Resolve Query Raised by Insurer
Expertise | Convenience | Personalized
About This Plan
After reimbursement claim submission, insurer may need more information and documents to process the claim. They will raise queries and additional document requirement in the claim.
Querysolve is designed to give you expert support in comprehending requirements stated in the query and give you a plan and assistance in resolving them. Claim advisor assigned to you will go through all the claim documents submitted to insurer and identify solution to the query based on this assessment.
Your advisor will draft the clarifications and justifications required in the query by referring to available medical documents.
This plan covers resolution of one round of queries. If after submission of query response, insurer again asks further queries or clarifications in the second or third round, separate sign-up will be required for resolution of those queries.
Scope of Service
Query validation and review or discharge summary and main bill, receipts
Preparation of clarification letters
Advice on possible responses to query
Review of claim response documents
Resolution for only one round of queries is covered in plan
Out of Scope activities
Who should buy this plan?
Any policyholder who has received query in their reimbursement claim
Documents to be shared with us
Copy/scan of Query letter, Discharge summary, Main bill and receipts
Other medical records on need basis
Insurance card or policy copy/scan
Sign-up for service
Share documents through Email / WhatsApp / upload tool
Claims Advisor will be assigned within 24 hours
Guidance on response preparation
Any and every kind of query can be shared and resolved in this plan.
In a large majority of cases, there is only one round of queries. Insurers highlight their information and document needs in one letter only. However, it has been observed that in some complicated cases, insurers may raise queries after response for earlier queries are submitted. It is not feasible to anticipate multiple rounds of queries.
In some cases, additional information and documents may be required from claimants to prepare a response to the queries. If such information is not made available, it would not be possible to prepare proper response to queries. In some other cases, our claim advisors may detect that the claim may get rejected due to the nature of query. So they may advise client to recall their claim to avoid claim rejection. In both of these situations, it may not be feasible to respond to queries. Service fee will not be refunded in such cases.
SureClaim does not guarantee claim approval. Claim processing is the sole ownership of insurance company and SureClaim will not be responsible for claim rejection as per policy terms and conditions.
querysolve is a solution aimed at clients who struggle to identify requirements stated in queries, or who need support in preparation of clarifications, or who require expert assistance to review their claim documents and claim response.
Insurer establishes validity and truthfulness of claim before approving or rejecting it. To come to a conclusion, it may need further evidence/details. If the treatment is not covered in policy, or waiting period may be applicable, or in cases of non-disclosure of pre-existing diseases, insurers are bound to reject the claim.
Our Claim advisors work very objectively to make available all information insurers need to process a client’s claim. Claimants have every right to be sensitive about the outcome of their claims, however, SureClaim follows a professional approach to claim preparation and query resolution unaffected by such sentiments. Given the policy terms and conditions, we may have to face adverse claim outcomes even after best efforts from our end.