Why health insurance claims get denied! Know these details – Times Now

How to avoid getting health insurance claim rejected

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When buying a health insurance policy for yourself or any of your family member, you must make sure that all terms and conditions are fully understood. All insurance policies come with certain riders and conditions with regard to processing of claims, and health insurance is no exception.

Buying a health insurance policy is an amazing way to safeguard your hard-earned money in case you need to avail medical treatments. Nowadays, this process has become easy due to various options available to buyers. A policy can be bought easily, even online, but when claims are raised, are they always settled? There could be various reason due to which a claim might get rejected. We will discuss these possible reasons.

Top reasons behind health insurance claim rejection:

Claim process

Since a health insurance policy is a contract between two parties — you and insurance company, you must follow the claim process diligently. Many a times, it is seen that insurance buyers incompletely or incorrectly fill application forms. There may be lack of documentation, etc. It is advisable to clear every doubt by asking the agent or insurance company representative questions you have in your mind regarding the policy you are supposed to buy. This will reduce the chances of claim rejection.

Pre-existing diseases

Some health insurance plans do not cover any diseases you already might have while buying the policy. If you fall ill due to these diseases and require hospitalization, your health insurance company will not be able to cover you for the cost of treatment. Thus, if you raise a health insurance claim, there are high chances that it will get rejected.

Policy period

A health insurance policy is usually valid for a period of one year. At the end of one year, the policy gets expired. So, you need to get the policy renewed. Renewal of a policy comes with other benefits as well. For example, you might have to pay a lesser premium. But if you do not renew your health insurance policy, it will lapse. If you are unaware that your policy has expired and you raise a claim, it will get rejected. Thus, you must make sure to check the expiry date of your health insurance policy.

Waiting period

A waiting period with respect to a health insurance plan means one has to wait for a certain period of time to avail the insurance cover. For example, some insurers cover pre-existing diseases or maternity benefits after a waiting period of a couple of years. This duration de-pends upon the terms and condition of the insurance company.

Exclusions

Health insurance comes with a financial cover against illness. However, there are certain conditions under which you cannot raise a claim. These conditions are called exclusions. If you raise a claim against an exclusion of your policy, it will be rejected. To avoid this situation, you must always read the policy document thoroughly.