{"id":3537,"date":"2023-10-11T15:46:22","date_gmt":"2023-10-11T10:16:22","guid":{"rendered":"https:\/\/www.insurancesamadhan.com\/blog\/?p=3537"},"modified":"2023-10-11T15:48:24","modified_gmt":"2023-10-11T10:18:24","slug":"what-to-do-if-your-health-insurance-claim-is-delayed","status":"publish","type":"post","link":"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/","title":{"rendered":"What to Do If Your Health Insurance Claim is Delayed"},"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-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/#Overview\" >Overview<\/a><\/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-to-do-if-your-health-insurance-claim-is-delayed\/#Key_reasons_why_obtaining_a_health_insurance_policy_is_a_good_idea\" >Key reasons why obtaining a health insurance policy is a good idea<\/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-to-do-if-your-health-insurance-claim-is-delayed\/#Workings_of_Health_Insurance_Claims\" >Workings of Health Insurance Claims<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/#Cashless_claims\" >Cashless claims<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/#Reimbursement_Claims\" >Reimbursement Claims<\/a><\/li><\/ul><\/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-to-do-if-your-health-insurance-claim-is-delayed\/#Why_the_Health_Insurance_Claim_Gets_Delayed\" >Why the Health Insurance Claim Gets Delayed<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/#What_if_your_Health_Insurance_Reimbursement_Claim_gets_Delayed\" >What if your Health Insurance Reimbursement Claim gets Delayed?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/#Things_to_Keep_in_Mind_While_Raising_A_Health_Insurance_Claim\" >Things to Keep in Mind While Raising A Health Insurance Claim<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/#Conclusion\" >Conclusion<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Overview\"><\/span><b>Overview<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">When it comes to paying for hospital stays or other related medical expenses, health insurance might be helpful. Comprehensive health insurance policies cover a variety of costs, including those related to prescription drugs, hospital stays, procedures, and doctor consultations.<\/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<h2><span class=\"ez-toc-section\" id=\"Key_reasons_why_obtaining_a_health_insurance_policy_is_a_good_idea\"><\/span><b>Key reasons why obtaining a health insurance policy is a good idea<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><b>Protect yourself from lifestyle diseases:<\/b><span style=\"font-weight: 400;\"> Due to a sedentary lifestyle and increased stress, these diseases are becoming more prevalent in younger people, even though they were formerly more common in older adults. A comprehensive health insurance plan helps you pay for prescription costs and shields you from unexpected payments that may arise from routine testing.<\/span><\/p>\n<p><b>Protection for the whole family:<\/b><span style=\"font-weight: 400;\"> Health insurance companies provide all-inclusive policies that take care of everyone&#8217;s medical needs. In addition to protecting your family and allowing you to give them the best healthcare facilities, having comprehensive family health insurance can stand you in good favor in the event of any unfortunate events.<\/span><\/p>\n<p><b>Protect yourself against medical inflation: <\/b><span style=\"font-weight: 400;\">Every day, there is a noticeable increase in inflation in all areas of goods and services. The cost of everything is constantly going up, from consultation fees to medications, hospital stays, and ambulance rides. Keeping up with inflation can be achieved by purchasing a comprehensive health insurance plan.<\/span><\/p>\n<p><b>Protecting your savings:<\/b><span style=\"font-weight: 400;\"> If you and your family do not have comprehensive health insurance and you become ill or are involved in an accident, you might have to use your hard-earned money and savings to pay for quality medical care. Insurance guarantees that in the event of a health emergency, your savings catastrophe.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Workings_of_Health_Insurance_Claims\"><\/span><b>Workings of Health Insurance Claims<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The moment of truth for any insurance policy, but particularly for health insurance coverage, occurs when an insurance claim is filed. It&#8217;s critical to have a sufficient health insurance policy, but it&#8217;s also critical to comprehend the claims procedure so that you can rely on your insurance in an emergency.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Health insurance policies admit two types of claims:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cashless claims<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reimbursements<\/span><\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"Cashless_claims\"><\/span><b>Cashless claims<\/b><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The fact that cashless claims are simple and easy to use is now their greatest advantage. The majority of insurance companies typically have partnerships with a network of hospitals, and you can take advantage of the cashless claim option when you select one of these hospitals for your care. You wouldn&#8217;t be required to pay anything in the event of a cashless claim because the insurance company will handle the settlement with the hospital directly. This implies that you won&#8217;t have to pay out of pocket for care received at any of the network hospitals because the insurance company will pay the bills immediately.