PolicygaidoDidn't get your full claim?
Most people accept a rejection or reduced payout without questioning it. You don't have to.
Understand exactly what went wrong
Jargon-free breakdown of why your claim was rejected or reduced.
Know your rights before you respond
Find out if the rejection is valid, or if you have grounds to challenge it.
Fight back with the right paperwork
Ready-to-file appeal with documents your insurer actually needs.
Claims reality in India
24%
of health claims are rejected or under-settled — and most are never challenged.
How it works
Upload your rejection or settlement letter
Get a plain-English breakdown of what happened
Receive a ready-to-file appeal + document checklist
Submit with confidence, track your outcome
Try it now
Got a question? Get clarity.
Coverage doubts, claim queries, or finding the best plan for your family, get clear answers instantly.
Ask GaidoAI any questions about health insurance, coverage options, policy terms, or get personalized recommendations
Understand claims with confidence
Learn both cashless and reimbursement flows in plain language, so you know exactly what to do when it matters.
Cashless Claims
Treatment at empanelled hospitals without upfront payment.
Reimbursement Claims
Understand how to pay first and claim back later with proper documents.
Claim Queries
AI answers your common questions on claim steps, timelines, and requirements.
Network Hospitals
Know what a hospital network is and why it matters in cashless claims.
CASHLESS CLAIM PROCESS
Admission
Get admitted to a network hospital and present your health insurance policy card.
Pre-Authorization
Hospital submits your treatment plan and requests claim approval from insurer.
Approval
Insurer reviews and approves claim, then notifies the hospital to proceed with treatment.
Final Settlement
After treatment, the hospital sends the final bill directly to the insurer for payment.
Reimbursement CLAIM PROCESS
Visit Any Hospital
Get treated at any hospital (network or non-network) and pay the bills yourself upfront.
Pay Bills
Get all original bills, prescriptions, and discharge summaries post treatment.
Submit Documents
Send your claim form, collected bills and required documents to your insurer.
Reimbursement
Insurer reviews claim and transfers approved amount to your bank account.
Documents that speed upclaim approval
Keep these essentials ready to avoid back-and-forth with the insurer and reduce processing delays.
Why do claims Get Rejected?
Policy Not Active
Premium not paid or waiting period not completed.
Hospital Not In Network
For cashless claims, going to a non-network hospital may lead to denial.
Claim Filed Late
Not informing the insurer within the required time frame.
Excluded Treatments
Some conditions, procedures, or pre-existing illnesses may not be covered.
Mismatched Information
Wrong policy number, incorrect details, or form discrepancies.
Incomplete Documents
Missing bills, prescriptions, or doctor’s notes.