Bima Seva Kendra

 Why Health Insurance Claims Get Delayed and How to Expedite Them

It’s a situation no one wants to face—you're dealing with a medical emergency, already feeling the weight of concern for your health or a loved one's well-being. In such moments, the last thing you expect is to be caught in the middle of a delayed health insurance claim.

Unfortunately, insurance claim related issues are all too common in India, where delays in settling claims leave many policyholders feeling frustrated and helpless.

However, knowing why delays happen and how to speed up the process can help you avoid frustration and get the financial support you need, right when you need it most.

1. Why Do Health Insurance Claims Get Delayed in India?

1. Confusion Over Policy Exclusions

One of the most frustrating things for policyholders is realising that a treatment or procedure isn’t covered under their plan, or falls under a waiting period for pre-existing conditions. This can slow down the claim process as the insurer verifies whether the treatment qualifies under the policy’s terms.

● What can I do ?

Be aware of exclusions, waiting periods, and specific sub-limits on treatments to avoid claim rejection related issues. Understanding your policy thoroughly allows you to tailor your claim correctly, so you don’t waste time submitting ineligible expenses.

2. Documentation Delays and Errors

This is perhaps the most common cause of claim delays. Missing documents or incorrect paperwork, such as hospital bills, prescriptions, or discharge summaries, can throw the entire process into disarray.

● What can I do ?

It can feel overwhelming during a medical emergency, but keep all documents complete and accurate before submission. Keep a checklist handy so that you don’t overlook anything. Even communications between you and the insurer. Keep a detailed record of every interaction you have with your insurance provider. Should your claim get delayed or denied, having these records on hand can make the follow-up process much smoother.

3. Lack of Timely Intimation

Most insurers in India require that they be informed within a specified timeframe of the hospitalisation. While the time frame varies from insurer to insurer, if this intimation window is missed, it can lead to a longer wait as the insurance company verifies the circumstances.

● What can I do ?

As a best practice, contact them as soon as possible. The sooner your insurance company knows, the faster they can begin the approval process.

4. Network Hospital Confusion

Policyholders frequently assume that any hospital will accept their cashless claim, only to find out the hospital is not in the insurer’s network. When this happens, the claim must be processed as a reimbursement. It’s easy to see how this misstep could lead to frustration when you're dealing with an urgent medical situation.

● What can I do ?

Opt for network hospitals that are tied up with your insurance company for cashless treatments. This step alone can save you from a delay in the claim process.

Pre-authorization is key for cashless claims, and verifying this beforehand can save you days of waiting.

2. Professional guidance: A Friend in Need

If your claim continues to be delayed or is rejected outright, it may be time to seek professional assistance from subject matter experts with experience in claim rejection services.

These experts specialise in addressing claim rejection-related issues and can offer guidance on how to resubmit or appeal the claim. In complex cases, having experts on your side can expedite the resolution process.

Conclusion

There’s nothing more stressful than facing insurance claim-related issues in the midst of a medical crisis. However, by staying informed and proactive, you can significantly reduce the chances of facing a delay in claim process. And remember, if all else fails, help is available. Professionals specialising in claim rejection and delay resolution can assist when you're stuck. You are not alone, through thick and thin of insurance claims...you are not alone.