Health insurance disputes are emotionally draining. We handle cashless claim denials at network hospitals, disputes over pre-existing disease (PED) clauses, room rent capping issues, co-payment disputes, and claim rejections for pre & post-hospitalization expenses. Our medical experts review hospital records to build a strong, evidence-backed case.
Practical guidance for common insurance questions
Ask the insurer or TPA for the rejection reason in writing and obtain the relevant policy clause. Review the hospitalization records, bills, discharge summary, claim form, and policy terms against that reason. If you believe the decision is incorrect, submit a documented representation through the insurer's grievance process and keep copies of all records.
Ask the hospital or TPA for the reason for the cashless denial and request it in writing. Keep the medical records and policy documents, and ask the insurer what reimbursement or alternative claim process is available. A cashless denial does not by itself answer whether the underlying expenses are covered, so the policy terms and final claim decision should be reviewed separately.
Yes, you can raise a dispute if you believe an exclusion has been applied incorrectly. Compare the exact exclusion wording with the medical records and circumstances of the treatment, then submit a written representation explaining why you believe the clause does not apply. The policy wording and evidence are central to the assessment.
Review hospital records & policy terms
Analyze cashless denial reasons
Consult medical experts if needed
Challenge PED misinterpretation
File appeal with insurer + IRDAI
Recover full eligible amount
Common questions about health insurance disputes
First, get the denial reason in writing from the TPA/insurer. Then file for reimbursement immediately to preserve your rights. Simultaneously, contact us to challenge the cashless denial — many are overturned on appeal.
Only if the disease was existing before policy purchase AND you failed to disclose it. If the policy has completed the waiting period (typically 2-4 years), the claim must be honored. We challenge wrongful PED rejections regularly.
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