pays for your hospital bills for diagnostics, surgery etc.
A Health Insurance is a contract which provides financial security to the extent of the sum which has been agreed in the policy. It not only takes care of the Hospitalization expenses but also other expenses such as pre hospitalization expenses, expenses on test and sometimes even medicines depending upon the terms and conditions of the policy.
Medical insurance may be a complicated Term as there are various terms and conditions which may differ from one person to another depending on their health. And unfortunately it's not very uncommon to hear the denial of health insurance claims.
Following are few of the reasons for denial of medical claims and health insurance:
The most obvious reason for denial of medical Claim is that the procedure, treatment or medication which has been undergone is not mentioned in the health insurance policy.
Each medical Policy may be unique. Before framing a medical policy your medical health is carefully scrutinized .If it is found that the claim has been made for an ailment which was pre existing and was not found to be disclosed then the claim amount may be rejected.
In order to have a successful claim it is very important to submit proper and complete documentation. For example, if all the required medical documents including doctor’s medical certificate is not provided then there are very bright chances of its denial.
Normally the intimation of hospitalization is mentioned in the policy and in most cases it should not be later than 48 hours. Hence if the insurance company is not intimated within 48 hours of hospitalization then it is possible that the medical claim may be denied.
One must be very careful while filling the form. If there happen to be clerical errors or silly mistakes such as wrong address or improper signature then it may lead to rejection of the claim amount.
Following are few of the ways to avoid medical claim rejection:
Remember to spend some time and read the policy carefully in order to clearly understand what all is covered. If something is not clear, it is advisable to talk to an Insurance Agent and get all your doubts cleared. Assumptions always invite problems.
Make sure to submit the medical claim within 7 days after release from the hospital. In case of post hospitalization expenses the upper limit of submitting the claim amount is 60 days.
Maintain a file where you must keep all the copies of all the important documents until the claim amount is settled.
Do not assume that medical insurance and the medical claim procedure may be similar for 2 different cases. Therefore in times of confusion always consult a professional insurance agent.
Keeping the above points in mind will certainly help in settling your medical claim amount and make things easy.