Illness in the family can result in exorbitant expenses. Health insurance is one of the best ways to fight a medical calamity in the family. It helps you get insured against a number of ailments. However, one of the most common reasons for not many people being in favour of a health insurance is the rejection of the claim.
Once a claim is rejected, people start the blame game but do not try to understand the reason for the rejection. Most of the times the insurance company is not at fault when it comes to the rejection of the claim. It is important for the customer to understand the underlying causes of rejection.
Common mistakes made by insurer
- Insurer hides information about his previous diseases as many medical claim policies do not cover diseases that the person suffers prior to the insurance. This is sufficient reason for rejecting the claim.
- The policy expires and is not renewed by the client
- Provision of insufficient or wrong information at the time of applying for insurance
- Claiming for ailment before the waiting period is completed. Waiting period is the time before which the person is not offered insurance cover for a particular disease
- Late information about hospitalisation of the insurer
- Going for cashless hospitalisation in a non-network hospital
Reasons Your Health Insurance Plan Will Deny Your Medical Bill
- Certain charges are not covered by the insurance company like cosmetic surgeries, treatment for infertility etc. At times the company may have the opinion that the treatment that you have received is not that critical. To avoid such cases, it is important that you understand the terms and conditions of the policy before purchasing it.
- Certain tests like MRI or CT scan need a preauthorisation. When the physician asks for certain tests to be done it is important that you get the same approved by the company to prevent any problems later. Also certain companies prefer that appointment with a specialist is by reference from a general physician.
- You should ascertain that you go to only those healthcare providers which are in the network of your insurance policy in order to prevent rejection.
- Wrong data entry like the wrong name,wrong codes etc. can result in rejection of the claim.
- Ensure that your hospital is sending the bills to the right company and referring to the active policy and not some old policy.
Things You Should Identify When Your Healthcare Claim Is”Denied”
- Check your medical insurance claim form and if there is a typing mistake then make sure that you fill a new form with the correct details. Inform the insurance company about the same and request them to reopen the case.
- Check if all the documents are submitted. Incomplete documents can result in rejection of claim. Collect all the documents like bills,reports,discharge documents and submit the claim.
- Take the help of hospitals and doctors in order to prove to the insurance company that the treatment was essential and the claim needs to be honoured.
- Maintain records of all the correspondence with the medical claim company. As far as possible communicate by emails so that you have sufficient proof.
- Don’t give up and reapply with all the corrected measures.
Health insurance is one of the best ways of managing the cost of medical treatment. But the rejection can be frustrating. It is, therefore, important to understand all the terms and conditions well in order to prevent this frustration.