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:-

• 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.