What to Do if Your Health Insurance Claim is rejected?

Learn why health insurance claims get rejected and how to prevent it. Understand common mistakes, documentation errors, and policy terms to ensure smooth claim approval without delays.
Check health insurance plans with comprehensive coverage
Get Quote
3 min
28-August-2025

The primary reason most people purchase health insurance is to secure financial support during medical emergencies. The last thing you would want in such a critical moment is to have your health insurance claim denied. This can be both stressful and overwhelming, particularly when you are relying on the claim amount to cover hospital expenses. If your claim gets rejected, here’s what you should know about the next steps.

This article helps you uncover the real reasons behind health insurance claim rejections, what you can do to fix them, and how to ensure your future claims are approved without hassle.

What is health insurance claim rejection?

A health insurance claim rejection occurs when an insurance provider refuses to honour a claim made by a policyholder. The insurer may decline the claim for many reasons – often due to errors in the claim submission or policy terms and conditions. A rejected health insurance claim can result in notable financial stress for individuals, especially those dealing with substantial medical costs.

Pro Tip

Avail hospitalisation and treatment benefits with health insurance plans starting at just Rs. 15*/day.

End Uses

Common reasons for health insurance claim rejections

Facing a rejected claim can be disheartening—especially during a medical emergency. Understanding the common reasons why health insurance claims are denied can help you avoid costly mistakes and ensure smoother approvals in the future.

Here are some of the most common causes of health insurance claim rejection:

  • Inaccurate information submitted: Even small errors in your name, policy number, diagnosis codes, or hospital documentation can lead to immediate claim denial. Always double-check the paperwork before submission.
  • Overlooked policy exclusions: If your treatment falls under the list of exclusions in your health insurance policy—like cosmetic surgeries or certain pre-existing conditions—it may not be eligible for coverage.
  • Missing pre-authorisatio: For planned surgeries or high-cost procedures, insurers often require pre-approval. Skipping this step—even unintentionally—can result in outright rejection.
  • Billing and coding discrepancies: If the hospital makes billing errors like duplicate charges or wrong treatment codes, your claim can be flagged. It’s wise to ask for an itemised bill and verify it before filing.
  • Non-covered or unnecessary treatments: Claims for alternative therapies, experimental treatments, or procedures deemed medically unnecessary under the policy are usually denied.
  • Claims during the waiting period: Most health insurance plans have a waiting period for pre-existing diseases, maternity benefits, or specific treatments like hernia or joint replacement. If you raise a claim for such conditions before the waiting period ends, your insurer can reject it.
  • Tip: Understand your policy’s waiting period clauses clearly and plan treatments accordingly. You can also compare policies with shorter waiting periods for critical needs.
  • Claim request not deemed fit: Sometimes, insurers may reject claims if they feel the treatment or hospitalisation was not justified. For example, admission for minor ailments that could be managed on an outpatient basis may be seen as unnecessary.
  • Tip: Always ensure your hospitalisation is medically necessary and backed by your doctor’s prescription, reports, and discharge summary.
  • Policy lapse due to missed premium payments: If your policy has lapsed because of unpaid premiums, any claims made during that period will not be honoured. Even a single missed payment can make your policy inactive.
  • Tip: Set reminders for premium due dates or opt for auto-debit options to keep your policy active and avoid claim rejection due to technical lapses.

Avoid surprises. Always verify coverage, documentation, and claim process in advance.
Check and compare health insurance plans that offer claim advisory and cashless hospitalisation at top network hospitals—only on Bajaj Finance Insurance Mall.

What to do if your insurance company denies your claim in India?

  1. Correct the Data: If the rejection was due to incorrect or incomplete details, inform your insurer about your intent to reinitiate the claim. Review the claim form carefully, identify the error, and fill it out again with accurate information. You can also take assistance from the insurer’s customer support team to ensure there are no mistakes this time. Submitting error-free data significantly improves the chances of your claim being approved.
  2. Provide Proper Documentation: If the claim was denied because of missing paperwork, reapply by submitting all the required documents, including the ones that were previously left out. Ensure you attach every supporting document requested by your insurer to avoid further delays or rejection.
  3. Prove the Need for Hospitalisation: In cases where the insurer rejected the claim on the grounds that hospitalisation was unnecessary, you can strengthen your case by submitting your doctor’s prescription recommending admission, along with diagnostic test reports. This helps establish that hospitalisation was medically essential. Presenting clear proof can convince the insurer or TPA to approve your claim upon resubmission.

