From the Medilock desk

How insurers decide a claim, what reverses a rejection, and how hospitals get paid faster.

Latest articles

• The insurer approved the claim but the money never came. What now? — An approval is a payable, not a promise. Here is the escalation ladder that actually releases a cashless claim an insurer has already approved — and the exact wording that works at each rung.
• Rejected for non-disclosure: when the insurer is wrong, and how to prove it — Non-disclosure is the most used rejection ground in Indian health insurance and one of the most frequently overturned. The deciding factor is almost always the treating doctor's note on date of first diagnosis.
• Short-paid after a tariff deduction: what you can argue back — The insurer paid, just not the full amount. Deductions on room rent proportionality, non-medical items and package rates are the three that recur — and two of them are frequently reversible.
• Your health insurance claim was rejected. Here is what to do next. — A rejection letter is not the end of the claim. It is the start of a process with fixed timelines, and a large share of rejections in India are overturned when they are properly challenged.
• Cashless denied at discharge: pay the bill, then do these five things — A cashless denial is a pre-authorisation decision, not a final verdict on your claim. The claim can still be filed for reimbursement — and the denial itself can be challenged.
• Eight fields that decide whether your pre-auth comes back approved — Most pre-auth queries are raised on the same handful of fields. Fill these properly and the approval comes back the same day instead of three days later.
• Why cashless claims get rejected — and what actually gets them paid — Nine out of ten rejections we see fall into five buckets. Here is what each one looks like on the letter, and the document that reverses it.
• Pre-authorisation form checklist: the eight fields that decide your TAT — Most pre-auth queries are raised on the same eight fields. Fill these correctly and the approval comes back the same day.
• Cashless funding: turning an approved claim into working capital — An approved claim is a receivable. Here is how hospitals convert that receivable into cash before the insurer settles.