Top Reasons for Delay in Health Insurance Claims


Top Reasons for Delay in Health Insurance Claims

A health insurance claim is a request made by a policyholder to the health insurance company that can be cashless or reimbursement. After all, during medical emergencies, health insurance is something that you can bank upon. Unfortunately, sometimes there is a delay in claim settlement, which is frustrating and even threatens patients' or their families' financials. But, health insurance companies and hospitals have their billing guidelines and coding procedures.  The claim management team performs the tight check and follows specific steps to verify the claim requests and submitted documents. So, if you still think that health insurance companies delay in approving claims unnecessarily. Let's check out behind the scenes to know the truth:

No Timely Intimation

Timely intimation to hospital TPA and the customer support team plays a crucial role. Whether it is an emergency or planned hospitalization, well-timed intimation to the TPA desk at the hospital and the insurer's claim management team is mandatory. But, as a policyholder, if you fail to do so, there are chances that your claim get delay. 

Incomplete Pre Auth Form

A pre-authorization form is mandatory for cashless claim settlement.  You can get it at the hospital TPA desk.  Read the form carefully and fill in all the required details correctly, along with the correct estimation of the treatment cost. Take the help of the executive if you get stuck somewhere. But, make sure you fill the form properly without overwriting. 

Delay in Submitting Documents

In case of reimbursement, you have to submit the required documents within the stipulated time after discharge from the hospital. If the timeline exceeds, there are chances that your claim request can put on hold. However, depending on the merit of the case, you can get some relaxation. 

Wrong Identity

Health insurance companies require valid identity proof of the patient and policyholder. It is essential to submit the correct photo id proof like an Aadhar card to the hospital TPA. If the claim management team finds any discrepancies, they can immediately hold the process until they verify the identity proof of the patient and policyholder.

Exchange of Documents between Hospital and Insurance Company

Exchanging documents between hospitals and insurance companies is a time-consuming process which can also cause a delay in the claim settlement.  Teams involved in the claim process from both the side have to follow a procedure. Check the status with them from time to time to avoid any chaos at the time of discharge. 

So, as most of the reasons are procedural, you can avoid such delays in health insurance claim settlement with awareness and the right steps.

>>Also Read Simple Steps for Health Insurance Claim Process

Checklist for Quick Claim Settlement

There are different types of claims in health insurance, like cashless or reimbursement. But, there are some essential things that you should be handy with for hassle-free claim settlement:

  • Duly filled pre-authorization form and required documents
  • Right estimation for treatment cost
  • Valid identity proof of policyholder and patient
  • Policy details, including policy number, name of the insurer, and contact details

>>Also Read About Important Documents While Claiming Health Insurance


Last but not least, the one good way to avoid delay in claim settlement is to opt for a trusted health insurance company like Care Health Insurance. We have a track record of processing claims in just 2 hours(approx.) and settled 30 lacs+ claims till now with many happy customers.

Disclaimer: The above information is for reference purposes only. For more details about the health insurance plans please refer to the sales prospectus, policy terms, and conditions.

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