Services
Insurance Claim Consulting
Insurance Claim Consulting
The claim process is usually not smooth. There are flaws and refusal of claims without appropriate justification, which wear claimants. Agents frequently mislead consumers while taking insurance, Leading to a denial of claims
While claiming a health plan insurance the policyholder, typically, needs to deal with numerous entities–physicians, the hospital, and the third-party administrator (TPA) and the insurance company. There may be an issue vis-a-vis some of those things Delay in claim compensation because of reasons such as incomplete paperwork, excess claim number and non-disclosure could cause delays and other problems. Sometimes, TPAs even claim that the insurance company hasn’t released the money.
The payoff has been a struggle with disputed rejections and grey-area claims. Sometimes, one gets a feeling that the procedures are made to pay the minimum claim, if at all.
What’s a Health Insurance Claims Rejection?
A claim has rejected once an Insurance Provider refuses an individual’s request to cover the health care services or hospitalization in a healthcare facility.
Buying a medical insurance plan is the perfect way to protect your savings in case of a health emergency or as soon as an unforeseen illness strikes. But while buying a policy is now simple, not all of the claims which are raised, have settled. This guide will talk about all the possible causes of claim rejection so that you are mindful of them, and you’ll be able to prevent a claim rejection. When your claim has been rejected, you must know why your health insurance policy claim has been reversed. Understanding the reason will set you in a much better place to fight your claim rejection and get it covered even though it had been denied initially.
Circumstances where Claims Rejection can be reversed.
If there are delays in submitting the claim and there is a genuine reason behind the delay.
Where delay arises in procuring and furnishing documents related to any clarifications asked.
In case, you do not submit the history from the first consultation leading to the treatment.
In cases where the physician has not clarified on some queries raised.
If claims get rejected for silly reasons or saying, the medical approach was false.
If the hospital makes mistakes in the documents.
How does Mayden Help?
At Mayden, we support people and their families, on medical claim matters by examining, inspecting, evaluating, auditing, analysing and resolving refused medical bills, insurance pre-authorisations, denied medical insurance claims, refused health claims and more.
What exactly do we do?
Follow through on every situation on your behalf, saving you time and money acquiring reimbursement for medical treatment where claims are denied.
Mayden is a health insurance consumer advocate and consultant for insured people, helping them get the money they deserve.
FAQ
Here are some answers to the questions we receive the most about our services. If we missed anything, please do not hesitate to contact us. We’ll be happy to hel
A valid cause of claim rejection is the non-disclosure of a pre-existing medical condition at the time of buying the medical insurance plan.
The claim also can be rejected when medical treatment is taken through the waiting period. Policyholders have to be aware that their policy covers certain diseases and ailments just after the conclusion of waiting period claim-free years, based on the policy.
After the Demand for hospitalisation is not justified, just like in the case of headache or fever or whenever the evaluations are conducted for evaluation function only.
Filed for an inpatient service in which the hospitalisation was for over 24 hours and if it doesn’t fall below an approved day-care process in the coverage, then the claim can get denied.
Suppose the Individual is hospitalised due to an illness that falls under the class of congenital diseases like congenital anaemia, thalassemia, cystic fibrosis or Down’s syndrome. In that case, they might not be addressed under the policy, which can make your claim.
