5 reasons for which your health insurance claim may be rejected

Even though purchasing a health insurance policy online is simple, are claims always processed quickly? Your health insurance claim could be denied for a variety of reasons

Abeer Ray
17 Nov 2022
5 reasons for which your health insurance claim may be rejected

New Delhi: In this day and age, the number of health risks is constantly increasing. A serious medical emergency can leave a person in a financial bind that is likely to exceed their savings. In such a case, the value of health insurance is now undeniable.

When you purchase a health insurance policy, the insurer is required by the terms of the contract to provide financial assistance in the event of a medical emergency. The conditions of the insurance policy apply not only to emergencies but also to routine doctor's appointments and hospital stays.

A health insurance policy is simple to obtain, even online, but are claims always resolved when they are filed? A claim may be rejected for a variety of reasons. Let us go over them in depth.

Insured amount exhausted

When you choose a health insurance policy or a personal accident policy, whether it is a family floater or individual medical coverage, there is a sum insured involved. Depending on the plan you choose, the sum insured is the annual amount to which you or your family have access. If you exhaust your allowance for the year, your subsequent cashless claims will be denied.

Incorrect filing of insurance claims

The policyholder must follow the steps outlined by the insurance company when filing a claim. Notifying the insurer of the emergency, seeking treatment at an accredited hospital, completing the necessary claim form, and attaching all pertinent receipts and reports are all requirements for filing a claim. If you file your claim incorrectly or improperly, it may be rejected.

Incomplete details submitted

A health insurance policy is issued on the condition that the applicant has provided all necessary information in the proposal form in a truthful and accurate manner. Underwriting is performed by the insurer to assess the risk you pose based on the information you have provided.

If you withhold vital information or lie about any medical problem, you are putting yourself in danger. When a claim is filed, the insurer investigates the circumstances. If it is discovered that you withheld or lied about a material fact, the insurer may deny your claim.

Claiming towards exclusions

Every health insurance policy includes a list of situations that are not covered. These are the indefinite exclusions, and any claim pertaining to an instance that falls within them will be rejected.

Furthermore, there is a waiting period for pre-existing conditions, and some conditions are only covered after the waiting period has passed. Claims for such exclusions with a waiting period would be rejected for the duration of the waiting period.

Exceeding the prescribed time limit

A health insurance reimbursement request must be submitted within a certain amount of time. The time period for emergency admission is 24 hours after the patient's admission. In other cases, it will depend on the type of policy you have chosen and the type of treatment you are receiving. Your claim may be denied if you do not submit your application by the deadline.

Furthermore, keep in mind that if you have been paying your health insurance premiums for at least 8 years, no health insurance company may deny a claim. The Insurance Regulatory and Development Authority of India expressly states this ( IRDAI).

Keep in mind, however, that some transparency and clearly presenting the information from your end may go a long way toward reducing the likelihood of your health claim being rejected.

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