**Covering Insurance Rejections for Ineligible Beneficiaries**

**Introduction**  

Under the terms and conditions of health insurance policies, certain services such as radiology, laboratory tests, and surgeries may be denied to beneficiaries (individuals or groups) due to eligibility criteria. This often leads to dissatisfaction among policyholders, generating complaints to regulatory authorities and potentially exposing insurance companies to accountability and additional risks. To address this issue, I Project Investment has developed a new generation of medical networks and smart medical platforms to cover rejected claims within its exclusive network. This solution allows beneficiaries to receive the services denied by their insurance provider without the insurer bearing the financial burden for these claims or bills.

**Challenges and Solutions**

- **Customer Dissatisfaction with Rejections:**  

  Although insurance companies offer diverse and successful health insurance programs, around 65% of customers express dissatisfaction, especially when it comes to exclusions related to pre-existing conditions, chronic diseases, and services classified as cosmetic.  

  **Solution:** I Project Investment contracts with reputable hospitals, medical centers, and clinics rated A and A+, ensuring that beneficiaries continue to receive high-quality care in the same facilities they are accustomed to, without experiencing a reduction in the level of coverage.

- **No Financial Burden on Insurance Companies:**  

  While I Project Investment provides significant benefits and a competitive advantage, it does not request compensation or reimbursement from insurance companies for any treatments or services delivered to beneficiaries. This allows insurers to maintain their financial stability without incurring additional claims.

- **Additional Health Benefits Beyond Coverage Rejections:**  

  The scope of the new-generation medical networks extends beyond covering insurance rejections. Beneficiaries can also access additional benefits such as biannual comprehensive check-ups, dental services, optical services, cosmetic treatments, and other healthcare services not typically covered under standard insurance policies.

**Mechanism and Implementation**

- **Additional Benefits as Privileges:**  

  These services are offered as added privileges to the beneficiary’s policy benefits. Insurance companies can include these options directly in the schedule of benefits, with customers contributing a co-payment of 10% to 20% based on the facility's declared tariff, the service type, and associated risks, which may occasionally reach 30%.

- **Streamlined Appointment Process:**  

  A seamless process allows beneficiaries to book appointments directly with a network facility without cumbersome procedures. Services are provided at the nearest medical center in the I Project Investment network.

- **Report Submission:**  

  Once services are completed, all relevant medical reports and results are sent to the beneficiary through the healthcare facility and insurance provider for proper record-keeping, ensuring transparency and continuity of care through the I Project Investment platform.

By covering rejections through a smart, efficient medical network, I Project Investment enhances customer satisfaction and supports insurance companies by reducing claims and financial risks, all while maintaining the highest standards of healthcare.