It’s been over two years since we heard the word “coronavirus” for the first time. We have seen our family members spending days on the hospital bed. We were distressed about their recovery. On top of the mental stress, the medical expenses of their treatment added the stress of finances. During these unprecedented times, it was health insurance that came to the rescue of many. The insurance sector aided patients as well as their families in reducing the financial burden. Insurance companies received a huge number of health insurance claims.
Reasons for Health Insurance Claim Rejection during COVID-19
- Non-disclosure of pre-existing diseases: Pre-existing diseases like diabetes and hypertension have not been disclosed, therefore insurers may decline claims.
- Problems related to the documents: Customers sometimes fail to give proper documents which leads to the rejection of claims.
- Needless Hospitalization: Claim was denied when people opted to get admitted to the hospital instead of opting to get treated at home only and there was no need to be hospitalized.
- Exaggerated claim: Falsely inflating the value of the claim to receive more from the insurer can be the reason for claim rejection
- Not following a standard procedure of treatment can lead to claim rejection.
One of the cases which we handled related to the rejection of health insurance claims during Covid was
A customer’s mother and brother were hospitalized as they were suffering from covid-19. Both the patients had a health insurance policy. He intimated his insurance company for the claim, and the company rejected it. The reason stated by the insurance company for claim rejection for his mother was a pre-existing health issue. According to the company, his mother had diabetes and hypertension, before buying the health policy. In the case of his brother, they stated that there was no need for hospitalization.
However, the customer claimed that both mother and brother did a pre-medical check-up before the issuance of the health insurance policy. His brother’s case was serious. Doctors advised to hospitalize him immediately as he was suffering from high fever, breathlessness and uneasiness etc. Since the case was severe, he was admitted to the hospital for a month. He felt that it was an unfair rejection of the claim. For over 6 months, he had an email trail with the insurance company, but nothing happened.
He watched the episode of Shark Tank and learned about Insurance Samadhan. He immediately got in touch with us about his mother’s case. After understanding the case, we helped the customer and guided him on how to approach the case and talk to the insurance company. Within 20 days from the acceptance of the case, he got his money back. Thereafter, he approached us with the second one, which was his brother’s case. Under our guidance, he successfully received 50% of the claim amount in the first attempt. Then, from Bhopal Ombudsman’s office, he got the balance amount. He was highly satisfied with our service. He found the team of Insurance Samadhan supportive and honest.
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