How to Make a Complaint Against Your Health Insurance Company?

Health insurance is for the betterment of people. While designing health insurance policies, health insurance companies leave no stone unturned in giving a satisfactory and worthwhile experience to their policyholders. However, there are also times when policyholders do not find themselves content with their health insurance purchase. Even at times, policyholders go to the extent of filing a complaint against their health insurer.

Are you too sailing in the same boat? Have you started to realize that your health insurance experience is not going as it was expected to be? In case, you are feeling that your health insurance company is not being fair to you, go ahead and lodge a complaint. Do not forget, it is your right to take an action against your health insurance company in case you find the latter being unjust.

Before you go ahead, read along with the 8 key reasons policyholders file a complaint against their health insurance company.

Top 8 Reasons People Lodge a Complaint Against Their Health Insurance Company

The list comprises:

• Negligence
• Claim rejection
• Policy mis-selling
• Unsatisfactory payouts
• Sudden, unexpected premium hike
• Policy refusal due to a high claim possibility
• Unaffordable expense on additional policy features
• Denied policy renewal request without any valid reason

If you have experienced any of the above with your health insurance company and feel the need to file a complaint, make sure you follow the below-mentioned steps.

Steps to File Complaint Against Health Insurance Company

To lodge a complaint against your health insurance company, follow these steps:

Step 1: Complaint With Health Insurance Company

Before opting the legal way against your health insurance company, it would be better to approach the Grievance Redressal Officer of your health insurance company’s nearest branch. You can find details of the same in your policy document or on the website of your health insurance company. Learn that the complaint should be given in writing with the relevant documents. You will be provided a written acknowledgment as well as the date of submission of the complaint.

It is important to understand that health insurance companies have a maximum Turn Around Time (TAT) to resolve complaints/grievances/requests with regards to the services offered by them. In case, your grievance is not resolved within the TAT of solving a grievance, it would be best to go with Step 2.

Step 2: Register a Complaint With IGMS

If Step 1 did not work out well with you and you wish to take your complaint further, it is advisable to submit a complaint with IGMS or Integrated Grievance Management System. Take note that IGMS is IRDAI’s grievance redress monitoring tool. What’s best is that you can also keep a tab on your complaint on the website using your reference number.

P.S. It would be a must to have a registered complaint with the insurance company prior to approaching IRDA.

File a complaint with the IGMS

Step 3: Talk to an Ombudsman

Approaching an ombudsman is one way to file a complaint against your health insurer. To those who are new to the term ombudsman, know that an ombudsman is a government-appointed official who investigates the grievances of health insurance policyholders and arbitrates the dispute without being biased.

For filing a complaint, it would be important to talk to an ombudsman within the time span of a year from the date of receipt of the insurer’s decision, which is not to the satisfaction of your complaint.

Keep in mind to take all the necessary documents along with you. Also keep the documents that you have been documenting throughout the complaint with your health insurance company. Being transparent with the ombudsman will increase your chances of winning against the fraud.

If unsatisfied with this step, you can go ahead with Step 4.

Step 4: Go Legal Against Your Health Insurance Provider

If you are dissatisfied with any of the steps above and ready to opt the legal way, make sure you are fully prepared with the information you need and fight for your right in the civil court.

How to Minimize Chances of Getting Ditched by Your Health Insurance Company?

If you haven’t had a bad health insurance experience so far and want to prevent the same, here are a few points you need to be aware of while buying a health insurance policy. Keeping the following points in mind will help you lower your chances of encountering fraud in any form:

• Choose a plan with maximum coverage at an affordable premium. Don’t just go with a plan with a low premium amount.
• Keep your family size and the medical needs of your family members in mind.
• Check the claim settlement ratio or CSR of the health insurance company beforehand.
• Check your health insurance policy for sub-limits.
• Check the availability of restore benefit.

Also, Read

Advantages of Buying Health Insurance from New India Assurance

Want to Lower the Risk of Heart Attack? Read This

Conclusion

Do not just lose hope or feel helpless if you are stuck with a health insurance policy that you don’t feel is what you were promised. Fight for your right so that you are safe both, in terms of health as well as finances.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.