A list of reasons that can lead to the rejection of your health insurance claim
Customers buy health insurance with a mindset that it will rescue them from severe medical emergencies. But what happens when the claim is rejected? The setback of claim rejection can have major financial implications for the insured. The rising costs of hospitalization and medicines further intensify the apprehension, leaving the insured vulnerable.
You need financial support to recover from an illness or injury and medical expenses are the last thing that you want to be bothered about. To ensure that your claim is not rejected and you get reimbursed on time, you must adhere to these points before making a claim.
Waiting Period
Waiting period is the most common reason for health insurance claim rejections. Waiting period can be of different types depending on the insurer and policy. There may be an initial waiting period where a claim is rejected within 30-90 days of buying the cover. There may be a waiting period for pre-existing illnesses where the claim will get rejected within a specified period (usually 1-2 years) if the claim is made for the pre-existing illness. Besides, there may be specific waiting periods for medical conditions such as maternity.
Incorrect Information
It is probably one of the leading causes for claim rejections. The insurance policy is based on the details that the insured provides at the time of filling the proposal form. All insurance policies are based on good faith and the insured is expected to provide complete and honest information at the time of purchasing the policy. If any discrepancy is found or if an ailment is discovered, which was not informed to the insurer earlier, then the claim will be rejected.
Permanent Exclusions
Every insurance policy has certain permanent exclusions that will not be covered under any circumstances. These can be anything from certain diseases to treatments. Not all policies have the same content in their exclusion list. Therefore, it is advisable to go through the exclusions carefully to avoid unexpected surprises later on.
Lapsed Policy
It is important to keep a track of your premium payment due date. Paying premium on time is necessary for availing insurance cover. The policy lapses, if the premium is not paid by the due date. Claims filed under a lapsed policy will immediately be rejected, as a lapsed policy is similar to not having a policy at all. Besides, a lapsed policy will also result in the loss of all benefits accrued over years for not making a claim.
Delay in Making Claim
When an emergency strikes, even the most composed people lose their wits. At that time procedures and policies are the last things on a person’s mind. However, insurance policies require the insured to file a claim within 24 hours of hospitalization. Failure to do so results in the rejection of claim. Be sure the insurer is intimated within the stipulated time to avoid claim rejection and avail timely medical assistance.
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