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

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Written by Dr. Sameer Sippy | Medically Reviewed by The Medindia Medical Review Team  on Sep 18, 2014
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Steps involved in filing a Health Insurance Complaint

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

  • 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.
  • 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:

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

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After purchasing and continuing a reliance medical policy for last 3 yrs,when we went for a claim they denied it on baseless ground,I warn everybody before buying any products of them.Asis Pal[frm Panipat]

jillsj

MY NAME IS SAM THOMAS, I BUY A MEDI CLEAM POLICY FROM ROYAL SUNDERAM , POLICY NO IS "HQM-000140000100, STLL 5 MONTHS NOW, I DID'T GET ANY PAPPER AND ANY CARD FROM THIS COMPANY
THIS IS THE RULES AND REGULATION FROM THE COMPany

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