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Know The Reasons Why Cashless Mediclaim Policies Can Be Denied

There is a famous adage that states “Health is wealth”. However, with the fast-paced lifestyle, rising pollution, and hectic schedules, health has turned into a noteworthy concern today. Along these lines, it has become extremely significant for everyone to have health insurance irrespective of their income or age.

Health insurance is designed to offer a financial safety net for severe illnesses or injuries. Generally, the insurance company pays the claim to the hospital, especially in the case of cashless claims. However, the cashless claim can get rejected due to several reasons the policyholder is not aware of and could disastrously affect his/her contingency plan for the rainy days.

To avoid such a scenario, we have given below five reasons policyholders should be aware of when their cashless claim can face rejection.

Incorrect Claim Procedure

While filing for a cashless claim, a particular process needs to be followed, which includes:

  • Filling up the required claim form correctly
  • Attaching all the relevant reports and bills

In the event that there is a mistake from your side during the process, for instance, the claim form is incorrectly filled, or the relevant documents are not attached, the insurer cannot verify your application; which may result into a claim rejection.

Non-disclosure or Misinterpretation of Facts

The health insurance policy is issued on the understanding that the insured has stated all correct information in the proposal form. Therefore, if you lie about your medical condition or hide any vital information and it is later discovered that the claim aroused due to the same condition, the insurance company has the right to reject your cashless claim.

Conditions For Pre-Existing Illnesses

Generally, health insurance does not cover pre-existing diseases right from the commencement of the policy. Meaning, there is a certain waiting period, only after which the pre-existing diseases are covered by the health plan. Therefore, there are high chances that cashless claims related to a specific pre-existing condition will get rejected, in case the waiting period is not over.

Permanent Exclusions

There are specific conditions or diseases for which health insurance does not offer financial coverage. These conditions are called exclusions. Therefore, if the cashless claim is raised against any disease/medical condition that is excluded from the health insurance plan, it will be rejected.

To avoid such a situation, one must read the policy document thoroughly. In case of any doubt, contact the representatives of the insurance company and get it clarified.

Lapsed Health Insurance Policy

Usually, a health insurance policy is valid for a year, and it expires at the end of this period. Subsequently, policyholders need to get their policy renewed because, in the case of non-renewal, the policy lapses.

If the policy has expired and a cashless claim is raised, it will get rejected. Therefore, it is necessary to check the expiry date of the health insurance policy and renew it at the earliest.

All in all, to avoid cashless claim rejection, a policyholder must have a good understanding of his/her health insurance policy, right from the time of its purchase. It is additionally relevant to keep up a record of all the essential documents and bills, including hospitalization records, diagnostic tests, pre and post hospitalization expenses, discharge summary, etc. as these documents are extremely crucial during the claim process.

Bharti AXA wants all policy seekers to understand that the real purpose of having health insurance is to shield yourself and your loved ones from the expenses that follow a medical emergency. If purchased and maintained correctly, health insurance is nothing short of a blessing, particularly during difficult times.