1. Home
2. Blogs

Why are insurance claims sometimes delayed? Here are the five reasons

• 
• 
• 
• 0
• 0

Published on Sept 16, 2020. EST READ TIME: 3 minutes

Health insurance is an important investment that can cover many of your hospital bills and prevent financial setbacks during medical emergencies. However, there can be times when the claim settlement process takes longer than usual. This can be a cause of stress, especially if the medical procedure is an expensive one.

If you are wondering, “Why is my health insurance claim taking so long” or “Why did you receive a delay letter for a medical insurance claim,” there can be several reasons for this. Read on to know the primary reasons why claims for health insurance plans get delayed sometimes. These reasons apply to individual as well as family health insurance policies.

Why do health insurance claims get delayed?

The following are some of the top reasons why health insurance claims get delayed:

1. Filing the claim too late

There is a pre-set time limit within which you must file your insurance claims for their timely settlement. If you fail to do so, you can expect a delay in the claim settlement process.

The best practice is to file the claim soon after getting discharged from the hospital when you have the hospital bills and discharge summary handy. This can expedite the claim settlement process and save you from unnecessary stress and financial woes.

In most cases, policyholders must file health insurance reimbursement claims within 90 days from the date of discharge from the hospital. Make sure you check the policy documents to know the deadline for claim filing, as this may differ from insurer to insurer. You can also contact the insurance provider for better clarity on the matter.

2. Non-submission of important documents

The insurance company will start working on your claim only after the final submission of the required documents. If you fail to submit one or more documents or lose the insurance papers, the claim settlement process will get delayed. Hence, it is essential that you keep the original documents properly and also take a backup of the same on your computer. Before submitting any bills or documents to the insurance company for reimbursement claim settlement, make sure you retain their photocopies to be on the safe side.

3. Incomplete pre-authorisation form

If you are opting for cashless treatment, you must do the following for quick claim settlement:

• Get pre-authorisation from your insurance provider.

• Take the claim form from the hospital TPA desk and fill in the required details.

• Request the treating doctor to fill in the required details about the treatment.

• The doctor must send the estimated cost of the procedure to the insurance company.

• Submit the duly filled pre-authorisation form and the supporting documents to the insurance company.

Once you submit the form and the documents, your insurance provider will review the same and proceed with the claim settlement process.

Incorrect information in the pre-authorisation claim form can delay the entire claim settlement process.

4. Non-disclosure of information

When you file a claim with the insurance company, you must disclose all required information correctly. Based on this information, the insurance company will investigate the matter and proceed with the claim settlement process. Non-disclosure of the correct or required information will delay the process.

5. Late intimation

Be it a planned medical procedure or an emergency one, you must intimate the third-party administrator (TPA) at the hospital and the claim management team of your insurer at the earliest. Late intimation can delay the claim settlement process.

These are the main reasons that may delay your health insuranceclaim settlement. Whether you have an individual or family health insurance policy, make sure you submit all necessary documents to the insurance company on time for quick and easy claim settlement.

Some more reasons that can delay the claim settlement process are:

• Delay in the exchange of information between the hospital and the insurance company.

• Delay in the submission of discharge summary and other bills to the insurance provider

• Submission of wrong ID proof to the insurance company

• Not following up with the insurance provider and the TPA about the claim

Conclusion

The right health insurance plan can minimise medical expenses and make things easier during medical emergencies. If you have an individual or a family health insurance policy, keep all policy documents in one place, as you may need them anytime for the claim settlement process. If you are filing a claim, carefully fill in the claim form and submit the required documents to the insurance provider. Most importantly, make sure you file your health insurance claim soon after getting discharged from the hospital for its quick settlement.

Disclaimer : The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales

RELATED ARTICLES

• Avoid Denial of Your Health Insurance Claims with this Guide

• Forgot to declare your health condition while buying insurance? Here’s what you can do

• Was Your Health Insurance Claim Denied? Here’s What You Should Know

• Dos and Don’ts of health claims

• What should you know about health insurance claim process

---

• 
• 
• 
•