Not Satisfied with Your Health Insurance Company? This is what you need to follow!

Health insurance is an important safety net. It gives you protection against costly medical care. Here, the insured and insurer bond together to follow the process.

FYI- The insured is someone who gets the policy, and the insurer is someone who helps the insured get coverage against medical emergencies.

However, misunderstandings and disagreements can happen anytime between the two. The reason could be a denied claim, billing error, or difficulty finding any network provider. So, if you have gone through this situation, this article is for you. But before going through the process, let me explain the situation.

When to File a Complaint Against Your Health Insurance Company?

It is suggested to file a complaint against your health insurance company, in the case of the following situations:

• When your insurance company denies coverage for a medical service you knew was covered under your plan.
• When there is any billing error by the insurer, you have been charged incorrectly or need to pay a higher premium than expected.
• When you are not able to find any network hospital, or the network directory provided is incorrect.
• When there are unreasonable delays in the processing of your claims or receiving the response to your queries.

How to Make a Complaint?

Follow the steps below to file a complaint against the health insurance company:

• Step 1

  Visit the grievance redressal office of the branch of your insurance provider.

• Step 2

  Write a complaint letter.

• Step 3

  Attach the supporting documents.

• Step 4

  Take a written acknowledgement of your complaint with the date.

FYI- It should hardly take 15 days to resolve your complaint.

But,

What if the complaint is not resolved on time?

In case, your complaint is not resolved within two weeks or you are not satisfied with the solution they provided, then approach the following:

• Grievance Redressal Cell of the Policyholder's Protection.
• Grievance Redressal Department of IRDAI.

Via

• Register complaints directly in IRDAI's online portal says- Bima Bharosa System- https://bimabharosa.irdai.gov.in/
• Send the complaint through email to complaints@irdai.gov.in
• Call the toll-free number at 155255 (or) 1800-4254-732

Look for the Options to Avoid this Situation!

It is not always necessary to file a complaint. You can follow some rules right from the beginning to avoid such cases. For example:

• Check every aspect of the plan before buying it. Just do not go for the lowest premium, you might lose out on a lot of features.
• Understand the needs of your family and their requirements, and buy a plan accordingly.
• Check for the claim settlement ratio of the company—the higher the number the better.
• Understand the coverage before buying the plan to avoid claim rejection later.

Conclusion

By following these steps and tips, you can make sure that you have a smoother experience with your health insurance company . But, do understand your policy wording and most importantly understand your rights as an insured individual. Make an informed decision and avoid unnecessary complications. But, if you encounter any such issue, do not worry. File a complaint on the resources mentioned above.

For any queries, call our IRDAI-certified insurance experts at PolicyX today!

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