Here’s When Your Health Insurance Claim Could Be Rejected
Health insurance is undoubtedly the best way you can ensure safety for yourself and your family. But buying one does not guarantee you coverage from all medical problems. Unfortunately, this is a common perception but isn’t the truth.
A particular health insurance policy might not cover all the medical expenses that you may face. There are specified lists of inclusions and exclusions that one need to be aware of. While inclusions are the ones you must consider in your purchase decision, it is equally important to account for the exclusions. Exclusions can give you a bad surprise if you are not aware of them in advance, some cases being as extreme leading to rejection of your application. To avoid these stressful situations, let us look at the circumstances when your claim could be rejected.
#1 Declaring incorrect information
Incorrect information whether on the claim form or at the time of purchase is a common reason for claim rejection. Also, avoid hiding any important information as it can end in rejection of your claim too. This puts you at risk of having no insurance cover despite buying one. Further, ensure all your hospital documents like bills, medical reports and prescriptions have the correct information to ensure quick and hassle-free settlement.
#2 Ignoring the requirement of prior authorisation
If you are undergoing a planned medical treatment, the insurer requires you to obtain a priori authorisation. For example, cashless treatments generally require prior authorisation requests. If you ignore this prior authorisation requirement, there is a high chance your claim application can be denied.
#3 Not paying attention to excluded perils
Exclusions are the events that your insurance plan does cover. If you file a claim for such an event, your application will be denied. Hence, it always helps to be aware of the policy terms when purchasing one. Some of the common exclusions are about pre-existing diseases, dental procedures, hearing and vision, cosmetic surgery, and alternative treatments, be it individual or health insurance plans for family.
#4 Making delayed claims
When it comes to making a claim, it should be done as early as possible. Waiting for extended periods can lead to rejection. The terms of your policy mention the duration till when you can file your application.
#5 Exclusion for the waiting period
All insurance plans, whether an individual cover, family cover or critical illness insurance have waiting periods. After the end of this waiting period, pre-existing ailments are covered. This duration differs among individual plans and policies. Thus, at the time of claim, ensure you have served the waiting else would face policy rejection.
When you purchase a policy, it is obvious that most individuals assume the policy coverage. But only on making a claim, it is known that these specific events are outside its scope. Hence, read the fine print carefully when you purchase a policy. Also, make sure you compare the available plans. It will ensure you make a suitable choice depending on your requirements.