-Blacklist-Hospital.png\" alt=\"Blacklisted hospital\" width=\"1920\" height=\"1080\" srcset=\"http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/Treatment-Blacklist-Hospital.png 1920w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/Treatment-Blacklist-Hospital-300x169.png 300w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/Treatment-Blacklist-Hospital-1024x576.png 1024w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/Treatment-Blacklist-Hospital-150x84.png 150w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/Treatment-Blacklist-Hospital-768x432.png 768w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/08\/Treatment-Blacklist-Hospital-1536x864.png 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p><span style=\"font-weight: 400;\">Most of the companies have an exception for emergencies in case of blacklisted exclusion i.e., they allow charges for blacklisted hospitals if the admission is due to an emergency and the same is justified. However please ensure below:<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If the situation is under control and your company has no exception to emergency hospitalization, try to shift to an empaneled hospital.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Maintain records of each document and bills.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Get an emergency admission certificate from the treating doctor stating reasons.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ensure to check the complete bills at the time of discharge.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Try and get all the possible proof i.e. police papers, MLC report, statements of people who take you to hospital etc. These might come in handy in case of case rejection.<\/span><\/li>\n<\/ol>\n<p style=\"text-align: center;\"><strong>In case your claim is still rejected, delayed or short settled, contact Insurance Samadhan who have resolved more than 15,000 insurance complaints.<\/strong><\/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-8\/\"\n  },\n  \"headline\": \"What are the most common reasons for Health Claims Rejection: The Series: Part 8\",\n  \"description\": \"Discover how to handle hospitalization in a blacklisted facility for insurance claims. 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Someone from the public took him to a nearby hospital. The insurer rejected the claim stating that the hospital&hellip; <a href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-are-the-most-common-reasons-for-health-claims-rejection-the-series-part-8\/\" class=\"more-link\">Continue Reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":14,"featured_media":3202,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[317,313,315,311],"tags":[],"class_list":["post-3200","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blacklisted-hospital","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>Common Reasons for Health Claims Rejection: Part 8 | Insurance Samadhan<\/title>\n<meta name=\"description\" content=\"Explore why health insurance claims get rejected. 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