Steps to take when your health insurance claim gets rejected

A claim rejection doesn’t have to be the end of the road. With the right approach and timely action, many rejected claims can be reviewed, appealed, and even approved. Here’s a step-by-step guide to help you navigate the situation confidently:

  • Start by reviewing the rejection notice: Go through the Explanation of Benefits (EOB) or the insurer’s denial letter carefully. Identify the exact reason for rejection—whether it’s missing documentation, billing errors, or an uncovered service.
  • Gather supporting documents: Compile all relevant paperwork—this includes hospital bills, prescriptions, doctor’s notes, test reports, and any communication between you and the healthcare provider.
  • Contact your insurance provider immediately: Call the insurer’s helpline or use their online portal to clarify the reason for denial. Sometimes, claims are rejected due to easily correctable errors like wrong codes or incomplete forms.
  • File a formal appeal: If you believe the rejection was unjust or based on incomplete information, raise a formal appeal. Submit a written explanation along with the necessary medical documents and a letter from your healthcare provider if needed.

Claim denials can feel overwhelming—but you don’t have to face them alone.
Explore health insurance plans that offer 24x7 claim assistance, minimal exclusions, and faster resolution support

Understanding the appeals process for medical insurance claims

  • Internal appeal: Start by submitting an internal appeal to your insurer, following their specific guidelines and deadlines.
  • External review: If your internal appeal is denied, you may request an external review by an independent third party.
  • Legal recourse: In cases of persistent denial or unresolved disputes, seeking legal assistance may be necessary to pursue further action.

Tips for preventing health insurance claim rejections

Given below are the tips to prevent your health insurance claim from getting rejected:

Understand your policy: Familiarise yourself with the terms, conditions, and coverage limits of your health insurance policy to avoid surprises.

Obtain pre-authorisation: For procedures or treatments requiring preauthorisation, ensure you obtain approval from your insurer before proceeding.

Double-check information: Review all forms and documentation for accuracy before submitting them to your insurer to prevent administrative errors.

Stay in-network: Whenever possible, choose healthcare providers and facilities within your insurer's network to minimise the risk of claim rejection.

Also, check: Calorie Calculator

Where to get help with rejected health insurance claims?

  • Insurance broker or agent: Seek assistance from your insurance broker or agent, who can provide guidance on understanding your policy and navigating the health insurance claims process..
  • Patient advocacy organisations: Organisations specialising in patient advocacy may offer support and resources for addressing rejected health insurance claims.
  • Legal aid services: Legal aid services may provide legal assistance for individuals facing challenges with their health insurance claims, including filing appeals or resolving disputes.

Medical insurance claim rejections can catch you off guard—especially during a health emergency. But often, these rejections happen due to avoidable issues. Here are some of the most common reasons why health insurance claims get denied in India:

  • Undisclosed pre-existing conditions
    Claims linked to pre-existing diseases may be rejected if the condition wasn’t disclosed at the time of purchase or falls within the waiting period.
  • Policy lapses due to missed premium payments
    If the premium hasn’t been paid on time and the policy lapses, any claim raised during this inactive period is likely to be rejected.
  • Exceeding the sum insured or sub-limits
    Claims that go beyond the policy’s maximum coverage amount or breach sub-limits for room rent, specific treatments, or surgery types may be partially or fully denied.
  • Lack of medical necessity or documentation
    If the insurer deems the treatment non-essential, experimental, or cosmetic—or if critical documents are missing—your claim could be declined.

Want to avoid claim surprises? Compare health insurance plans on Bajaj Finance Insurance Mall with transparent terms, fast claim settlements, and pre-existing disease coverage

Get instant quotes

Top Health Insurance Plans

Private Medical Insurance

Group Health Insurance

Individual Health Insurance

Family Health Insurance

Mediclaim Insurance

Senior Citizens Health Insurance

Maternity Insurance

Health Insurance For Parents

Critical Health Insurance

Frequently asked questions

What are common reasons for health insurance claim rejection?
Common reasons for health insurance claim rejection include inaccurate information, policy exclusions, lack of pre-authorisation, billing errors, and non-covered services. Understanding these reasons is crucial for navigating the claims process effectively and preventing rejections.
How can I appeal a rejected medical insurance claim?
To appeal a rejected medical insurance claim, review the rejection notice, gather supporting documentation, contact your insurer for clarification, and file an internal appeal following their guidelines. If necessary, escalate to an external review or seek legal assistance.
 What to do if my health insurance claim is rejected?

