Hospitalization not Required
Last week, we discussed the problem related to delays in intimation or in the submission of documents that may lead to health claim rejection.
Today, we will discuss another major reason for which a claim gets rejected. Health claims rejection can be frustrating, often confusing policyholders and seeking answers. As we delve deeper into the series exploring the most common reasons behind health claims rejection, we arrive at Part 2: Hospitalization not Required. This article will explore the complexities surrounding the denial of claims where insurers assert that hospitalization was unnecessary, significantly impacting health insurance claims.
Suman Lata was hospitalized for a few days due to Dengue fever. Her husband filed a health insurance claim to recover the hospital expenses. However, the health insurance company said that hospitalization was not required for the said illness and rejected the claim. The family disagreed and argued that her health was deteriorating and the doctor who treated his wife clearly stated that she needed to be hospitalized.
What is the Reality here?
The above case study reveals that despite the treating doctor’s recommendation, the health insurance company rejected a claim for hospitalization expenses. This reality raises questions about the criteria used to determine medical necessity. Seeking a second opinion, understanding the appeals process, and maintaining thorough documentation become crucial for policyholders facing such denials.
There are so many cases where doctors recommend the patient to be hospitalized and they have no option but to follow the procedure. The only reason people buy health insurance is that they believe that the medical expenses would get recovered. Also, the worst part is that nobody knows that these kinds of situations can be challenged. Let us understand what you can do.
Get in touch with Insurance Samadhan
If you get hospitalized and your insurance company rejects the claim, do not worry! Insurance Samadhan can help you in this situation as these cases can be challenged. Our team of experts specializes in resolving insurance-related grievances and advocating for policyholders’ rights.
We have helped 15,000+ people in resolving insurance claim-related complaints. We are always here to help you!
Stay tuned for more insider knowledge about health claim rejection reasons and how you can get your money back.
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