While facing medical emergencies, health insurance plans for family serve as a financial shield and save you from undue stress. However, even a small mistake on the policyholder’s end can result in the rejection of the health insurance claim. Read further to know the reasons for claim rejection and the steps to prevent it.
What are the reasons for Health insurance Claim rejection?
When your insurance claim gets rejected, you must look for the reasons for the rejection and rectify your mistakes. Below are some factors behind claims rejection:
Exclusions refer to the medical expenses or conditions not covered by a health insurance plans for family. Most common exclusions are cosmetic surgeries, alternative treatments, self-inflicted injuries, pre-existing ailments, lifestyle-related diseases, and others. When a policyholder files a claim against the excluded treatments, their claim will get rejected by the insurance company.
If you file a reimbursement claim with an insurance company, you must produce original copies of the hospital bills and other documents. An insurer may reject a claim due to incomplete or incorrect documents.
Most health insurance claims get rejected if a policyholder has provided wrong or incomplete information. Some applicants don’t disclose their pre-existing diseases and medical history of a particular illness while purchasing an insurance policy. And, insurers reject their claims when they try to claim coverage for such conditions. It is always advised to fill in the correct information on a claim form, as insurers will eventually discover discrepancies during the verification process.
A health insurance policy may lapse if a policyholder stops paying the premium. In such a situation, any claims made against the lapsed policy will get rejected by the insurance company.
Delay in filing a claim
Insurance companies usually provide a specified period during which you must file a claim. If an insured submits a claim after the expiry of such period, an insurer will reject the claim. So, read all the terms and conditions mentioned in your insurance policy carefully and don’t wait too long to file a claim.
If you fail to provide proper documents to health insurance companies, they will not settle your claims. You must complete your paperwork and submit an insurance claim to avoid this.
What Steps to Take if the Insurance Claim Gets Rejected?
You can take the following steps according to your claim rejection reasons and get your claim approved.
Get help from a medical practitioner
You can get an opinion of a licensed medical practitioner to prove the importance of the medical procedure if the claim is rejected for the reason that the medical procedure wasn’t medically important.
The insured should speak to the health insurer’s customer service representatives to know the missing information needed. They will help you in identifying and submitting all the necessary additional documents.
You should check the documents or details in the insurance claim form to locate the discrepancies or mistakes. After identifying your errors in the claim form, you should correct them by submitting the correct details and required documents to the insurance company.
You should send a letter to the insurance company and re-appeal within the specified period. Remember to attach all the copies of the documents which are required to submit a claim.
What to Do When your Insurer Doesn’t Respond?
If the policyholder doesn’t get a reply from the insurance company within 30 days, he should approach Ombudsman. Ombudsman is an official person who investigates the complaints of individuals against the public authority. He is a mediator between the insured and the insurer and provides appropriate recommendations. The insured can also seek legal help and hire a lawyer.
How to Prevent the Rejection of Insurance Claims in Future?
You should always provide accurate information to the insurance company. If you are honest about your medical history and conditions, the insurer can offer you a policy per your needs and requirements. Suppression of even minor details can sometimes lead to the rejection of an insurance claim.
The policyholder should always choose an insurance company’s network hospital for medical treatment. Network hospitals offer cashless claim facilities, and all your medical expenses get settled directly by the insurer.
The best health insurance in India, insurance company doesn’t settle claims on a lapsed policy. So, you should pay health insurance premiums timely and don’t delay the policy renewal.
Maintaining all documents and records is essential to prevent a claim’s rejection.
If you don’t want your insurance claim to get rejected, you must avoid making the above mistakes and take corrective measures wherever necessary without any delays. Those who don’t have a health insurance policy should check out the best health insurance in India as per their needs to make an informed decision.