Denied claims:

If your health insurance claim has been denied in the UAE, the first step is to understand the precise reason for the denial. Denied claims are claims that have been processed and deemed unpayable. Review the explanation provided by the insurance company, such as an Explanation of Benefits or Electronic Remittance Advice. This will detail the reasons for the denial. You can then submit a well-constructed appeal, explaining why the claim should be reconsidered and paid. Gather supporting documentation from your doctor explaining the medical necessity, and craft a well-structured appeal letter outlining your case. Resubmitting the claim without an appeal may result in it being denied again as a duplicate.

Rejected claims:

Rejected claims are claims that were not properly filed and entered in the insurance company's system. To address a rejected claim, you simply need to correct the errors such as incorrect details, missing documentation, services not covered, or treatments deemed not medically necessary and resubmit the claim. Appeals are generally not necessary for rejected claims, as they just need to be resubmitted correctly.

If you need assistance, don't hesitate to reach out to your insurance broker or consider reaching out to Sanadak for further resolutions.