Understanding health insurance rejections to avoid them
Health insurance is available at discounted prices compared to offline options, attracting people to buy them digitally.
image for illustrative purpose
Understanding health insurance rejections to avoid them
These days, buying a health insurance policy has become an easy task with many insurance companies offering their services online.
Additionally, they are available at discounted prices compared to offline options, attracting people to buy them digitally.
People generally opt for health insurance to secure their families, overcome medical inflation, and shield savings.
When purchasing becomes easier, it also brings along numerous issues if not given proper attention. Even the slightest error could result in significant consequences, resulting in the rejection of your claim.
So it becomes imperative to know why your claim gets rejected and be cautious while purchasing one.
Filing incomplete or false information: One of the most common reasons behind claim rejections is failing to furnish genuine or prompt information, particularly regarding pre-existing diseases.
The premium amount is decided based on the information filled in the application form, be it online or offline.
Thus, any disparity between details furnished and facts while claiming may lead to rejection.
For instance, some may not disclose their smoking and chewing tobacco habits with the insurer during policy purchase.
In such cases, an insurer may reject your claim upfront. If you’re a smoker or consume nicotine, you may still get insurance, but it comes at a higher cost.
Filing a claim too late: There is a certain window to report your claim, and the insurance holder has to report their claim in the stipulated time frame.
Delay in notifying within the specific timeframe will result in the rejection of the claim, underscoring the importance of adhering to time frames.
While the time frame for availing of a cashless facility is 48 or 72 hours, for availing reimbursement, the same is between 30 to 90 days. Again, these timelines keep changing from insurer to insurer.
Non-payment of premiums & surpassing the sum insured limit: Non-payment of the premium on time or within the grace period will lead to claim rejections.
Insurance companies keep sending reminders to pay the policy premiums before the arrival of the due date and grace period.
If you don’t keep track of insurance premiums payment details, it may pinch a hole in your pocket during unforeseen circumstances.
All insurances come with a certain sum insured, and if it gets exhausted or exceeded, the policy provider will reject your claim, forcing you to pay from your pockets. Thus, opt for the sum insured considering your requirements.
Ignoring exclusions: Every health policy will have some or the other exclusions that do not cover certain diseases, particularly critical illnesses.
Insurance providers will list those exclusions in the policy documents, and if you fall sick due to any of the diseases mentioned in the list, you cannot claim insurance.
Even if some insurance companies cover certain diseases, they come with a waiting period that restricts insurers from processing the claim request.
Note: Also getting admitted to healthcare centers that are not part of network hospitals may also lead to the rejection of cashless claim requests. During such instances, you have to pay money first and then apply for reimbursement with all the required documents within the prescribed time frame.
