Health Insurance Plans

pays for your hospital bills for diagnostics, surgery etc.

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How to Prevent Rejection in a Health Insurance Claim

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Numerous factors can contribute towards rejection of Health Insurance claim. An insight into them will lead to adoption of proper means to steer clear of such hurdles.

Deficiency of knowledge

Customers are caught unawares about the Policy Exclusions as they are disinclined to pore over the health Coverage plans’ terms and conditions during purchasing. This costly mistake drives your attention away from policy Term when you specifically act in disregard to it. The agent in haste to make commissions often keeps you in dark about the limitations.

You should thoroughly go through the policy conditions and seek clarification about cryptic clauses to avoid Claim rejection. You should utilize the free look up period offered by insurance company to cancel the policy if you discover that the policy terms deviates from the understanding instilled in you by the agent.

Facts not disclosed

A significant contributor for denial of insurance cover is non-disclosure/partial or wrong disclosure of facts pertaining to existing diseases, occupation, income, medical conditions etc. Any deviation from facts stated on the Proposal form at the time of filling often leads to declining of coverage.

The solution lies in understanding the consequences of hiding or providing incorrect information when applying for a product. Every health policy operates based on Underwriting principles that draw the information furnished by you. If you are prospecting a suitable policy, divulging all relevant information is crucial.

Proposal form disparities

Inadvertent errors creep in the proposal form owing to the dependence of customers on intermediaries for filling up the proposal form. The intermediary is unaware of accurate details and blunders happen in the declaration form. When you buy health insurance with incorrect representation of materially vital facts, the Insurer rejects your claim upon verification of the same in detail.

The solution lies in filling up the declaration form by yourself rather than relying on the expertise of agents. Only authentic documents should be submitted while purchasing the policy. Document submission should happen in an orderly manner on time. After receiving the policy papers bundled up with photocopies of the application form and relevant documents, go through them intently to check the veracity of papers filed with the insurance company. Any discrepancy should be brought to the notice of company and rectified instantly. Remember, laws also enable insurer to repudiate the claim if it proves that any vital information has been withheld by the Policyholder during renewal or purchase of policy.

Excess expenditures

Insurance company often reject claim stating that the medical procedure undergone was not mandatory. It has now become a trend, earnestly followed by private medical facilities to subject the patient to unnecessary medical procedures in pursuit of more revenues. It assumes a more severe form if the facility comes to know that the patient is paying health insurance premium. The policyholder assumes on misunderstood grounds that the entire expenses would be borne by the insurer. Certain consumers also present inflated claims through the doctors by outrageously distorting the actual expenditures incurred. The irregularities float in sight upon investigations conducted by the health plans provider.

The solution is to limit the procedures to fulfill the conditions stipulated when you buy health insurance.