<\/span><\/p>\n<h3><span class=\"ez-toc-section\" id=\"Reimbursement_Claims\"><\/span><b>Reimbursement Claims<\/b><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If you choose the reimbursement option, you will be required to pay the bills in full before the insurance provider processes your claim and reimburses you for the amount you spent, based on the original hospital bills. This will undoubtedly not go as smoothly as a cashless claim. You are not, however, limited to using network hospitals while seeking medical attention. You can select any hospital of your choice.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Why_the_Health_Insurance_Claim_Gets_Delayed\"><\/span><b>Why the Health Insurance Claim Gets Delayed<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Delays in insurance claims might happen for a number of reasons. The following are some typical causes that may cause delays in the processing of insurance claims:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Erroneous or incomplete information: The insurance company may need to request further documentation or clarification if the information on the claim form is not complete or contains errors. This can lead to delays.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Absence of supporting documentation: Police reports, medical records, claim forms, and other types of evidence are frequently needed to substantiate claims. The claim procedure may be prolonged if certain documents are missing or need time to collect.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Investigation: If there are any suspicions of fraud or if the claim is large, insurance firms may be required to look into the circumstances surrounding it. This research may require some time.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">High claim volume: Insurance firms may be inundated with claims during periods of high claim volume, such as following a natural disaster. Processing times could get longer as a result.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Underwriting review: In order to ascertain coverage and liability, certain claims must be reviewed by the underwriting department of the insurance company. The procedure can be slowed considerably by this extra step.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Administrative problems: Internal administrative problems in the insurance company, like incorrect data entry, misunderstandings, or misdirected claims, can also cause delays.<\/span><\/li>\n<\/ul>\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<h2><span class=\"ez-toc-section\" id=\"What_if_your_Health_Insurance_Reimbursement_Claim_gets_Delayed\"><\/span><b>What if your Health Insurance Reimbursement Claim gets Delayed?<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">As per IRDA Guidelines on Standardization of General Terms and Clauses in Health Insurance Policy Contracts Ref. No: IRDAI\/HLT\/REG\/CIR\/152\/06\/2020 dated 11\/06\/2020, Annexure 1, Point 3:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The company shall either settle or reject a claim, as the case may be, within 30 days from the date of receipt of the last necessary document.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In the case of delay in the payment of a claim, the company shall be liable to pay interest to the policyholder from the date of payment of the claim at a rate of 2% above the bank rate.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">The insured has the option to expedite the claim in the following circumstances when a claim is delayed and the cause is unknown\u2014even after all requirements are met and the procedure has been finished:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">To determine the precise point at which the claim is blocked, you might consult your agent. Because the agents represent the insurance companies, they have a relationship with them and can therefore find out the current status of the claim.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clients can log in on the companies\/TPAs portal. Therefore, by going to their web portals, you can ascertain the current status of your claim, ascertain the cause of any delays, and determine a resolution.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Consistently sending emails to the GROs and claims team, seeking updates to the concerned team.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Maintaining continuous correspondence with persons engaged in the claims procedure, such as the surveyor, TPA, company, and investigator.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">You may also raise a complaint on Bima Bharosa, the Grievance Redressal Mechanism integrated by IRDAI.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In case of no response or resolution, you can approach the Insurance Ombudsman.<\/span><\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Things_to_Keep_in_Mind_While_Raising_A_Health_Insurance_Claim\"><\/span><b>Things to Keep in Mind While Raising A Health Insurance Claim<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medical emergencies are a serious concern, and in the heat of the moment, you could forget about the claims procedure.