why are health insurance claims delayed
Health Insurance

Understanding Why Health Insurance Claims Are Delayed

Health insurance is the most remarkable tool you can have in your arsenal in a battle against any medical condition. It offers you coverage for the expenses incurred during the diagnosis and treatment of the condition. Thus, you must ensure that you are aware of all the procedures followed to raise a claim for your health insurance plan.

However, many times you may face issues like delays in insurance claim even after researching the claim process in depth. The reasons for delay in claim process can be wide ranging, and you may find yourself pondering ‘why are health insurance claims delayed’? These delays can add to your stress and may take a toll your finances. You can gain an insight into the reason behind these delays and ways to tackle them here.

Reasons for delay in health insurance claim process

While raising a medical insurance claim, it is beneficial for you to make yourself familiarise with the claim settlement process beforehand to avoid unnecessary delays and/or rejection of the claim request. You can find the required information in your policy document easily. Some of the common reasons for the delay in claim process are presented here.

1. Filing the claim after the time limit

This one of the most common causes of delays in claim settlement. Every insurance policy comes with a deadline for raising a claim, which can range between 14 and 30 days post discharge from the hospital. You must ensure that you know this deadline for your health insurance policy and raise a claim request within the time limit to ensure fast settlement.

2. Misplacement of required documents

You need to submit an insurance claim form along with some other documents to raise a claim. Misplacing any one of these documents can lead to delay in the claim filing process. In case that claim is filed without all the required documentation, your health insurance company may face issues in approving your claim, which may further delay your claim settlement. You should make sure that all the documents are shared appropriately by adhering to the policy conditions for easy claim.

3. Incompletely filled pre-authorisation form

At times, you may choose to opt for the cashless facility offered by the insurance company if your preferred hospital is a part of the hospital network of your insurance provider. In such a case, you are expected to fill a pre-authorisation form requesting cashless hospitalization. If this form is filled incompletely or inaccurately, your claim settlement can get delayed. To avoid this, you must fill the pre-authorisation form completely and accurately and enjoy stress-free settlement for your claim.

4. Non-adherence to the claim process

Most insurance companies provide you with two settlement approaches, namely cashless claim and reimbursement. The process followed to raise these two claims differ to a great extent. For reimbursement, you must submit documentation including your hospital bills, hospital payment receipt, medical bills, medical bill payments receipts, whereas for cashless claim, you only have to fill the pre-authorisation form. Any errors in submission of the required documents or filling of the form can lead to a delay the settlement of your claim. Thus, you must ensure that all the mandatory documents are submitted to the insurer and/or the pre-authorisation form is filled accurately to avoid any delays in settlement.

5. Delay in communication between hospital and insurance company

Even when you follow each step to book, you may receive your claim settlement after some delay. In such a case, the reason can be delay in document submission by your hospital to your insurance company. Both, your hospital and insurance company, follow a stringent checking process before submitting and approving, respectively, your claim. This process may add to the time required to process a claim request and result in a delayed settlement. Furthermore, if some documents are shared back and forth between the hospital and insurance company, your claim settlement time can get affected.

How can you deal with health insurance claim delays?

Now that you are aware of some common reasons for delay in claim process, you need to understand how to deal with this delay. There is no way that you can know about a claim delay in advance, but you can adhere to your insurance provider’s requirements for document submission to experience a stress-free settlement. Reading your policy document can also help you get your claim settled easily.

If your claim is delayed, the first step you need to take is get in touch with your insurance provider for a follow up regarding your claim request. You may have to follow up with your insurer regularly and communicate your intention to have the claim settled in a calm manner. A delay can be a minor inconvenience or a financial burden. If you are having a difficulty getting ahead with your claim request, you can ask for professional assistance to settle your claim. In case that your claim is denied, you can opt to appeal.

How to file a health insurance claim

You must know the accurate protocol for raising a claim request so that you receive the approval from your insurance provider with minimal hassle. Having the knowledge of how to raise the claim request accurately can increase your chance of getting the claim approved fast.

The procedures followed by different insurance companies differ slightly. You can find the preferred method of proceedings adhered by your insurance provided in your health insurance policy document. Moreover, these procedures change vastly with the type of claim, i.e., reimbursement and cashless claim, you choose. If your preferred hospital falls under the network of your health insurance company, you can opt for cashless claim, which can release half of your burden of gathering and submitting documents.


What is the time limit to raise claim for my health insurance?

The time limit to raise a claim request differs with the insurance provider. Usually, you can raise the claim request within 14 to 30 days after you are discharged from the hospital.

What can I do to avoid claim rejection?

You must adhere to the protocol provided by your insurance company for the submission of documents and filing of claim and other forms to achieve fast claim settlement. You cannot provide misleading or inaccurate information while submitting documentation and filling forms; doing so can cause your claim to get rejected.

How can I file health insurance claim within the time limit?

You can find out the time limit for raising the claim request to ensure timely claim settlement. You can collect the mandatory documents and information and keep it handy before raising the claim request to file the claim hassle free.

What is the claim settlement ratio?

The claim settlement ratio is a number that tells you the percentage of claims settled successfully by an insurance company in a year.

Why is my health insurance claim delayed?

Many factors can cause a delay in health insurance claim; some of these factors include failure to file claim request within time limit, incompletely filled form, and failure to submit all mandatory documentation.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.

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