5 Reasons Why Your Health Insurance Claim Could Get Rejected

Medical bills have become expensive with time and many people cannot afford to get the desired treatment due to lack of money. But if you purchase a good medical insurance policy, you wouldn’t have to worry about bearing the costs of hospitalization. However, it is essential that you know how the claim process works, because there are chances of your claim getting rejected as well. In this case, you will have to face some troublesome situations and pay from your pocket. The circumstance is avoidable if you know the exact reasons why your claim can get rejected.

Following are the top 5 reasons:

1. Postponement in the filing of the claim

This is the first and most important point that people overlook; they tend to forget informing their preferred insurer on time. If you notify the insurance provider early, you avoid any kind of fraudulent claims. Either you or a representative must inform the insurer regarding hospitalization in the stipulated period as instructed by your insurer. You need to do the same in case of planned hospitalization, in fact in this case, you are expected to inform them at least a week prior. If you miss the given deadlines, your claim maybe rejected.

2. Policy lapse

Many people tend to forget the date of healthinsurance renewal, which leads to policy lapse. In case you don’t renew your policy on time, you may lose the continuous cover. If you file a claim with an expired health insurance policy, your claim will be rejected. Therefore, always renew your policy before it expires, to avoid claim rejection.

3. Pre-existing condition

Many insurers do not provide coverage for pre-existing conditions as soon as the cover starts. To avail it, there is a waiting period that you need to pass, which will vary for different insurance companies and different illnesses as well. To get a better understanding of the same, go through your policy document carefully. In case you file a claim before completing the given waiting period, your claim will be rejected.

4. Stating incorrect facts/ hiding

Your insurance provider will issue a health insurance policy based on the disclosures you make. The same will be checked when you file a claim. In case you make any misrepresentations or hide certain facts while enrolling the policy, your claim will be rejected. For instance, if you hide a family medical history which was important for the insurer to know, and they find out during claim verification, they might rightfully reject the claim request.

5. Filing claim against excluded expenses

Every health insurance policy won’t cover all the medical expenses. Certain expenses might have a cap on the amount which can be claimed. You must know, situations that arise from alcohol or drug abuse, or even self-harm cases etc. do not get covered by most health insurance policies. And if the claim isn’t mentioned in your policy’s list of exclusions but you file a claim against it, your request will get rejected. Therefore, to be certain of what’s included as well as excluded in your health insurance policy, make sure to go through the policy document thoroughly.

There are various types of health insurance policies that you can choose from online. But before buying, check the claim settlement ratio of the insurance company you’re opting, along with the claim process. Looking at the lifestyle and busy schedules, nobody has the time for long and tedious claim processes. Go for the company that has a smooth one and is available 24×7 to solve any queries.

Jennifer Eonflux