Reimbursement rejected · Bills submitted

Reimbursement claim rejected? Why it happens and how to get paid

You paid the hospital yourself, filed the bills, and the insurer said no. Most reimbursement rejections come down to paperwork, timing or a policy clause that can be answered in writing.

By the MediclaimSaathi team Updated 8 November 20267 min read

Why reimbursement claims get rejected or closed

• Documents missing: final bill, itemised bill, discharge summary, prescriptions, investigation reports or payment receipts.
• Claim filed after the time your policy allows (often 15–30 days after discharge for the claim form).
• The insurer was not told about the admission in time.
• A waiting period or pre-existing disease clause was applied.
• The insurer says hospitalisation was not medically necessary.
• A query letter was not answered, so the file was closed.

Closed is not the same as rejected

A claim that is “closed for want of documents” has not been decided on its merits. You can usually send the missing papers and ask the insurer to reopen it. A claim that is “repudiated” has been refused on a stated ground, and that needs a reasoned written grievance.

What to do, step by step

1. 1Get the decision in writingAsk for the rejection or closure letter with the reason and the clause relied on. A phone explanation is not enough.
2. 2Build the filePolicy schedule, renewal receipts, claim form, all hospital bills with receipts, discharge summary, prescriptions, reports and the insurer’s letters.
3. 3Answer the exact reasonReply to the reason the insurer gave, with dates and documents. Do not send a general emotional appeal.
4. 4Write to the Grievance Redressal OfficerQuote policy and claim numbers, the amount due and what you want. Keep the acknowledgement.
5. 5Escalate after 30 daysIf the insurer rejects the grievance or stays silent, register on Bima Bharosa and file with the Insurance Ombudsman within one year.

Frequently asked questions