Short-paid claim · Non-payable items

Non-payable items and consumables deducted from your health claim: what you can challenge

Many claims are paid short because the insurer strikes off items from the hospital bill as “non-payable”. Some of those deductions are valid. Many are not.

By the MediclaimSaathi team Updated 8 November 20267 min read

What “non-payable” usually means

Insurers use IRDAI’s standard list of non-medical expenses when they settle claims. Items on that list are excluded; items not on it are, as a rule, payable if they are part of the treatment and within your policy limits.

Disputes arise because hospitals bill the same item under many names, and settlement letters often show only a total “non-payable” figure with no breakup.

How to check a deduction

• Ask for the settlement letter with every deducted line and the reason against it.
• Compare each deducted item with the standard list. An item that is not on the list needs another reason to be refused.
• Check whether the item was prescribed or used as part of the treatment (surgery, ICU, dialysis, chemotherapy).
• Check your policy for sub-limits. A cap is a different ground from “non-payable”.
• Look for double deductions: an item cut once as non-payable and again through room-rent ratios.

Do not confuse it with room rent deduction

Room rent proportionate deduction is a separate issue. IRDAI’s rules say it should not be applied to pharmacy, consumables, implants, medical devices or diagnostics, or in hospitals that do not charge differently by room category. If both deductions were applied to the same item, raise both in your grievance.

How to recover a wrong deduction

1. 1Get the breakupAsk the insurer or TPA for the line-by-line settlement.
2. 2Mark the disputed itemsList each item, its amount and why you think it was payable. Add up the total.
3. 3Attach proofPrescriptions, procedure notes and the discharge summary showing the item was part of treatment.
4. 4Write to the Grievance Redressal OfficerSend the list and the amount due. Keep the acknowledgement.
5. 5EscalateNo reply in 30 days or a rejection? Use Bima Bharosa and the Insurance Ombudsman (free, within one year).

Frequently asked questions