Faqs
Mis-selling of Insurance Policy – FAQs
What is insurance mis-selling?
Mis-selling occurs when an agent or advisor sells a policy using false promises or incomplete information.
How do I know if my policy was mis-sold?
If you were promised fixed returns, loan approval, or benefits not mentioned in the policy document, it’s likely a mis-sold policy.
Can I get a refund for a mis-sold policy?
Yes. With proper representation, you can get a refund or resolution through the Insurance Ombudsman or company grievance redressal.
How long does the mis-selling complaint process take?
Usually 30–60 days depending on the insurer’s internal procedure and case complexity.
How can Claretix Health help?
We analyze your policy, identify mis-selling, and represent your case for a fair resolution.
Claim Rejection – FAQs
Why are health insurance claims rejected?
Claims are rejected mainly due to incomplete information, policy exclusions, or non-disclosure of pre-existing illnesses.
What can I do if my claim is rejected?
You can appeal through your insurer’s grievance department or approach the Insurance Ombudsman with expert support.
How do I avoid claim rejection?
Always disclose medical history truthfully and read your policy inclusions/exclusions carefully
Can Claretix Health reopen a rejected claim?
Yes. Our experts assess the rejection reason and help you reinitiate or escalate the claim.
Delay in Claim Process – FAQs
Why does my insurance claim take so long?
Delays happen due to missing documents, slow hospital–TPA coordination, or insurer verification delays.
How long should a normal claim take?
Typically, cashless claims take 2–7 days and reimbursement claims 15–30 days.
What can I do if my claim is delayed?
Follow up regularly with your insurer or contact Claretix Health for escalation support.
How can Claretix Health speed up my claim?
We track your claim, communicate with TPAs and insurers, and push for faster resolution.
Claim Short Settlement – FAQs
What is a short-settled claim?
It’s when your insurer pays less than the claimed amount, often citing deductions or exclusions.
Why was my claim amount reduced?
Reasons include room rent limits, non-payable items, or incomplete documentation.
Can I dispute a short settlement?
Yes. You can raise a grievance with the insurer or Ombudsman for reassessment.
How can Claretix Health help?
We review deductions, identify unfair settlements, and fight to recover your remaining amount.
Health Claim Reimbursement – FAQs
What is the difference between cashless and reimbursement claims?
In a cashless claim, the insurer directly pays the hospital. In reimbursement, you pay first and claim later.
How soon should I file a reimbursement claim?
Usually within 7–15 days after discharge (check your policy for exact timeline).
What documents are required for reimbursement?
Original bills, discharge summary, test reports, prescriptions, and bank details.
Why was my reimbursement delayed or rejected?
Common causes include missing documents or treatment not covered under policy.
How can Claretix Health help?
We ensure all documents are complete, track claim progress, and handle disputes if the claim is rejected or delayed
Know Your Policy – FAQs
Why should I review my insurance policy?
To understand coverage, exclusions, and ensure you’re not underinsured or misinformed.
What happens if I don’t disclose my health conditions?
Non-disclosure may lead to claim rejection in the future.
How can I check my policy details easily?
You can download your policy document or contact Claretix Health for a detailed review.
Can Claretix Health help me compare my current policy with others?
Yes. We provide unbiased comparisons and recommendations based on your needs.
