Most of us buy insurance as a precaution against any misfortune. It provides a safety net to help us sail through in our difficult times. But all this planning can go in vain if the policy fails to serve its purpose when the need arises. Nothing can be worse than a health insurance claim getting rejected by the insurer at a time when it is needed the most.
To avoid landing in such a situation, it is important to understand some of the key reasons for rejected medical claims. This will help you ensure that you don’t repeat the mistakes, as well as take extra caution regarding certain elements of the medical policy. So, let us take a look at the major health insurance rejection reasons:
Insurance policies provide protection against uncertain events that may occur in future. Pre-existing diseases, meanwhile, are ailments that already exist at the time of buying a health policy. Therefore, insurers usually do not provide any coverage for treatment of pre-existing diseases. This restricts people from buying a health policy just before the time they are supposed to spend money on a pre-planned treatment. So, most of the claims that are related to any pre-existing illness such as arthritis, kidney stones, high blood pressure etc. are immediately rejected.
The biggest mistake that policyholders make is not reading the exclusions mentioned in the policy document. Exclusions refer to the healthcare expenses that are not covered under the policy and would have to be borne by you. They may vary from plan to plan and insurer to insurer. Raising a claim for expenses that are excluded by your policy would result in it being rejected.
Not renewing the policy on time
Policy lapse is one of the biggest reasons for rejection of Mediclaim. Health insurance policies are usually valid for one year and are supposed to be renewed annually. In case you forgot to renew the policy on time and, meanwhile, fell sick during that period, your policy would be rendered useless and your claims would be rejected.
Not informing the insurer on time
Most insurance providers usually put up a condition that they should be informed about hospitalisation of the policyholder within 24-48 hours in case a claim has to be raised. Failure to do so may result in the claim getting rejected.
Incorrect or incomplete claim process
The claim process involves filling up multiple forms and submitting supporting documents like hospital bills and certificates. Submitting incomplete or incorrect information in the claim form or not attaching required proof of expenditure will definitely get your health insurance claim rejected.
Exceeding the sum insured or sub-limits
Most people may not know the sum insured of their policy. Sum insured is the maximum amount that the insurance company can pay to the policyholder in case of hospitalisation or an eventuality. There can also be sub-limits on expenses related to room rent, etc. Claims raised for amount exceeding the sum insured or sub-limits are rejected by the insurer.
Health insurance policies do not pay for any expense related to the treatment of any illness within the first 30 days of buying the policy, irrespective of the insurance provider. Only claims arising due to an accident can be considered during this period, better known as waiting period. This waiting period can be longer for certain types of critical illnesses or maternity benefits as well. Filing a claim during this waiting period leads to Medicare claim rejections.
If you do not want to be a victim of rejected medical insurance claims, make sure you empower yourself with correct information. Read your health insurance document carefully and familiarise yourself with the policy coverage and all the relevant terms and conditions.
Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.