Health insurance claim rejected_ These could be the reasons
Bringing together accurate documentation during any process can be full of chaos. The problem becomes a tad worse while managing and ensuring that all paperwork is correct and up-to-date. On the one hand, when purchasing a health insurance policy can be an amazing way to safeguard your finances during any medical treatment; it can also be tiresome when you actually file a claim.
A health insurance policy takes proper care of your medical bills in case of any hospitalization. However, sometimes there could be many reasons due to which the claim might get rejected. These reasons can be new to you, which is why it is always recommended to read all the guidelines, processes, and terms and conditions before purchasing any insurance policy.
In this article, we will discuss various possible reasons behind the rejection of any health insurance claim rejection because if your claim is rejected, you may be caught off guard and may have to burn your savings.
POSSIBLE REASONS BEHIND HEALTH INSURANCE CLAIM REJECTION
- Pre-existing illnesses- Most health insurance policies may not cover pre-existing diseases of the insured. If you fall ill due to any pre-specified conditions and require hospitalization, your health insurance company will not be able to cover you for the cost of treatment. If you raise a health insurance claim, there are high chances of it getting rejected. Typically, such illnesses and ailments are covered after a waiting period. A waiting period is a period during which certain pre-specified diseases are not covered. If you file a claim for any of the pre-specified diseases before the end of the waiting period, it will be denied.
- Late Claim Filing- Many health insurance policies require the insured to disclose the insurer about the hospital expenses within a stipulated time. In case of any emergency, this helps avoid any fraudulent claims and binds the insured to inform about the emergency admission within 24 hours of the hospitalization. In the case of the planned hospitalization, most of the policies require the insured to inform about the plan at least a week in advance. Missing any of these guidelines could result in a claim being rejected.
- Claim for excluded expenses- All health insurance policies do not cover all medical expenses. There are several diseases for which insurance companies do not provide the coverage option. These are specifically mentioned in the procedures under the ‘Not Covered’ section. This section generally includes diseases that arise due to alcohol, drug abuse, or self-inflicted injuries. These are some of the conditions for which the insured cannot file the claim. However, if the policy provides coverage in these cases, it can be used after the waiting period.
- Elapsed policy– A health insurance is usually valid for a period of one year. At the end of the year, your policy lapses. In that case, all previous premiums also lapse. If due to any circumstances, you claim for the expenses after the policy is expired, the claim will be rejected.
As a policyholder, an expired health insurance policy is of no use, and you need to get it renewed every year. Sometimes, renewing the policy will allow you to pay a lesser premium. Thus, make sure that you do not miss the due date of your health insurance policy to enjoy its benefits. - Non-disclosure of Facts- Misrepresentation of data can be detrimental to life insurance claims. The claims are fulfilled based on the health disclosure you make. These disclosures are checked at the start of the policy and before the claim-made. If in any case, it turns out that some of the health issues (often family disease history) are not disclosed at the time of the enrollment, then there are higher chances of your claims getting rejected.
Thus, always fill the application form very carefully and fill in all the details like age, income, occupation, qualification, habits, family history correctly. These are the crucial factors in determining the premiums, and any incomplete or incorrect data can lead to false claims and suspension of policy benefits.
The best way to dodge surprises is to attentively read the policy terms and conditions and be familiar with all the exclusions specified in them. At Suraksha Insurance, we understand your insurance needs and analyze the same to help you choose the most appropriate policies to cover your risks. We offer our expert assistance in the prompt settlement of claims. Reach us at insurance@suraksha.seahwk.com for all your insurance needs.
