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 Explanation of Benefits (EOB) or 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 (e.g.. a doctor's letter explaining medical necessity or by addressing the rejection reason). 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:

These are claims that were not processed due to errors or incomplete documentation. You should:

• Correct errors or provide missing additional information.
• Resubmit the claim.
• Appeals are usually unnecessary for rejections unless the error leads to denial.

Appeals are generally not necessary for rejected claims, as they just need to be resubmitted correctly.

If you need assistance, consult your insurance broker or consider reaching out to Sanadak (DHA;s support center) for help only for DHA compliant plans.