PRACTICAL SCENARIOS TO DEAL WITH CLAIM REJECTION

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Vani Pandigunta

1. Medical abbreviations can make or break your insurance claim

Health insurance claims can be tricky, but sometimes, they take an unexpected turn, like this one. The reason?

Eg 1. Non-disclosure of AML (Acute Myeloid Leukemia), which is a type of blood cancer.

Now, here’s the catch:
– The client never mentioned having cancer at any point.
– The claim itself was for a completely different condition.
– This was news to everyone involved, including the client.

We swiftly took action by initiating an audit, and asked the insurer exactly which document proved this alleged non-disclosure.

After some persistent digging, we finally got our hands on the document that clarified everything, a medical consultation paper that stated: “AML since 3 years.”

We immediately sent it to the client, asking if this was a documentation error. They checked with their doctor, and here’s where things took a hilarious turn…
The doctor casually clarified: “AML since 3 years” meant Active Married Life since the past 3 years!

Moral of the story: Medical abbreviations can make or break your insurance claim, so you need a reliable partner, who can retrieve these documents from the insurer, interpret them accurately, and, if needed, challenge the insurer on your behalf.

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