Why health and medical insurance policy claims rejected; How to avoid claim rejection

Health and medical insurance make sure about you and your family on an occasion of unexpected ailment or an accident. Also, this has never appeared as urgent and vital as it has been amidst this COVID-19 pandemic. In the present times, a policy is effectively available given that everything is essentially online. Even though one gets ensured health insurance claims, chances are that the equivalent may get rejected because of some reason you didn’t know about it. To keep this from occurring, we should look at the 5 most basic reasons for a policy rejection and guarantee that we are satisfactorily protected against a rejection.

Reasons for health and medical insurance policy claims may be rejected

1. Suppression or non-disclosure of ailments: Hiding pre-existing illnesses is one of the significant missteps made by those searching for the best health insurance policy. Expecting that the insurers won’t give insurance, numerous individuals abstain from uncovering their real health conditions. Coverage is given based on the data given by the proposer on the proposal form, so any error between the declaration and the truth during the time of documenting claims can without much of a stretch lead to rejection. The only solution to this issue is to be brief and explicit while filling forms.

2. Avoidances: This explicitly applies on account of COVID-19. If the policy strategy completely specifies that it doesn’t cover pandemics, your claim for COVID-19 treatment will be rejected. Likewise, a few policies don’t cover home consideration costs and pre or post-hospitalization costs like expenses of diagnosis of COVID-19. Ailments not secured under the health insurance policy will be referenced under the head prohibitions or ‘not covered.’ If you raise a claim against avoidance of your policy, it will be rejected. To dodge this circumstance, you should consistently read the policy document completely. On the off chance that you have uncertainty or don’t see any aspect of your policy document, you ought to contact the health insurance organization and get it explained.

3. Surpassing time limit: In a health insurance policy, you are needed to apply for repayment within a specific timeframe. Concerning crisis admission, the time allowed is 24 hours after the patient has been admitted, and in different cases, it can change as per the kind of policy you have settled on and the treatment being availed by you. If you don’t apply within the time determined, your claim can be rejected.

4. Going beyond the sum insured: When you select a health insurance policy or a personal accident policy, there is an insured sum included – regardless of whether it is a family floater or an individual health cover. Contingent on the picked plan, the whole insured is the sum accessible to you or your family consistently. Accepting that you have used your whole sum for a specific year, your ensuing credit only claims will get rejected. Notwithstanding, if an aspect of your sum guaranteed is as yet flawless, the insurer may furnish you with repayment at a later stage.

5. Incorrect documentation: You have to follow the claim process steadily. There might be examples of deficiently/erroneously filled application forms, absence of documentation, and so on. Wrong data, concealment, or deception of realities could likewise prompt rejection of the insurance policy. Incomplete or wrong disclosure of significant insights about age, medical history, occupation, income, and so on can undoubtedly prompt rejection of any insurance claim. It is advisable to connect with the insurance agency to comprehend their health insurance claim process. This will decrease the chances of claim rejection.

List for avoiding rejection of medical insurance claims

• Fill up the proposal form yourself. Read all the terms and conditions carefully before submitting it. On the off chance that any uncertainty, look to explain them from your insurer or agent.

• Never disregard the avoidance list. It has all the circumstances and cases that are not secured under the claim policy as per the rules given by IRDA.

• Be straightforward about any pre-existing medical conditions and don’t conceal it from your medical insurer. Complete medical tests whenever required and present the report to your medical insurer.

• For smooth claim settlement, it is essential to a trusted insurer about your hospitalization alongside doctor’s prescription, hospital, and medical bills quickly or within a specified time.

• Renewing the health insurance policy within the time will assist you with evading any bother at the time of claiming. Even though a 15-day elegance period is given by the insurer, it is significant for one to renew their policy heretofore.

• You should outfit every one of your bills from diagnosis to hospitalization, surgery, medications, and doctor’s prescriptions to your insurer for timely claim settlement, failure of which brings about claim rejection.

• You are qualified to get the claim just when you are hospitalized in the network hospitals. Network hospitals are the pre-approved hospitals that have tie-ups with insurance agencies.

It very well may be handily presumed that to avoid claim rejection, you ought to have a decent comprehension of your health insurance policy, in a perfect world from the time of its buy.