Why Health Insurance Claims Gets Rejected

Health insurance and medical insurance policies are generally bought for having a financial cover during medical exigencies. The user buys these policies so that the insurance company can take care of his or her medical expenses of hospitalization and eases the user’s financial burden. The user, though, has to pay an annual premium to the insurance company against the policy he or she has taken, but that is much less in comparison to the hefty bills of the hospital they have to pay.

But the worst nightmare of the policyholder comes to life when the insurance company rejects the claim of customers. In this scenario, an ugly dispute rises between the customer and the insurance company. The rejection of the company to honor your claims can be quite disturbing and can put an unnecessary financial burden on you. Insurance claim rejection can lead to mental and monetary stress on you. There are certain things you need to check if your insurance claim gets rejected.

Claim process

Insurance policy is a monetary contract signed between you and the insurance policy. There are some processes that you have to follow diligently while claiming insurance money. There might be issues like incomplete or missed out information while filling insurance forms, lack of documents, etc. It is suggested to contact the insurance company to comprehend with their claim process. It will help in reducing the chances of rejection.

Preexisting diseases

There are some diseases or ailments that are not covered by the insurance company which you already have. In case you fall sick due to such illness and need hospitalization, the health insurance company won’t cover the cost of treatment. In such situations, if you apply for a health insurance claim, there are high chances that it might get rejected.

Period of the policy

Generally, health insurance or medical insurance policies have a validity period of one year. After a year, the policy gets expired, and it becomes useless. Hence, the policy needs to be renewed to use it further. Besides, each time you renew the policy, you have to pay a lesser amount of premium. If you make a claim after the policy has lapsed, your claim is bound to get rejected. Hence, always pay attention to the renewal date and renew it on time.

Waiting period

When you purchase a health insurance plan, you have to wait for a certain period of time before you can avail of its cover. For instance, some insurance policies cover preexisting diseases or maternity benefits after a cooling period of a few months or years. The time depends on the terms and conditions of the insurance company. If you make a claim within the waiting period, there are high chances of claim rejection.

Exclusions

Health insurances are meant for providing your financial coverage during hospitalization. But there are few situations due to which you cannot raise a claim. These conditions are known as exclusions. You need to read the policy documents thoroughly to avoid such situations. In case there is some confusion on the terms and conditions, then get in touch with the insurance company and get it clarified.

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