Categorized | Health Insurance

How to Avoid Rejection of a Health Insurance Claim

As healthcare costs are soaring high these days a rejection of your Claim means the entire purpose of buying a medical insurance is defeated. Besides, it could also give you a sense of being cheated. While insurance companies have proper guidelines to accept or reject a claim in most cases of rejection it is found that the Insured is not fully aware about the Policy terms.

To make sure that you do not have to pass through this pain of rejection, there are a few important things that you need to take care of.

1) Do not hurry into buying a Health Insurance policy

An Insurance Agent has all the reasons to hurry you into buying a medical insurance from him. However, you have to ensure that you are not carried away. Before buying a policy, you should enquire from the agent about both the benefits that are available under the policy and also those benefits which are not available (commonly referred as exclusions). It is quite common to see agents opting for a selective disclosure while they explain the policy terms.

2) Be aware about the Exclusions and Pre Existing disease clause

A host of diseases are excluded and not covered under the medical insurance policy. If you are not aware of these and file a claim for Hospitalization expenses owing to any of these diseases, your claim stands to be rejected outright.

The other important reason for a claim to be rejected is, filing a claim for hospitalization due to a Pre-existing disease. Most health insurance policies have a Waiting Period of 3-4 years before they would allow Reimbursement of healthcare costs related to these diseases.

Besides pre-existing disease, a certain types of disease like (fistula, piles, cataract etc) are not covered in the first year after the purchase of a policy.

3) False representation of personal / family information in the Proposal Form

While buying a mediclaim, be sure that all details submitted in the proposal form are not only accurate but also factually correct. The proposal form would ask you several details on your habits and existing health conditions and if these are found to be incorrect at any point in the future, you run the Risk of claim rejection. If you are a regular smoker, it is wise to disclose it upfront. Remember there are scientific ways to determine whether you were a regular smoker in the past or not.

4) Suspected malafide intention

A few people attempt to make money by submitting incorrect claims, which are either highly inflated or completely fake. With so many private hospitals on the market, it has been found some insurers collaborate with these private hospitals for making money from insurance claims. If the insurance company suspects such a malafide intention, it has the right to reject a claim.

A smarter way to buy a health insurance policy is through an online portal, which will help you get a more thorough understanding on the important features in a policy.

In a few cases, a health insurance claim may also be wrongfully rejected and people have a right to appeal the rejection.