Stories
What to Do When Your Health Insurance Cashless Claim Is Partly Approved
M
Moneycontrol•15-10-2026, 12:43
What to Do When Your Health Insurance Cashless Claim Is Partly Approved
- •Patients must usually pay the unapproved gap amount to the hospital before discharge while requesting the insurer's final approval letter detailing all deductions.
- •Common deductions include co-payments, treatment sub-limits, and non-payable consumables that fall outside policy terms.
- •Proportionate room rent deductions cannot legally apply to pharmacy, implants, diagnostics, or ICU charges under IRDAI guidelines.
- •Policyholders can formally challenge unjustified deductions in writing to the insurer's grievance officer or escalate the matter to the Bima Bharosa portal and Insurance Ombudsman.
- •Unpaid balances can often be claimed from a second policy, such as employer-provided group health cover.
Key Questions Answered
Under IRDAI's 2024 master circular, insurers must provide detailed reasons for any disallowed amounts. Pay the gap if required to secure discharge, but request the final approval letter and itemised bill to review deductions line by line and challenge incorrect cuts.
Yes, if you hold a second health policy, such as an employer-provided group cover, you can typically claim the remaining unpaid amount subject to that policy's terms. It is advisable to inform both insurance providers early in the process.
Yes. If your written complaint or appeal is successful, the insurance company will pay the disallowed amount directly to you, since you have already settled the initial balance with the hospital at discharge.
