What Should You Do if Your Health Insurance Claim Is Rejected?

Mumbai, October 17, 2020

The modern-day lifestyle is dynamic and ever-changing. Due to changes in lifestyle over the decades, there has been an increased rate of ailments and diseases. It has made health insurance of utmost importance in today’s day and age.

High incidence of ailments, coupled with rising medical inflation, can result in spending your hard-earned savings on medical treatments. The best way to avoid this financial stress is having a health insurance policy. 

Most individuals assume if their claim is rejected, it is the fault of the insurance company. While it is not always the case, most times it is because of their own mistakes. 

What should you do if your health insurance claim is rejected?

Health insurance is a contract between the insurance company and you, the policyholder. This contract is based on trust and the fact that you will not take undue advantage of your insurance policy. If the insurance company feels the claim application is unreasonable or if there is a lapse in procedural formalities, the insurance company has no option but to reject your application. 

That being said, ensure you declare true, correct and complete information. Still, if your insurance claim is rejected, here’s what you can do - 

 Once you receive the rejection letter, check your claim application form. It can so happen that your claim is rejected for errors or inaccurate information on your claim form. A claim rejection can happen even due to incomplete form, whether knowingly or unknowingly.

 Contact your insurance agent or third-party administrator for any clarification, if required regarding your claim application form. 

 Note that such mistakes can have a significant financial loss at the time of a medical emergency. So it is prudent to declare complete and accurate in formation to your insurer. 

What are some reasons for which your claim can be rejected?

Let us look at some of the reasons based on which your insurance company may reject your claim application. 

Non-disclosure of material facts or misrepresentation: Though you may blame your insurance company for rejection of your claim, it can be rejected even due to your fault too. If you do not disclose any pre-existing medical condition that may have a material impact, your claim can get rejected. The insurance company has the authority to evaluate whether your claim is valid or not. 

Incorrect health insurance claim procedure: Each insurance company has a set of prescribed steps that you may need to follow. Say, for example, if you have cashless health insurance, you need to follow a specific procedure of reporting to your insurance company so that your insurer directly settles the bill. If there is any procedural lapse, it may lead to rejectionof your claim.

Claim for permanent exclusions: Every health insurance plan has a list of exclusions that exclude specific treatment and ailments. If you have claimed for any of those mentioned treatments, there is a possibility your application can get rejected. 

Claim for temporary exclusions: If you are suffering from any pre-existing diseases, your insurer may levy a waiting period. During this tenure, your claim application for that particular disease is denied by your insurance company. 

So now you are aware of the various reasons why your claim is rejected and how you can avoid it, follow the guidelines as mentioned in your policy document. Be it an individual or family health insurance plan, it is essential you adhere to the terms and conditions for a hassle-free claim procedure.

(Disclaimer: This is branded content. Readers are advised to exercise due discretion before entering into any correspondence, investment, purchase, business dealings or any other decision on the basis of this content.)

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