Situations Where Your Health Insurance Claim Can Be Rejected
Many of us tend to ignore the last prints of our insurance policy whether it is health insurance or term insurance. However, this happens because of two reasons. Either there’s a lack of awareness and second, a lack of seriousness. Being less serious about health insurance could lead to rejection of your claim. This may actually sound a lot less severe for people who don’t understand the seriousness of the concern. But those who end up getting their claims denied find this experience quite punitive, honestly.
Hence, it is important for you to understand how your health insurance policy functions and what are its chances of getting rejected. Some people day prevention is better than cure and, in this case, it is exactly that.
Going beyond the insured sum
Ever heard of sum insured? Whenever you purchase an insurance or accident policy, you will find that there’s an insured sum involved, regardless of whether this is an individual or even family floater. Regardless of whatever plan you have chosen, the sum insured will be the amount that’s available to you and your kids annually. If you end up using the whole sum for a year, the cashless claim will end up getting rejected. However, if the sum assured stays intact, your insurer will also provide you with a proper reimbursement later on.
There are many diseases that don’t provide you with coverage in a basic health insurance plan or family health insurance policy. These could be for those diseases where you won’t be able to file claims which are also referred to as exclusions. But, if the same policies don’t provide coverage for the disease, then consider getting a waiting period for that. So, if you also file yourself a cashless claim for such diseases, then your claim will not get approved anyway.
A few common causes for claims getting rejected could be partial or non-disclosures or adding wrong details like nature of occupation, age, current insurance plans, income and other ailments from medical conditions that have existed before. Coverage will be provided on the basis of details that are given by the one who has proposed on the form of proposal. Hence if there is any discrepancy between the reality and declaration, chances are the claim will get rejected.
Crossing The Time Limit
You are always expected to apply for a reimbursement when it comes to things like these. In cases of emergency admissions, the time that is provided is 24 hours after the patient has been admitted. In other cases, you could change it depending on the kind of policy you have chosen and the treatment you have availed. If you don’t use it within the specified time, the claim will be rejected.
Many health insurance online companies will entertain your claim even after it has been rejected, as long as you can convince the agent that your claim is genuine. However, make sure to remember and understand what has happened in the 1st place before you make any such decision. So, make sure you keep this in mind to avoid your claim from getting rejected.