Health insurance policies always provide security to our lives. In these times when pandemics like Covid are intensifying, it is essential to take health insurance. However, we need to pay attention to several things while claiming health insurance. Health insurance claims are generally received on the basis of doctor’s certificate, standard protocol for treatment, documentation, and waiting period. However, in cases where these conditions are not followed properly, all claims will be rejected. Now let’s see in which cases health insurance claims are rejected
10 Situations in Which a Health Insurance Claim is Rejected
1. Insurance coverage is not available for risks not covered by any health insurance policy
2. A waiting period of 24 months to 48 months is applicable to get insurance coverage for current diseases when taking health insurance policies. Claims for past diseases can be made only after the waiting period.
3. Current disease details should be accurately informed to the insurance company while taking the policy. Otherwise, the claim amount may be denied.
4. Permanent execution is applicable in all health insurance policies. That is, there are hospital expenses that are never claimed.
5. Insurance coverage is not available for expenses incurred in the hospital or clinic, such as scanning, blood tests, etc. to detect or identify the presence of diseases.
6. To get an insurance claim properly, you must be admitted to the hospital. If you are treated as an outpatient, the insurance claim will be rejected.
7. Even if you rent rooms at a higher rate than the hospital fee mentioned in the policy, the insurance amount we get is likely to decrease proportionately.
8. Sub-limits are applicable in some policies. That is, the treatment costs of some diseases are already fixed in the policies. Due to this, the customer will only get the amount as per the policy, no matter how much
the treatment cost is.
9. Some other health insurance policies have a co-payment provision. That is, the policyholder has to bear a certain percentage of the treatment costs. The remaining amount will be received as an insurance claim.
10. The insurance companies have to submit sufficient documents and claim within the time limit set or the companies can reject the claim. Similarly, original documents of hospital bills, examination reports, doctor’s certificate, and discharge card must be submitted for the claim or the claim may be rejected.
Hospital insurance managers and third party administrators make various mistakes while settling claims. This adversely affects policyholders, so care should be taken right from the time of choosing a policy. In case the insurance claim is rejected without getting the due amount, the consumers can complain to the grievance cell of the respective insurance company. If even then they do not get a satisfactory solution, they can file a complaint with the Insurance Ombudsman’s Office or the Consumer Court.
Disclaimer: All posts are for educational purposes only. Opinions are personal. Before investing, please do your own research and seek the advice of a financial advisor if necessary. The risk is yours alone.
