Claim denial ka email dekh ke patient aur family dono ka BP badh jata hai. Kabhi-kabhi reason genuine policy clause hota hai, kabhi simple documentation error. Basic understanding se kaafi headaches avoid ho sakte hain.
Common reasons:
- Waiting period – kuch diseases ya maternity benefit policy start ke baad certain months/years tak cover nahi hote.
- Exclusions – specific treatments, cosmetic surgery, experimental therapy, etc.
- Non-disclosure – past serious illness bataya nahi, later records se pakda gaya.
- Wrong paperwork – incomplete forms, missing reports, mismatch in dates/names, hospital not on network.
Admission ke time TPA/insurance desk se clear kar lo ki cashless possible hai ya reimbursement hoga. Doctor ka diagnosis, admission notes, discharge summary, and itemised bill sab organised rakho.
Elective procedures ke case me pre-authorisation le lena safe move hai. Emergency me obviously pehle treatment, phir paperwork hota hai, lekin documents fir bhi complete rakhna zaruri hai.
Policy kharidte waqt sirf premium dekho mat; exclusions, room rent limit, co-pay, sub-limits (like for cataract, joints, etc.) samajh lo. Baad me “mujhe to bataya nahi” kaafi late ho jata hai.
Agar claim unfair lag raha ho, to insurer ke grievance redressal me likho, supporting docs attach karo. Kabhi-kabhi clarification se reversal possible hota hai.