I met with an accident. My claim got rejected because I was admitted to a blacklisted hospital. What can I do?

I met with an accident and a bystander took me to a nearby hospital. The insurer rejected the claim stating that the hospital was blacklisted. What can I do? 

Reply by Chirag Nihalani, General Manager at Insurance Samadhan 

It’s important to understand the concept of a blacklisted hospital and the steps you can take in such situations. 

A blacklisted hospital, in the context of health insurance, refers to a healthcare facility that has been flagged by insurers, leading to claim rejections. There are several common reasons for a hospital to be blacklisted: 

Fraudulent Activities: Insurers blacklist hospitals involved in fraudulent activities, where they collaborate with clients to provide fake documents and bills. 
Non-cooperation: Hospitals not cooperating with insurers by failing to provide required documents can lead to blacklisting, making it challenging for insurers to process claims. 
Excessive Charges: Certain hospitals are blacklisted for charging unreasonably high prices, particularly when dealing with insurance holders.
Considering these scenarios, it’s crucial to avoid getting admitted to a blacklisted hospital. However, if you find yourself in this situation after an accidental injury, here’s what you can do:  

Emergency Exceptions: Many insurance companies have exceptions for emergency situations, even if the hospital is blacklisted. Ensure you understand your policy's stance on this. 
Hospital Transfer: If your condition permits and your insurance allows it, consider shifting to an empanelled hospital, which is preferred by the insurer. 
Document Everything: Maintain thorough records of all documents and bills related to your treatment. 
Emergency Admission Certificate: Obtain a certificate from the treating doctor explaining the emergency nature of your admission. 
Review Bills Carefully: Inspect the complete bills when you're discharged to ensure transparency in the charges. 
Collect Evidence: Gather any relevant proof, such as police reports, statements from individuals who took you to the hospital, etc., as this evidence may be useful if your claim faces rejection. 
If, despite these efforts, your claim is still rejected, delayed, or not adequately settled, you can consider escalating the complaint by reaching out to the grievance redressal mechanism of the insurer and IRDAI or can seek the help of insurance resolving platforms. 

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