How Will You Avoid Health Insurance Claim Rejection?

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Having a health insurance policy can make you feel secure at the time of medical crisis. With the cost of medical treatment and services going high every year, it is impossible to bear the expenditure by oneself without an insurance policy.However, if your claim is rejected then the purpose and usefulness of a health insurance policy is nullified.One of the most common reasons for this is that the person insured is not well aware about the insurance company’s guidelines and policy terms.

To confirm that you do not face any rejection at the time of Insurance claim, here are a few important factors that you need to pay attention to:

  • Never rush into purchasing a Health Insurance policy under pressure: If you are buying medical insurance from an agent they will pressurize you to rush into decisions for his or her own benefit. However you have to take care and make sure that you buy the right insurance plan and not get manipulated by the agent. Enquire the agent about the benefits and exclusions under the policy terms.It is often seen that agents only explain very few selected disclosures of the policy terms avoiding the important ones.
  • Know the exclusions and pre-existing disease clause well: A number of diseases are not included and covered under the health insurance policy.In case you file a claim for hospitalization expenses not being aware of this fact then your claim is directly rejected.Another instance for rejection is when you file a claim for hospitalization expenses due to pre-existing illnesses.Most of the health insurance plans have a waiting period of about three to four years before they can reimburse the expenses related to these particular diseases.Apart from preexisting illnesses some of the illnesses like fistula, piles, cataract etc. are not insured in the first year after purchasing the policy.
  • Incorrect personal or family information in the form: When you purchase a mediclaim policy ensure that all details you submit in the proposal form are factually correct and accurate.The proposal form of an insurance policy requires you to provide several details about your habits and pre existing health conditions. If by chance the information you provide is detected to be incorrect in future you have high chances of getting your claim rejected.For example if you are an active smoker it is necessary to disclose it because there are several scientific ways to determine your smoking habits whether it is at present or in past.
  • Malafide Intentions: A lot of people make an attempt to falsely acquire money by submitting fake claims which are highly inflated or absolutely false.There are private hospitals growing like mushrooms everywhere and it is often found that insurance with wrong motives collaborate with these hospitals for making money from insurance companies. Therefore the insurance companies carefully scrutinize and research a claim file and if malafide intentions are suspected then they have the right to reject the claim.
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The best option to buy a health insurance policy is through online portals of the insurance companies where you get a detailed understanding of the important features of an insurance policy’s terms and conditions. In case a Health Insurance claim is wrongfully rejected you can go ahead and challenge the rejection.

Shailesh Kumar

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