Overcoming Partial Claim Rejection

Challenge:

A 52-year-old homemaker, Mrs. Mehra (different from Case Study 1), had her claim partially rejected after gallbladder surgery. The insurer cited an exclusion clause and noted discrepancies in the hospital's billing format.

Solution:

• Mrs. Mehra sought clarification from her insurer.
• She consulted consumer advocacy groups specializing in health insurance claims.
• She meticulously compiled additional documents and evidence to support her case.
• She persistently followed up with the insurer.

Outcome:

After weeks of effort, the insurer re-evaluated Mrs. Mehra's claim. She was granted a revised reimbursement that covered a significant portion of her medical expenses.