Reasons for Rejection of your Health Insurance Claims
8 Feb 2018
What Are the Reasons for Rejection and Escalation for your Health Insurance Claims?
A family health insurance secures you and your family in an event of sudden illness or an accident. Today, medical bills and medication is expensive and increasingly becoming unaffordable. This is exactly why you need to apply for and have a health insurance policy in place.
Though one receives guaranteed health insurance claim, chances are that the same might get rejected due to some reason you were not aware of. This could have a disastrous effect on your contingency plan for the rainy days.
Here we identify the reasons for rejection of a health insurance claim:
1.Zero Knowledge of the Pre-existing illnesses
Family health insurance policies do not cover pre-existing illnesses in the initial period. The initial period ranges between three to four years. For instance, someone suffering from high blood pressure will not receive claim in the first few years. But what is a pre-existing illness?
A health condition or illness that exists before signing the insurance contract is a pre-existing illness. Hypertension, obesity, diabetes and cataract may be considered as pre-existing illnesses. It is recommended that one checks the terms and conditions of pre-existing illnesses with the said insurance company before finalizing a health insurance contract. It is mandatory that you declare a pre-existing health condition or illness.
2. The Terms and Conditions of the Policy
Make it a point to read the health insurance policy, word by word as the legal language of the policy can be complex to understand. The applicant should read through the health insurance form to know the exclusions, understand the coverage limits, and other terms and conditions.
3.Lack of Correct Information
Another major reason for rejection of claim by the health insurance company is the provision of incorrect information by the insurance holder. Many a times it so happens that the application form is filled by an insurance agent. Now an insurance agent may not have detailed knowledge of your medical history due to which the health insurance company in question rejects the claim. To receive a timely claim, ensure that you have provided correct details in terms of the name of the patient and the doctor, correct set of papers, hospital bills and other relevant information. Therefore, be meticulous about filling the health insurance form as this will benefit you in the long run.
4.Room Rent Sub-limit
Room rent also is one of the factors taken into consideration for the health insurance claim. The cap on reimbursement of the claim is set as per the room-rent limit. Usually it is recommended to select a hospital room with rent equal to one percent of the insured sum. For example, if the sum insured is Rs. 2, 00,000 then the room rent should be Rs. 2,000 in a worst-case scenario.
5.The Insured forgets to renew the health insurance
Always remember to renew your health insurance policy before the due date. If you forget to renew the policy, the claims filed during the waiting period i.e. the start date and the end date won’t be taken into consideration. The Insurance companies generally sends the renewal reminders in advance. But it will be wise on your part to keep in mind the due date and renew the policy.
The insured customers file escalations against the health insurance company when the latter rejects payment of claims due to any one of the above reasons. To avoid such tricky situations, it is strongly recommended that the insured should have thorough knowledge about the health insurance policy and the insurance company in question.
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