Can your health insurance claim be rejected due to incorrect information, incomplete documents or policy terms? Have you disclosed your pre-existing diseases correctly? Can you avoid claim rejection by taking timely renewal and pre-approval? Let’s know the full details.
Health Insurance Claim Rejection: Often people think that after buying health insurance, the insurance company will bear the entire cost of their treatment. But when the claim is rejected, both trouble and anger increase. In such a situation, the question arises whether insurance companies deliberately reject claims? No, this does not happen every time. In fact, most of the cases are such where claim rejection could have been avoided with a little caution. So let us know the reasons for which health insurance claims are rejected and how you can avoid it.
Not disclosing pre-existing diseases
The principle of ‘Utmost Good Faith’ applies in the world of health insurance. This means that both the policyholder and the insurance company should share information with complete honesty while buying insurance. But many people do not disclose pre-existing conditions, such as diabetes, high blood pressure, or heart problems. Doing so can cause the insurance company to reject your claim.
The way to avoid this is quite easy. While buying the policy, you should tell your entire medical history, even if it seems minor to you. This will keep your claim safe.
Not reading the terms of the policy properly
Often people do not read the terms of the policy carefully while buying it. When they claim later, they find out that the treatment is not covered in the insurance or there is a waiting period applicable on it. For example, in many policies there is a waiting period of 2-3 years for surgery (such as hernia, cataract).
To avoid this, read all the terms and conditions of the policy carefully. If you do not understand anything, ask the agent or the insurance company. This will keep things clear.
Not renewing the insurance policy on time
If your policy lapses, the insurance company can reject your claim. Sometimes people forget when is the last date for depositing the premium and this ends their coverage.
In such a situation, you should keep your policy in auto-pay mode. You can also set reminders so that payments are made on time.
Providing incorrect or incomplete documents
During the claim process, not having the necessary documents can stop or reject your claim. Many times people do not keep the hospital bill, medical report or doctor’s prescription safe, due to which the claim is not passed. To avoid this, some things have to be implemented.
- Keep all medical documents safe.
- Take a copy of the hospital bill and discharge summary.
- Submit all the documents required by the insurance company on time.
Treatment not covered under the policy
Every health insurance policy covers some diseases and treatments, and some not. For example, cosmetic surgery, dental treatment, fertility treatment, etc. are usually not covered. If you make a claim for any such treatment, it may be rejected.
To avoid this problem, read the ‘Inclusions’ and ‘Exclusions’ list of your policy carefully. This will let you know which treatments are covered in your policy and which are not.
Not taking pre-approval in cashless claim
If you are getting admitted to the hospital for a planned surgery and you have not informed the insurance company in advance, then your cashless claim may be rejected.
In such a situation, it is important to inform the insurance company before the treatment and get the necessary approval from it.
What to do if the health insurance claim is rejected?
Health insurance is made to give you financial security, but for this you will also have to take some precautions. It is your responsibility to provide the correct information, read the policy terms carefully, renew it on time and keep all the documents in proper condition.
If your claim is still rejected, you can seek clarification from the insurance company. Still, if needed, you can also file a complaint with the Insurance Ombudsman.
