Right of Appeal and Reopening of Claims a. The Empanelled Health Care Provider shall have a right of appeal against a rejection of a Claim by the Insurer, if the Empanelled Health Care Provider feels that the Claim is payable. Such decision of the Insurer may be appealed by filing a grievance with the DGNO within 15 days of rejection of claim, in accordance with Clause 26 of this Insurance Contract. SHA may relax these timelines for public hospitals.
Right of Appeal and Reopening of Claims a. The Health Care Provider shall have a right of appeal against a rejection of a Claim by the NHA, if the Health Care Provider feels that the Claim is payable. Such decision of the ISA may be appealed by filing a grievance with the DGNO within 15 (fifteen) days of rejection of claim, in accordance with Clause 26 of this Contract. This timeline is not applicable for public hospitals.
Right of Appeal and Reopening of Claims. The Empanelled Provider shall have a right of appeal to approach the Insurer if the Provider feels that the claim is payable. If provider is not agreed with the Insurers’ decision in this regard, can appeal to the District and/or State Level Grievance Redressal Committee as per Section 20 of this document. This right of appeal will be mentioned by the Insurer in every repudiation advice. The Insurer and/or Government can re-open the claim if proper and relevant documents as required by the Insurer are submitted.
Right of Appeal and Reopening of Claims. The Empanelled Health Care Provider shall have a right of appeal against a rejection of a Claim by the SHA, if the Empanelled Health Care Provider feels that the Claim is payable. Such decision of the ISA may be appealed by filing a grievance with the DGNO within 15 days of rejection of claim, in accordance with Clause 26 of this Insurance Contract. This timeline is not applicable for public hospitals. The SHA and/or the DGNO or the DGRC, as the case maybe, may re-open the Claim, if the Empanelled Health Care Provider submits the proper and relevant Claim documents that substantiates their right to re-open such claims..
Right of Appeal and Reopening of Claims. 16.2.1 The EHCP shall have a right of appeal against a rejection of a Claim by the Insurer, if the EHCP feels that the Claim is payable. Such decision of the Insurer may be appealed by filing a grievance with the District Grievance Nodal Officer (DGNO) within 15 (fifteen) days of rejection of claim, in accordance with Clause 44 of this Insurance Contract. The SHA may relax these timelines for public hospitals.
Right of Appeal and Reopening of Claims. The Empanelled Health Care Provider shall have a right of appeal against a rejection of a Claim by the Insurer, if the Empanelled Health Care Provider feels that the Claim is payable. Such decision of the Insurer may be appealed by filing a grievance with the DGNO within 15 days of rejection of claim, in accordance with Clause 26 of this Insurance Contract. SHA may relax these timelines for public hospitals. The Insurer and/or the DGNO or the DGRC, as the case may be, may re-open the Claim, if the Empanelled Health Care Provider submits the proper and relevant Claim documents that substantiates their right to re-open such claims. No Contributions The Insurer agrees that any Beneficiary Family Unit or any of the Beneficiaries or any other third party shall be entitled to obtain additional health insurance or any other insurance cover of any nature whatsoever, including in relation to the benefits provided under this Insurance Contract and a Policy, either individually or on a family floater cover basis. Notwithstanding that such Beneficiary Family Unit or any of the Beneficiaries or any third party acting on their behalf effect additional health insurance or any other insurance cover of any nature whatsoever, the Insurer agrees that: its liability to make a Claim Payment shall not be waived or discharged in part or in full based on a rateable or any other proportion of the expenses incurred and that are covered by the benefits under the Covers; it shall be required to make the full Claim Payment in respect of the benefits provided under this Insurance Contract and the relevant Policy; and if the total expenses incurred by the Beneficiary exceeds the available Sum Insured under the Covers, then the Insurer shall make payment to the extent of the available Sum Insured in respect of the benefits provided under this Insurance Contract and the relevant Policy and the other insurers shall pay for any excess expenses not covered.
Right of Appeal and Reopening of Claims. Revoke of claims shall be as per latest guidelines issued by National Health Authority (NHA) or guidelines released by State Health Agency (SHA) which may be updated from time to time.
