What are the most common reasons for Health Claims Rejection: The Series: Part 8

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TREATMENT AT A BLACKLISTED HOSPITAL: Major Facts to keep in mind before Hospitalization and insurance Claim! 

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?

One of the most common reasons for health claim rejection is that the insured went to a blacklisted hospital.

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So let us first understand what is a blacklisted hospital and things that you should keep in mind:

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:

  • Fraudulent claims: 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.
  • Non-cooperation: 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.
  • Exorbitant Unjustified Charges: Certain hospitals are blacklisted for charging unjustified high prices from their customers, especially in the case of insurance owners. 

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.

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Coming now to the pressing issue, which is what you should do if after an accidental injury you are admitted to a blacklisted hospital. 

Blacklisted hospital

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:

  1. If the situation is under control and your company has no exception to emergency hospitalization, try to shift to an empaneled hospital.
  2. Maintain records of each document and bills.
  3. Get an emergency admission certificate from the treating doctor stating reasons. 
  4. Ensure to check the complete bills at the time of discharge.
  5. 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.

In case your claim is still rejected, delayed or short settled, contact Insurance Samadhan who have resolved more than 15,000 insurance complaints.

Also Read:  Understanding Insurance Claim Rejection

Click here to register your complaint with Insurance Samadhan

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Visit our website: insurancesamadhan.com

Call us on +91 9513631312

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Mail us at corporate@insurancesamadhan.com

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