Categorized | Health Insurance

how to avoid claim rejection in health insurance?

Health insurance or Mediclaim policies are fundamentally a contract between the Policyholder and an insurance provider. This contract provides financial protection for you in case of medical emergencies such as accidents, paralysis, death and so on. Life in many of our cities is too busy and diseases like hyper-tension, diabetics and cancer are fairly common these days. A health Policy provides you a cushion from the financial implications that you might incur due to Hospitalization in case of medical emergencies.

Knowing the importance of a mediclaim policy, you must have purchased the best Health Insurance policy in town. You are confident that when in need, you and your family are financially secure. However, in reality, you are jittery during the actual filing of the insurance Claim as you are unsure if your claim will be accepted. This could be primarily because you have come across instances of claims rejections, and there seemed to be no valid reason for doing so.

Therefore, it is extremely important that you are honest in your declarations and abide by the policy terms and conditions. You must not give the Insurer an opportunity to reject your claim. You must follow all rules, policies and procedures given in the insurance documents. If you give accurate information and follow the rules, there are adequate set of laws to protect your rights as a customer.

No insurance company would like to spoil its reputation by rejecting claims. However, insurance companies have a duty towards policyholders to make certain that only genuine claims are accepted. Most insurers therefore have measures in place to ensure that only true claims are taken care of and bogus ones rejected. Genuine policyholders will otherwise suffer by paying higher insurance premiums.
 
Why Claims are Rejected

There could be a lot of reasons why claims are rejected. Here are the main reasons why things could go wrong:

Incorrect or incomplete information

These could be regarding your age, occupation, income, treatments taken earlier and so on. This is primarily because your sum Assured depends mainly on these factors.

Non-disclosure of Pre-existing illnesses
 
These could be largely life-threatening ones such as regarding Cancer, HIV, brain, ailments of the lungs heart or liver, smoking and drinking habits and so on.

Coverages and exclusions

You must be well aware of all coverages and Exclusions regarding illnesses so that your claim is a genuine one.

Procedure deemed medically unnecessary

If found later that a procedure such as cosmetic surgery was medically unnecessary, your claim could be rejected.

What You Must Do

Here are some important things you can do to keep your insurance claim clean and hassle free:

You must know your plan and its benefits, and understand the contract terms and conditions, coverages and exclusions well.

Submit all claim documents in properly filled in, accurately and truthfully, and in a timely manner.

Ensure that nominations are made in the contractual documents, the nominations are correct, and the nominee knows all the details regarding the nomination.

You may also look at claim settlement ratios of insurance companies whose products you are planning to buy.

A health insurance claim normally arises in cases such as treatment of an ailment or permanent disability. While you cannot change the situation, a claim reduces the financial burden on the family to a great extent, especially when the Insured was the sole breadwinner. A swift, easy and hassle-free claim settlement incident only assumes greater significance under such circumstances.