First, identify the reason for rejection. Correct errors in data, submit missing documents, or provide proof of medical necessity. Then refile the claim with your insurer.

What happens if my claim is rejected?

If your claim is rejected, your insurer will not cover the medical expenses. However, you can appeal, resubmit with proper documentation, or approach the grievance cell/ombudsman if needed.

What should I do if my claim is rejected?

Review the rejection letter, rectify the issue, and reapply. If you feel the rejection is unfair, you can escalate it to the insurer’s grievance team or the IRDAI ombudsman.

Why are insurance claims rejected?

Claims are usually rejected due to incorrect information, missing documents, treatments not covered under the policy, lack of pre-authorisation, claims during the waiting period, or lapsed policies.

Show More Show Less

Bajaj Finserv app for all your financial needs and goals

Trusted by 50 million+ customers in India, Bajaj Finserv App is a one-stop solution for all your financial needs and goals.

You can use the Bajaj Finserv App to:

  • Apply for loans online, such as Instant Personal Loan, Home Loan, Business Loan, Gold Loan, and more.
  • Invest in fixed deposits and mutual funds on the app.
  • Choose from multiple insurance for your health, motor and even pocket insurance, from various insurance providers.
  • Pay and manage your bills and recharges using the BBPS platform. Use Bajaj Pay and Bajaj Wallet for quick and simple money transfers and transactions.
  • Apply for Insta EMI Card and get a pre-qualified limit on the app. Explore over 1 million products on the app that can be purchased from a partner store on Easy EMIs.
  • Shop from over 100+ brand partners that offer a diverse range of products and services.
  • Use specialised tools like EMI calculators, SIP Calculators
  • Check your credit score, download loan statements and even get quick customer support—all on the app.

Download the Bajaj Finserv App today and experience the convenience of managing your finances on one app.

Do more with the Bajaj Finserv App!

UPI, Wallet, Loans, Investments, Cards, Shopping and more

GET THE APP

Disclaimer

*T&C Apply - Bajaj Finance Limited (‘BFL’) is a registered corporate agent of third party insurance products of Bajaj Allianz Life Insurance Company Limited, HDFC Life Insurance Company Limited, Future Generali Life Insurance Company Limited, Bajaj Allianz General Insurance Company Limited, SBI General Insurance Company Limited, ACKO General Insurance Limited, ICICI Lombard General Insurance Company Limited, HDFC ERGO General Insurance Company Limited, Tata AIG General Insurance Company Limited, The New India Assurance Company Limited, Cholamandalam MS General Insurance Company Limited, Niva Bupa Health Insurance Company Limited , Aditya Birla Health Insurance Company Limited, Manipal Cigna Health Insurance Company Limited and Care Health Insurance Company Limited under the IRDAI composite CA registration number CA0101. Please note that, BFL does not underwrite the risk or act as an insurer. Your purchase of an insurance product is purely on a voluntary basis after your exercise of an independent due diligence on the suitability, viability of any insurance product. Any decision to purchase insurance product is solely at your own risk and responsibility and BFL shall not be liable for any loss or damage that any person may suffer, whether directly or indirectly. Please refer insurer's website for Policy Wordings. For more details on risk factors, terms and conditions and exclusions please read the product sales brochure carefully before concluding a sale. Tax benefits applicable if any, will be as per the prevailing tax laws. Tax laws are subject to change. Tax laws are subject to change. BFL does NOT provide Tax/Investment advisory services. Please consult your advisors before proceeding to purchase an insurance product. Visitors are hereby informed that their information submitted on the website may also be shared with insurers. BFL is also a distributor of other third party products from Assistance Services providers such as CPP Assistance Services Pvt. Ltd., Bajaj Finserv Health Ltd. etc. All product information such as premium, benefits, exclusions, sum insured, value added services, etc. are authentic and solely based on the information received from the respective insurance company or the respective Assistance service provider company.

Note – While we have made all efforts and taken utmost care in gathering precise information about the products, features, benefits, etc. However, BFL cannot be held liable for any direct or indirect damage/loss. We request our customers to conduct their research about these products and refer to the respective product’s sales brochures before concluding their sale.