5 Reasons Why Your Health Insurance Claims could get Rejected
The health insurance is an instrument to secure an individual from unforeseen circumstances. However, if at the time of claims, you are not able to reap benefit out of the same,the whole purpose goes in vain.
In such cases, the policyholder is disappointed. He feels frustrated and cheated as he is unable to fulfill his obligations. The reasons could be multiple—Non-adherence to the policy requirements, ignorance while paying a medical insurance premium, limited understanding of the policy, etc.
Below are six reasons why a health insurance claim could be rejected:
- Pre-existing health illness
Health insurance policydoes not cover pre-existing illnesses, which were present before signing the bond. In cases where it is detected that the illness was present before the policy was taken, the claim would be rejected.
However, there are policies which cover pre-existing illnesses as well. It is important to understand the clauses of the policy and then sign the bond.
- Period of diagnosis
Some insurers do not give or issue policy when the illness is getting diagnosed. They offer coverage only after the disease has been diagnosed. Claim filed during this period may be rejected.
- Network hospitals
In case of cashless health insurance, it is vital to understand the network of hospitals covered under the policy. In caseswhere an individual has signed the policy bond without taking into consideration the network hospitals, there are chances that the claims might get rejected when the treatment is not performed in those network hospitals.
- Conditions and exceptions
It is essential to understand the conditions and exceptions while taking a policy. Every policy has a set of conditions under which the claims cannot be processed. If you are not aware of such conditions while taking the policy, it may be difficult to receive claim when required.
It is, therefore,important to understand all the exceptions and conditions associated with the policy. It is also advisable to ask the insurer or personal manager if there are any such conditions stated in the policy, which would hinder the claims process.
- Selected disease waiting period
A policy may contain conditions where a certain disease is covered after a certain period of time. This period is termed as waiting period. For instance, you have taken a policy in 2016 and the policy says that certain disease will be covered after a period of two years, i.e. from 2018 onwards. In such cases, if you make a claim for that particular disease before 2018, your claim would be rejected.
Health insurance policies have some exclusions.It is very vital to understand the policy clearly before signing the bond.Claiming health insurance policybecomes easier when you are well-informed.