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CLAIM RECOVERY

Rejected Claims Assistance

A rejected claim is rarely a closed one. Most are refused on documentation and process grounds that can be answered — if someone has the time to chase them.

The claims we take up

  • Claims rejected outright by the insurer or TPA
  • Short-settled claims where the paid amount is well below the billed amount
  • Claims pending far beyond the normal turnaround time
  • Claims stuck in query loops with repeated document requests

Why claims get rejected

In our experience the reason is almost never medical. It is a missing discharge summary, a mismatch between the pre-authorisation and the final bill, a policy exclusion applied too broadly, or simply a file that nobody followed up on. Each of those has an answer.

How we work

1

Claim review

We go through the rejection letter and supporting documents and identify the exact ground of refusal.

2

Documentation

Missing or weak documents are collected and the file is rebuilt to answer the stated reason.

3

Representation

A written representation goes to the insurer or TPA citing the policy terms and the clinical record.

4

Escalation

Where a fair reconsideration does not happen, the matter is escalated through the proper grievance channels.

5

Status updates

You are told what moved and what is pending — no silent files.

What we will ask you for

  • Policy copy and the rejection or short-settlement letter
  • Discharge summary and relevant medical records
  • Final bill and pre-authorisation papers
  • Any email trail with the insurer or TPA

Send whatever you have. If something is missing we will tell you what to pull from your records.

Have a question first?

Leave your number and our specialist will call you back — usually within one business day.