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here are a few things to keep in mind in these kinds of circumstances:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Required documents: You must provide the pre-authorization form, the original medical records, a valid ID proof, bills for the tools and equipment used during the procedure, a canceled check, a copy of the policy plan, and any other documents requested by the service provider.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recall that your chosen sum insured limit determines the validity of your health insurance claims. If your claim exceeds this amount, you will be responsible for the difference. It is advisable to verify the amount covered and select a policy that offers sufficient coverage.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Watch out for the exclusions: There may be a few exemptions from some health insurance policies that you should be aware of. Select your coverage carefully since you won&#8217;t be covered for the exemptions.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Keep in mind the deadlines for the claims procedure; failure to comply with them may cause processing delays and prevent you from using the cashless claims feature.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In the event of an emergency, have a list of the partner hospitals available if you decide to go with the cashless claims option.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A lapsed policy will prevent you from being able to make claims, so make sure to renew your health insurance before it does.<\/span><\/li>\n<\/ul>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-full wp-image-3538\" src=\"https:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1.png\" alt=\"Health insurance claim delayed \" width=\"1920\" height=\"1080\" srcset=\"http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1.png 1920w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1-300x169.png 300w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1-1024x576.png 1024w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1-150x84.png 150w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1-768x432.png 768w, http:\/\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1-1536x864.png 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Conclusion\"><\/span><b>Conclusion<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Policyholders should communicate effectively with their insurance carrier, promptly supply all required documentation, and submit complete and correct information to help speed up the claims process and prevent delays. It might also be useful to understand the terms and coverage of your insurance in order to avoid misconceptions that could cause delays. You can think about submitting a complaint or contacting your Insurance Company Branch for help if you encounter lengthy delays that you feel are unjustified.<\/span><\/p>\n<p><b>By- Priyanshi Aggarwal<\/b><\/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>Visit our website:\u00a0<a href=\"https:\/\/www.insurancesamadhan.com\/\">insurancesamadhan.com<\/a><\/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-to-do-if-your-health-insurance-claim-is-delayed\/\"\n  },\n  \"headline\": \"What to Do If Your Health Insurance Claim is Delayed\",\n  \"description\": \"Discover the importance of health insurance, claim types (cashless & reimbursements), causes of delays, and tips to expedite claims for smoother medical coverage\",\n  \"image\": {\n    \"@type\": \"ImageObject\",\n    \"url\": \"https:\/\/i0.wp.com\/www.insurancesamadhan.com\/blog\/wp-content\/uploads\/2023\/10\/blog-1.png?resize=1024%2C576&ssl=1\",\n    \"width\": 1920,\n    \"height\": 1080\n  },\n  \"author\": {\n    \"@type\": \"Person\",\n    \"name\": \"Insurance Samadhan\"\n  },\n  \"publisher\": {\n    \"@type\": \"Organization\",\n    \"name\": \"Insurance Samadhan\",\n    \"logo\": {\n      \"@type\": \"ImageObject\",\n      \"url\": \"https:\/\/insurancesamadhan.com\/images\/logo.svg\",\n      \"width\": 224,\n      \"height\": 47\n    }\n  },\n  \"datePublished\": \"2023-10-11\",\n  \"dateModified\": \"2023-10-11\"\n}\n<\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Overview When it comes to paying for hospital stays or other related medical expenses, health insurance might be helpful. Comprehensive health insurance policies cover a variety of costs, including those related to prescription drugs, hospital stays, procedures, and doctor consultations.&hellip; <a href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-to-do-if-your-health-insurance-claim-is-delayed\/\" class=\"more-link\">Continue Reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":14,"featured_media":3539,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[324,332,3,322],"tags":[],"class_list":["post-3537","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-claim-settlement","category-health-claim-reimbursement-process","category-health-insurance","category-insurance-problem"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>What to Do If Your Health Insurance Claim is Delayed - 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