Worried about why your health insurance claim got rejected? This can be extra stressful during the ongoing COVID-19 pandemic. However, there can be numerous reasons behind this, and the first thing you need to do is look for the errors in your claim form that you have submitted. Even a small mistake or ignorance can lead to non-payment of claims at the time of a medical emergency. Sometimes the reason for claim rejection is knowingly or unknowingly submitting incomplete and inaccurate information to the Health Insurance Company. You can also avail of the help of TPA or the Third-party
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Administrator to help you submit the right documents and get the information corrected in the claim documents. The first thing that you need to be aware of is the accuracy and authenticity of the information provided and the documents submitted to ensure hassle-free claim settlement.
Before any action is taken, let us first consider the reasons that generally lead to the rejection of health insurance claims in India. It applies to individual health plans, family health plans, coronavirus health insurance plans, senior citizen health plans, etc. Having prior knowledge would help you avoid making the same mistakes and you will be able to benefit from your mediclaim policy at the time of a medical emergency.
Most of the medical insurance claims get rejected when the policyholder has furnished incorrect or wrong information. Some applicants do not furnish all the information correctly at the time of purchase so that they have to pay a lesser premium. This is one of the biggest blunders that they end up doing and should be avoided especially during the time of COVID-19. Insurers usually find out such discrepancies sooner or later, therefore, avoid providing any incorrect details in your form.
If you have purchased the policy in a hurry or a non-registered agent has duped you into submitting fewer documents then you can end up losing your claim amount. Without proper documents, health insurance companies in India do not settle claims. Missing documents are one of the major reasons for medical insurance claim rejection In India. Even when you port a health insurance policy, make sure that you complete the paperwork as required.
And if you have not renewed your medical insurance policy on time and it has got lapsed then you also your health insurance claim will not be entertained by your health insurer.
If you file a claim for any treatment or illness that is not covered by the insurance company or a waiting period applies to it, then your claim will not be initiated. For example, if someone is treated for injuries resulting due to adventure sports, and is mentioned in the list of exclusions in the policy wording the insurer holds the right to reject it.
If the insurer finds that hospitalization was not required for your treatment or the insurer feels that you have made an unjustified claim, then your claim request will not be taken forward and intimation will be provided to you by the Insurer.
In a recent circular, the Insurance Regulatory and Development Authority of India (IRDAI) announced that health insurance claims can be questioned by insurance providers after a policyholder has paid the premium regularly for 8 continuous years, and this period is called as the moratorium period.
For others, you need to negotiate with your health insurance company and try to know the reason for denying your claim. In case you get the reason then you can take the following actions to amend it:
Inform your insurer about reinitiating the claim. Gather the data and understand where you went wrong. When filling the claim form again you can seek help online from our experts and make sure that there is no error in the data provided. It will ensure that your claim gets accepted the second time.
In case the reason why your claim did not get processed was a missing document, then make sure that you provide it this time. Losing your claim amount for this is the last thing that you would want to happen.
For smooth claim settlement, the health insurance company would require original hospital bills, medical practitioner’s certificates, hospital discharge summary, etc. And if the hospital doesn’t cooperate, then you would need to follow up and submit the entire required document to support your insurance claim request.
If your medical insurance company rejected your policy claim because hospitalization was not required then you can submit your doctor’s medical prescription suggesting hospitalization. Show the diagnostic reports before hospitalization. If you can convince your Insurer or TPA that it was essential to undergo the treatment and stay in a hospital for more than 24 hours and your claim request must be accepted.
You can try using any of the above-mentioned methods when your mediclaim gets rejected. Be truthful and furnish correct information and leave no scope for errors. If you avoid making the above mistakes then surely your claims will never be rejected.
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