Customer Care in Health Insurance Industry - Steps involved in filing a Health Insurance Complaint

Steps involved in filing a Health Insurance Complaint

The steps to be followed while filing a health insurance complaint are enlisted below:-

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First and Foremost important point is that records and copies of all relevant documents should be maintained.
Make a note of all transactions between yourself (policyholder) and the insurance agent and the insurance company.
Maintain a file of correspondences in order for easy tracking and retrieval of information.
Maintain a record of the receipts (from the agent and Insurance Company), policy documents and TPA (Third Party Administrator) cards in order.
Approach the Customer Care Department and explain them your grievances or disputes regarding the claim. Give the Insurance companies sufficient time or duration to address your doubts and grievances.
If the policyholder does not feel satisfied with the reply, he/she can elevate this dispute by approaching the Insurance Ombudsman.

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If the outcome at the Ombudsman remains unsatisfactory, it is possible to examine the possibility of taking the legal route i.e approaching the court or the Consumer Forum.
If the claim amount involved is high, services of a suitable lawyer or an advocate can be taken.
Remember that negotiation skills and tenacity to overcome the challenges for the sake of your rights are essential for resolving the disputes pertaining to the claim.

References:

Customer Satisfaction in 7 Steps - (http://articles.sitepoint.com/article/satisfaction-7-steps)
Have an insurance complaint? Read this - (http://www.rediff.com/money/2004/mar/22perfin.htm)

Published on Sep 18, 2014
Last Updated on Jul 30, 2020

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APA

Dr. Sameer Sippy. (2020, July 30). Customer Care in Health Insurance Industry - Steps involved in filing a Health Insurance Complaint. Medindia. Retrieved on May 24, 2022 from https://www.medindia.net/patients/insurance/customer-care-in-health-insurance-industry-complaint.htm.
MLA

Dr. Sameer Sippy. "Customer Care in Health Insurance Industry - Steps involved in filing a Health Insurance Complaint". Medindia. May 24, 2022. <https://www.medindia.net/patients/insurance/customer-care-in-health-insurance-industry-complaint.htm>.
Chicago
Dr. Sameer Sippy. "Customer Care in Health Insurance Industry - Steps involved in filing a Health Insurance Complaint". Medindia. https://www.medindia.net/patients/insurance/customer-care-in-health-insurance-industry-complaint.htm. (accessed May 24, 2022).
Harvard
Dr. Sameer Sippy. 2021. Customer Care in Health Insurance Industry - Steps involved in filing a Health Insurance Complaint. Medindia, viewed May 24, 2022, https://www.medindia.net/patients/insurance/customer-care-in-health-insurance-industry-complaint.htm.