Information last checked: November 2026. Processes, forms and portals change, so please confirm current details with your insurer, provider or the relevant health authority before acting.
Three different things are often called “rejection”, and the response differs for each, so start by naming which one you have.
Rejection, denial or pre-approval?
- Pre-approval declined or pending. The provider asked your insurer to approve a test, procedure or admission before it happens, and the insurer said no or has not answered. Nothing has been paid or refused yet, which gives you the most room to act.
- Claim rejected after treatment. The treatment happened and the insurer refused to pay all or part of it. Often the provider has billed you the difference.
- Partial payment. Co-payments, limits and exclusions can reduce a payout without a formal rejection. Check the explanation of benefits before assuming an error.
Get the reason in writing
A phone call is not enough. Ask the insurer, or the provider’s insurance desk if they submitted the request, for the rejection reason and any reference or code in writing. Typical reasons include the procedure needing pre-approval that was not obtained, a condition within a waiting period, a treatment judged not medically necessary under the insurer’s criteria, an item the policy excludes, or an out-of-network provider. Missing or inconsistent paperwork is also common, and the easiest to fix.
Check it against your policy
Read the reason next to your policy schedule and table of benefits, not the marketing summary. Look for the relevant limit, exclusion, waiting period and network rule. Three outcomes are possible: the rejection matches the policy (then your options are to pay, ask for a goodwill review, or look at alternatives), the rejection contradicts the policy, or it rests on missing information. The second and third are worth appealing.
Appeal with the right documents
Insurers decide on documents. For anything that turns on medical necessity, your treating doctor’s letter is usually the strongest single item, because it states in clinical terms why the treatment is needed. Gather:
- The rejection notice with its reference and date
- Your policy schedule and table of benefits
- The doctor’s letter or report supporting the request, and relevant test results
- The provider’s itemised bill, if the treatment has happened
- Any prior approvals, referral letters and correspondence
Then submit one clear written appeal that quotes the reference, states which reason you are answering, and attaches the evidence for it. Keep it short and factual. Ask for a written response by a set date, and note the date you sent it.
Appeal outline
- Who I am, policy number, claim or pre-approval reference
- The decision I am appealing, and its date
- Why I think it should be reconsidered, in two or three sentences
- Documents attached (listed)
- What I am asking for, and by when
Escalating to the regulator
If the insurer’s final answer does not resolve it, health insurance is regulated by the emirate, and each regulator has a complaints route:
- Dubai: the Dubai Health Authority runs a health insurance complaints service through the DubaiNow app. It has been described as free and as covering matters such as rejected claims, treatment refusals and network issues.
- Abu Dhabi: the Department of Health accepts health insurance complaints, including for the Thiqa, Basic, Enhanced and Aounak programmes, through its website and the TAMM platform.
- Other emirates: ask your insurer or the Ministry of Health and Prevention which body handles complaints for your policy.
Expect to be asked to show that you raised the issue with the insurer first, so keep the written trail. Reported timelines vary widely between sources, so treat any figure you read online as a guide and confirm the current process on the regulator’s own page. Complaint portals and forms change; the links in the sources below are the right starting points.
Keep a claim log
When several providers and an insurer are involved, memory fails. A simple log keeps the story straight:
| Date | Who | What was said or sent | Reference | Next step and date |
|---|---|---|---|---|
| 12 Nov | Insurer, claims | Asked for written reason; told 3 working days | CLM-0000 | Chase 17 Nov |
Avoiding it next time
- Ask the provider whether the procedure needs pre-approval, and who is submitting it, before booking a date.
- Ask for the approval reference in writing and carry it to the appointment.
- Confirm that the facility and the doctor are in your network.
- If the plan changes (a different procedure, an extra night), ask whether the approval still applies.
Our planned surgery checklist covers these steps in order, and care coordination can take on the insurance paperwork alongside your provider’s own team. We do not give insurance or legal advice and cannot guarantee an outcome, but we can help you organise the case clearly.
Sources and further reading
- Khaleej Times: Dubai medical claim denied, what you can do
- Emirates 24|7: filing a health insurance complaint through DubaiNow
- Department of Health, Abu Dhabi: submit a health insurance complaint
- Gargash Insurance: what to do if your claim is rejected
This article offers general, non-clinical information only. It is not medical, legal or insurance advice. Always speak to your doctor or healthcare provider about clinical questions. In a medical emergency, call 998.
