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How to avoid claims rejection in health insurance? 

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Nothing is more disheartening than being rejected by your health insurer. so we decided to write on how you can avoid claim rejection in health insurance? 

How to avoid claims rejection in health insurance? 
How to avoid claims rejection in health insurance? 

The Covid-19 pandemic was a big lesson in health insurance for many. While it did create awareness around the need for having a health insurance policy, it also served as a crude reminder as to what may go wrong when buying a health cover that may lead to claims rejection. Even as you are covered under a health plan, you can’t be sure if it will protect your pocket in case of hospitalization. Why? Because understanding policy features are complex. More often than not even an insurance agent may not be knowledgeable enough to explain all details. Caveat emptor (let the buyer beware) is the basis of insurance. We tell you key points to keep in mind when buying a health insurance plan:

  • Pre-existing diseases

If you are already suffering from a disease, you have to disclose it to the insurer. This may lead to a hike in insurance premiums or rejection of the proposal altogether. This is the reason why some agents may convince customers to lie about pre-existing diseases. They want to close the deal to earn a commission. Just buying an insurance policy is not enough. You have to be transparent. If the insurer figures out at the time of the claim that you had not disclosed a pre-existing disease, your claim will get rejected surely.

  • Know all exclusions
Also Read:  Can claims be rejected?

You must have a deep understanding of what all is excluded in your policy. You should go through the exclusion section in your policy brochure thoroughly. Clear all your doubts, if any.

  • Know policy limitations

If you have a policy coverage of, say Rs 5 lakh, it does not mean that hospital expenses up to Rs 5 lakh will be covered entirely. There could be a disease-specific limit that the treatment cost of a particular disease will only be covered up to Rs 1 lakh even as it may cost you more. Similarly, there are room specific limits also. For example, if your policy has a daily room rent limit of Rs 8,000, but the room where you got admitted costs you Rs 10,000, the balance Rs 2000 will not be covered under insurance.

Besides, you should check the credentials of your insurance agent. Keep his contact details safe. Ultimately, despite all your caution if your claim gets rejected, you should write to the insurance regulator. You may reach out to Insurance Samadhan to contest the rejection of a claim.

What to do if your health insurance claim gets rejected by an Insurance Company?


Ultimately, despite all your caution, if your claim gets rejected, the best way to resolve this is to reach out to the Insurance Samadhan via their website or call on 844-844-0626 or Whats app on 7799058555. Alternatively, you can also visit the IRDA website.




Aprajita Sharma

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