We have all read the popular saying, “Health is Wealth”. However these words start making sense in real life when you feel the pinch of costly medical treatments. Today staying healthy has become a challenge for most due to the combination of pollution, unhealthy lifestyle, stressful schedules and contaminated food. This has made most of the people aware of the importance getting optimum health insurance cover. However, many a times, it so happens that your claim request gets rejected due to some reason or the other. In order to ensure that your claims do not get rejected in the time of need, you need to first understand the parameters behind it.

Reasons for Claim Rejection

Let us discuss some of the possible reasons behind claim rejection. Read ahead so that you make yourself aware and avoid future problems.

  • Pre- Existing diseases: There are many health insurance plans that do not cover the diseases that you may already have when buying the policy. As a result, if you require hospitalization due to these pre existing conditions, the health insurance company does not cover the treatment cost and your claim gets rejected.

  • Going above the insured sum: Whenever you opt for a health insurance or personal accident policy, there is the involvement of insured sum- both for individuals as well as family floater plans. Depending upon what plan you choose, this sum insured is the amount that is available for you and our family on an annual basis. Assuming that you have utilized the entire amount in a year, any further claims shall be rejected by the company. However, in case some of your insured sum is still left, the health insurance company may reimburse it to you at some later stage.

  • Processing of the Claims: A health insurance is in essence just a contract between the insurance company and you. In order to reduce any chances of claim rejection, it is important to follow the process of the claim diligently. This causes increased instances of incorrect or incomplete application forms, lack of right documentation and many other problems. In order to ensure complete understanding of health claim process, it is best if you get in touch with the company itself. This will help in reducing the chances of many rejections.

  • Waiting period: Many health insurance plans have a certain waiting period that requires you to wait for a certain time for availing some benefits of insurance cover. For example, maternity benefits and pre existing diseases are included in some policies after a couple of years. The duration of this wait depends upon the terms and conditions of insurance company. Thus, if you raise a claim during this period, it is sure to get rejected.

  • Non consideration of exclusions: There are certain medical conditions mentioned in your insurance contract that are not covered under the policy. These are the diseases that are referred to as exclusions. So, if you file a claim for these excluded conditions, it is sure to get rejected.

Remember, a health insurance plan need to be understood properly at the time of purchase so that you choose the one that best meets all your requirements. In addition, maintain a record of all your hospitalization documents, diagnostic tests, reports and discharge summary to avoid any later issues in claim approval. In order to get more information , drop your query with our experts for best advice [email protected]



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