How to Avoid Medical Insurance Claim Rejection in India?

A health insurance policy acts as a financial shield that can protect you as well as your family in case a medical emergency strikes. The unpredictability of medical emergencies can destabilize not just your physical and mental health, but your financial health too. With soaring medical and hospitalization expenses, it is important to layout a safety net in the form of health insurance. It is essential that you pick the best health insurance and select a policy that insures you against several diseases and keeps your finances secure.

In the event of an emergency, you can claim your insurance in two ways: cashless and reimbursement. In case of the cashless facility, the insurer pays for the treatment like medicine, and pre and post hospitalization expenses directly to the hospital you were admitted to. On the other hand, reimbursement entails compensation for all the medical expenses you had to make during hospitalization by the insurer, for which you need to hand in your medical bills to your insurance company.

However, sometimes your health insurance claims may get rejected, defeating the entire purpose of the policy. There are generally legitimate reasons for health insurance claim rejection, and there are ways to avoid it as well. By following the specified rules and taking the right precautions, you can avoid getting your medical insurance claim rejected.

Main Reasons for Facing Health Insurance Claim Rejection and How to Avoid Them:

1. Pre-Existing Diseases

In the domain of insurance, pre-existing diseases are defined as health conditions that an individual has knowledge of and has faced prior to getting health insurance. Insurers are generally reluctant to provide insurance coverage to people with pre-existing diseases, and even when coverage is offered, the pre-existing ailments are only covered after a waiting period that lasts 3-4 years. As a result, fearing that they may not get insurance coverage, people might avoid disclosing their pre-existing diseases. However, this can backfire as you may face health insurance claim rejection by the insurer on the grounds of non-disclosure of the ailments.

In order to avoid this, remember to disclose all your medical conditions to the insurer; if required, get all medical tests done and submit the reports to the insurance company with all the necessary details.

2. Incorrect Information

The information provided by the insured in the application form is the basis on which coverage is offered, and the main point of reference for the insurer. However, in cases where people let their insurance agents fill out the application form on their behalf, the information may not be entirely accurate as the agents do not know your complete medical history. As a result, if the insurer finds any discrepancies at the time of claim settlement, the claim may be rejected.

To avoid this, fill out the form yourself and ensure that it includes the complete details of your medical history. Read the terms and conditions thoroughly and consult your insurer or agent in case you face any doubts.

3. Policy Lapse

If you have missed the premium due date or not renewed the policy in time, your claim could be rejected since insurers will only settle the claims as long as the policy is active.

While insurance companies may send reminders for renewal, it is your responsibility as a policyholder to keep track. You can also renew your policy during the grace period of 30 days after the due date when you can pay the premium.

4. A Delay in Informing the Insurer

Delaying informing the insurer about hospitalization may lead to having your medical insurance claim rejected. It is essential that you inform your insurer within 24 to 48 hours of hospitalization.

To avoid this, seek the insurer’s approval in advance if the hospitalization is pre-planned. In case of an emergency, proceed with the treatment and then inform them within the stipulated time.

5. Not reading the Exclusion List

The exclusions list includes all the possible situations and cases which do not have coverage under the policy. For example, treatment expenses for procedures such as dental treatment, transmitted diseases, infertility, weight reduction, etc. are generally not admissible for health insurance claims. If you face a situation that is mentioned in the exclusions list, your claim for the same may be rejected, leaving you stranded during an emergency.

In order to avoid this, ensure that you have read the exclusions list thoroughly during the application process.

6. Absence of Required Bills

If all your bills from the entire duration of the medical emergency are not submitted to your insurer on time during reimbursement, your claim may get rejected immediately.

To avoid this, you need to furnish all the required bills including those for surgery, hospitalization, medicines, prescriptions, etc. promptly and within the specified time. For this reason, it’s vital to maintain originals as well as duplicate copies of all the necessary documents.

Conclusion

Medical emergencies can burn a hole in your pockets and impose financial burdens that may take several years to get rid of. It’s of crucial importance to review all your options and compare them before finalizing the best health insurance. Even after purchasing a policy, you should be well-prepared for the claim settlement, which is the most important aspect of health insurance and the real saviour you will need in a dire situation. Reviewing all the possible hurdles you may face well in advance can help you have a hassle-free claim settlement. By taking these necessary steps, you will be able to enjoy the full benefits of health insurance.