We can never gauge the medical emergencies that can come our way. For that reason, it is important to have health insurance which is also known as medical insurance. Health insurance covers medical coverage in case of hospitalization for more than 24 hours.
Health insurance is one of the best ways to make sure medical bills due to illness, surgeries or accidents are covered. But what if your medical claims get rejected? How can you avoid such a situation?
Understanding the different reasons for claim rejections
Having a health insurance policy and not understanding how to claim or various reasons why a health insurance claim may be rejected is futile. Know situations in which your health insurance claims may get rejected. Say goodbye to the problems faced during the claim settlement of your mediclaims by keeping a track of a few simple things. Here are a few reasons why your health insurance claims may be rejected:
#1. Wrong information
If there is an unintentional error while filling the form like the age, occupation, income details or any other information sought during the application will lead to not just rejection of the claim but also termination of the policy.
#2. Non-disclosure of medical history
The health insurance claims have a high chance of being rejected under the circumstances where the policyholder hides their medical history. Health insurance companies don’t cover pre-existing diseases such as high blood pressure, diabetes, and a few more. Hiding medical history is usually practiced to avoid rejection while purchasing a health insurance policy. However, doing so will certainly lead to claim rejection.
#3. Lapsed policy
People often delay renewing their health insurance policy. If the policy lapsed due to failure in payment of the premium and the policyholder’s claims during such a time period, then that would lead to claim rejection. For a successful claim, your health insurance policy is required to be functional and not lapsed.
#4. Delay in filing the insurance claim
Health insurance claims can be rejected in a situation where the policyholder or the relatives of the policyholder files the claim beyond the time limit. Usually claims are to be filled within 7-15 days after being discharged from hospital.
#5. Ignoring the exclusions of the plan
Along with exclusion of pre-existing disease for a particular time period, there are
other exclusions also come along with certain plans. Policyholders usually miss out on reading the terms and conditions that specify various exclusions. Some of the exclusions are being hurt or injured due to being drugged or under the influence of alcohol. Similarly, there is a standard waiting period of at least 30 days from the date of purchase of the policy. So if a policyholder makes a claim during this duration, it may lead to claim rejection.
How can you prevent your claim being rejected
To avoid hassle at times of medical emergencies, it is important that your health insurance claims are not rejected. Now we know what are the circumstances when your health insurance claim can be rejected. Here are a few ways by which you can prevent your claim being rejected:
#1. Paying premium regularly
Health insurers settle your mediclaims only under the condition that your premiums are paid within the grace period. To avoid rejection of your claim, it is advisable to pay premiums regularly without fail.
#2. Keep relevant documents in hand
It is always advisable to keep the policy documents with you at the time of making a claim. Missing documents can lead to claim rejection. The policyholder must have all the documents of the policy drawn from that particular insurer company.
#3. Choose network hospitals
During medical emergencies, people get admitted to nearby hospitals that are not listed under network hospitals of the insurance company. In such a scenario, they have to opt for reimbursement. Choosing network hospitals reduces the process of reimbursement and also the claim settlement is handled at ease.
#4. Provide accurate information
It is advisable to be transparent about minute details of pre-existing disease, occupation, family history, and a few more details. Providing accurate information while purchasing a health insurance plan eases the claim settlement.
Conclusion
The sole purpose of purchasing health insurance is to provide financial support to uncertain medical expenses for you and your family. To avoid having a situation where your mediclaim is not approved, it is advisable to keep a check on the above listed points.
You can also visit MyInsuranceClub, our certified insurance advisors will guide you through in choosing the best plans.
