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6 Ways to Avoid Denial of Health Insurance Claims

When we invest in health insurance, it is human tendency to focus primarily on the price of the premiums or the tax benefits we can avail of. We rarely carefully scrutinize the features of the policy or its limitations, which is why we feel bitter when our claims are rejected.

While settling for a health insurance plan, we need to be mindful of a number of important aspects, in order to ensure that we are never in an unfortunate situation. They are as under:

1. Read the terms and conditions of the policy -

In a large number of cases, it is seen that customers are not even aware of the inclusions and exclusions under the policy. Since policy documents are generally written in a jargon-based, complicated manner, it is important to take one’s time and go through all the terms and conditions stated in the policy. Individuals should conduct research on the internet, especially on consumer forums and review cases where the claim has been rejected and the reasons why this has happened. Most insurance companies provide a free look-in period of 15 days, during which time, the policyholder can carefully go through the policy documents to alter or cancel the policy if the policy isn’t in line with their expectations or understanding.

2. Have the insurance form filled by the policyholder -

Generally, when it comes to health insurance, we tend to depend on the agent to fill in the details. This is a major oversight, as the agent might get some of the information provided to them wrong. It is thus very critical that the insurance document be filled in by the policyholder themselves, to ensure that the policy is not underwritten with incorrect details. Furthermore, the policyholder should also thoroughly check the policy documents before submitting them to the insurer, to ensure that information is not being misrepresented.

3. Disclose information accurately to the insurer -

Often, claims get rejected because policyholders either misrepresent facts or do not fully disclose information concerning the history of their health in terms of pre-existing medical conditions or major illnesses, or age, income or occupation. Policyholders need to understand that insurance policies are individually fashioned according to the information provided by the policyholder which is why anything outside the ambit of the policy is not covered. The best way to ensure that this does not happen is to find out about the consequences of not disclosing information and accordingly stating things in an accurate manner.

4. Only avail of relevant medical treatment -

Medical centres are known to perform procedures that may not be necessary for the patient in question, in their endeavour to closing more business. The policyholder mistakenly avails of these procedures, assuming that the insurance company will cover the amount. However, if these procedures are not in line with the medical history of the policyholder in question or necessarily required during the course of their medication and hospitalisation, there is a likelihood that the claim might be rejected.              

5. Consider factors beyond the basic claim -

Agents and insurance companies attempt to draw in more business by offering health insurance packages at low premiums. One thing customers tend to forget is that these low premium packages could very well be basic packages that do not cover incidental losses or a loss of earnings in the case of an accident, emergency or critical medical condition. Furthermore, conditions like lifestyle diseases, pregnancy, etc. also might not be covered. As a result, though the premium is low, the full benefits of the policy are not being made available to the policyholder. This is why, policyholders ought to ensure that they opt for riders or ad-ons while signing up for health cover.

6. Stick to network hospitals provided in the policy -

Most policies offered now a days contain a list of network hospitals they have partnered with, so as to provide cashless treatment. Policyholders could risk having their health insurance policy claim rejected if they have not scrutinized this list, and have gone and availed of medical treatment at a centre not mentioned in the list of affiliated network. Click here to know more about health insurance. policybazaar.com

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