What are the most common reasons for Health Claims Rejection: The Series: Part 4

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Required documents not submitted

Our previous blog emphasized the crucial role of laying down all the facts when filing a health insurance claim. When it comes to health insurance, transparency and accuracy play a vital role in ensuring a smooth claims process. We hope these articles help you avoid claim-related issues as we move to the next health claim rejection reason, i.e., required documents not provided. 

But before we delve into the topic, let us understand the meaning of “required documents not provided.” Here’s a case study for you to understand the issue better. 

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Case Study 

Mr. Aryan’s disappointment grew when he received an email from the insurance company stating they couldn’t process his health insurance claim after a long wait. He had been admitted to the hospital due to illness, and during his hospitalization, he underwent several tests that confirmed his diagnosis of dengue. When he finally approached the insurance company with the necessary documents, he made an unfortunate error– forgetting to include the crucial doctor’s report explicitly stating his dengue diagnosis. Regrettably, this oversight led to the rejection of his claim. It highlights the significance of providing complete and accurate documentation to ensure a smooth and successful health insurance claims process. When he contacted Insurance Samadhan, we analyzed the case where we asked Mr. Aryan to provide the relevant reports. Once he submitted all the required reports, the case was settled in favor of Mr. Aryan. 

The important thing to Note:  Ensure to make a checklist and submit all your claim-related documents so that you get your claim money without any hassle. 

health claim

Importance Of Providing The Required Documentation

Providing the required documentation is of utmost importance in the insurance industry. It serves as the foundation for a smooth and successful claims process and plays a critical role in determining the legitimacy and validity of a claim. Here are the key reasons why submitting the necessary documentation is crucial:

  • Claim Verification: Insurance companies need proper documentation to verify the claim details. With the required paperwork, it becomes easier for them to ascertain the accuracy. 
  • Preventing Fraud: Requiring specific documentation helps in reducing fraudulent claims. Fraudulent claims can lead to higher premiums for honest policyholders and financial losses for insurance companies. Proper verification procedures help identify and prevent such fraudulent activities.
  • Transparency and Trust: The policyholder demonstrates transparency and trustworthiness to the insurance company by providing the necessary documentation. This fosters a positive relationship and strengthens the trust between both parties, which is the core principle of insurance. 

Now, we know the importance of submitting the required documents. But, still, there might be situations where your claim might get rejected. 

Insurance Samadhan

What To Do If Your Claim Gets Rejected

If your claim gets rejected, don’t worry; contact Insurance Samadhan, we specialize in helping policyholders with insurance-related grievances and claim issues. We can provide valuable assistance and guidance throughout the appeal process and help you regain your hard-earned money. 

Next week, we’ll be coming up with another very important reason for claim rejection with an interesting case study. Till then, stay safe and stay tuned for more.

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Shikhar Vashisht

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