Health Insurance Claim: Health insurance claim has been rejected, know here the exact way to get the claim – how to avoid rejection of health insurance claims
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policy term
Most health insurance plans are time bound contracts. Renewal is required every year to keep these policies in force. Sometimes, policyholders do not realize that their contract has come to an end. This comes to light only when their claim is rejected, and it comes as a big shock to many. Note that if the policy has lapsed then the insurance company is not liable to pay the claim. To avoid such bitter experiences, it is important that the insured ensures that he/she keeps a close track of policy renewals and makes sure that he/she is fully covered. If you have missed renewing the policy, then you need not panic, most of the insurance companies provide a grace period of 15 days during which you can renew the policy without losing the benefits earned during the policy term. However, any claim arising during the break-in period will not be entertained by the insurance company.
non-disclosure of existing diseases or other information
It is very important to disclose pre-existing diseases or conditions in the insurance policy. Such as whether the insured person has blood pressure, heart disease, hypertension etc. If anyone has had any major surgery in the past, it should also be disclosed. It is also important to disclose any new medical condition or illness that may have occurred in the recent past at the time of insurance renewal. In a health insurance policy, it is extremely important to share health-related details honestly with the insurer to avoid hassles at the time of claims. Certain pre-existing diseases result in permanent exclusions or may materially affect the decision to accept the offer. So it is important to disclose these details.
waiting period
The waiting period in health insurance refers to a pre-determined time period in the policy. The claim cannot be made for the specified disease or condition during this period. The waiting period starts with the inception of the policy and varies from insurer to insurer and disease to disease. The policyholder has to complete a waiting period before the insurer becomes liable to pay for the mentioned illness. The policyholder should go through the waiting period clause of the policy thoroughly to get clarity about the duration of the waiting period for certain diseases. If the claim is made during the waiting period, it will be rejected.
If the illness is not covered by the policy
All insurance policies clearly mention the list of coverage and exclusions and if the policyholder makes a claim for a disease which is specifically a part of the exclusion list, the claim will be rejected. Hence, one must go through the list of exclusions at the time of purchasing the policy to know what is not covered in the policy.
claim over time
Insurance policies mention a specified time limit. Within this, the policyholder should claim. Usually the policy allows a period of 60-90 days from the date of filing the claim. Failure to adhere to this deadline may result in claim rejection. Hence it is wise to file the claim immediately after discharge. The insurer can accept the claim for the actual or genuine reason for the delay in making the claim.
lack of documentation or incorrect documentation
Sometimes claims, especially reimbursement claims, get rejected due to missing or misplaced documents. In such a situation, the policyholder has to submit all the original documents, test reports, doctor’s consultation letter and other necessary documents along with the duly filled claim form to avoid any problem. After filing the claim early, if there is any paper shortage, the insurance company informs it. So that you submit all the papers within the time limit.
Select preferred network hospital
To ensure smooth claim settlement, it is advised that you choose a preferred network hospital for treatment. There you can avail cashless facilities, get better rates, waiver on certain charges and other non-insurance items at these hospitals. Most insurers have an empaneled network of hospitals spread across the country. It helps in hassle free claim settlement. Even if a policyholder claims reimbursement and they have filled the claim documents properly and submitted all the required supporting documents, they will not face any major issues with the claim settlement. As long as the claim under the policy is admissible and valid, the claim will be paid and the policyholder should be rest assured about the same.
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