Health insurance: A look at reasons why your claim can be rejected

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You have bought a health insurance policy and as a result, you are mentally at peace about tackling sudden medical emergencies. But, somewhere at the back of your mind, there is a lingering concern about the claim settlement process. Thus, it is essential to look at the common reasons under which the insurance company can reject your claim or pay your claim partly.

Here are some of the common reasons:

Disclosures

Non-disclosure of pre-existing illnesses when filling a form is one of the common reasons for the rejection of a claim. It is therefore crucial that you do not rely on your agent for filling the form. Instead, take your time out and fill in all the necessary information in detail so that it cannot be held against you later at the time of making a claim. You also need to keep all prescriptions properly in one place so that if any need arises in the future, you can prove your point to an insurance company.

Hospitalisation

At times as a precautionary measure, one gets hospitalised even though there is no need. It is important to know that insurers tend to reject claims where hospitalisation is not required. In such cases, the onus falls on the insured to explain that it was impossible to treat without hospitalisation. So, be careful of mild conditions that can be treated at home without any active monitoring.

Homecare

In the case of unavailability of beds, the insurance company will reimburse you for home treatment only when there were no hospital beds available in your area. Therefore, check with your insurer before going for home treatment so that they are aware and let you know of the required documents to be submitted for the same. Notably, many times claims get rejected if the insurance company is not informed about the domiciliary treatment. Hence, before taking the home treatment, always notify your insurer.

Fine print

It is essential to understand that the coverage under health insurance policies does not start immediately. Even after buying the policy, there is a waiting period of 15-30 days. For example, basic comprehensive policies come with a waiting period of 30 days. Similarly, there is a waiting period of 2-4 years for pre-existing illnesses, which needs to be disclosed when buying the policy. There are also time limits for certain diseases such as diabetes and hypertension. Similarly, if any pre-existing condition is not disclosed when purchasing the policy, then it can lead to the rejection of the claim.

Documentation issue

Insurers often complain that documents submitted are either not updated or incorrect. This at times, is not sufficient as it gets difficult for insurers to approve the claim just based on the documents submitted. For example, insurers say that the severity of the case gets difficult to gauge just by looking at the Covid testing report. Therefore, they need more documents to approve the claim.