If Your Insurance Claim is Denied, you can file an appeal against the insurance company, here is the procedure how you can do that –
1- First get written claim denials letter from insurance company.
2- Check your policy documents, whether the claim was legitimately denied.
3- Do your own research to support your claim. Start by reviewing your paperwork file.
4- Contact Insurance Company – First call the local office you are dealing with then call your Insurer’s customer service. Clear your doubts on claim and ask why the claim is rejected. Be sure to take notes on all phone conversations, including the date and time of the call, the names of the people you talk to and what was discussed.
5- Complain in writing if your phone calls don’t work.
File an Appeal with Insurance Company
If speaking with a customer service representative does not work, you may have to escalate to a formal written appeal. You need to provide all the information in writing with supporting documents including copies of bills, hospital address (where treatment is taken), TPA deatils if any and your physician’s statement about why your treatment was or will be necessary.
Submit following Documents with your Appeal
1- Your Insurance Policy
2- Copies of denial letters from insurer
3- Copies of any correspondence between you and your Insurer, or between your hospital (such as your doctor or lab or TPA), Insurance Surveyor
4- Copies of claim form
5- Any other document
Note – Always keep a photocopy of all the above documents in your own record.
If within 30 days of lodging the complaint with the insurance company, if you do not get a satisfactory response from insurance company and you may approach IRDA.
Step 1 – How to file an Appeal against Insurance Claim Denial?
Step 2 – How to file a complaint to IRDA for an Insurance Claim?
Step 3 – How to file a Complaint to Insurance Ombudsman?
Step 4 – How to file an Insurance Claim Complaint to Consumer Court?