3 Reasons Why Your Health Insurance Claim Might Get Rejected

Health insurance is the need of the hour. Developments in the medical sector have increased the life expectancy of an average human. Along with it, the lifestyle of the modern generation has increased the rate at which we suffer from ailments and diseases. The result is rising medical costs. Health insurance policy is the only hope of battling out the highly probable medical costs that would befall us. Awareness of health insurance is crucial to avoid the aftermath of a medical complication. The benefits of a health insurance claim compensate the substantial hospital bills accrued in the event of a medical emergency and become the lifeline of many individuals.

If you have a Health Insurance policy, you don’t need to worry about medical bills if you are hospitalized. However, a rejection of your insurance claim could catch you off guard and possibly drain your life savings.

In order to avoid a health insurance claim rejection, attain a thorough understanding of your own policy’s term and conditions, and avoid making these common mistakes.

Firstly, you need to know the reason behind the rejection of your health insurance policy and then take corrective measures. There are many reasons for denying your claim. So, let us elaborate on the three reasons because of which your claim can be rejected.

Insurance Claim

  1. Ignoring the exclusions


Health insurance policies have a wide coverage, although, they do not cover every single disease. These are specifically mentioned in the policies as being ‘not covered.’ These are some diseases for which you cannot file a claim and are generally referred to as exclusions. Thus, if you file a cashless health insurance claim for one such disease or medical condition that is excluded, then you might face rejection. While you might opt for a family health insurance plan or an individual cover, it is always important to go through the documents of the policy to know exactly what is not covered.

  1. Suppression, misrepresentation of facts

Some common causes for health insurance claim rejection are non-disclosures, partial disclosures and wrong disclosures of important details such as age, nature of occupation, income, current insurance plans, major ailments or pre-existing medical conditions. Coverage is provided based on the information given by the proposer on the proposal form. Therefore, any discrepancy between the declaration and the reality during the time of filing claims can easily lead to rejection. The only solution to avoid rejection is to be prompt and specific while filling forms.

  1. Non-disclosure of pre-existing illnesses

It is always advised to be honest and accurate when stating your medical history and any illnesses that you suffer from. Not providing correct information regarding these might lead to rejection of your claim if you happen to be hospitalized due to these illnesses.

In order to avoid a cashless health insurance claim rejection, you should have a good understanding of your health insurance policy, ideally from the time of its purchase. You can compare health insurance plans online to understand what is on offer and choose a policy that meets your requirements. Another important point for you to remember is ensuring that your policy is valid while you make a claim for it. Setting insurance renewal reminders can help you with that. It is also relevant to maintain a record of all your documents, which include your pre and post hospitalization expenses, hospitalization records, diagnostic tests, discharge summary, investigation reports, etc. These documents can be extremely crucial if your insurer needs clarifications.

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