4 Common Reasons Why Health Insurance Claims Get Rejected

  Author: Jai Prakash

One of the most common grouses of health insurance policyholders is of their health insurance claims getting unfairly rejected. In fact, after getting to know of such instances many other policyholders remain apprehensive whether their claims too will get rejected. The irony of the situation is that many of the claims get rejected for some common mistakes by policyholders. Here are four such mistakes.

Ignorance of coverage by the medical insurance policy Most people don’t try and find out what is covered by their medical insurance plan. A common area of ignorance is about pre-existing diseases. If you were suffering from a disease at the time of buying a policy, the policy conditions might have explicitly stated that pre-existing diseases will not be covered for the first three or four years.

Exclusion of specific treatments Your health insurance plan may not necessarily cover all kinds of treatment. These exclusions are typically mentioned in the health insurance policy document. Among the treatments that are typically excluded are cosmetic surgeries and dental procedures. Outpatient department costs, no matter how significant they are, are also excluded.

Incomplete documentation The claims process needs to be followed down to the last detail. Even a small slip can be costly and can lead to rejection of the health insurance claim. This means ensuring that all documents such as discharge slip are taken care of.

Inaccurate declarations Whatever you declare at the time of applying for health insurance needs to be accurate. Often, essential medical facts are either concealed or inaccurately recorded. Subsequently, this can be a major reason for a health insurance claim getting rejected.