Situations When Your Cashless Health Insurance Claim Can Get Denied

Why Your Cashless Health Insurance Claim Could Get Denied?

There are multiple instances when your health insurance provider can deny your cashless claim. Take a look at some of the reasons below:

If the Treatment is Being Taken at a Non-Network Hospital

Your insurance company will deny your cashless claim request if you have been admitted to a hospital outside its network. This is because cashless claim facilities are available only if the insured is receiving treatment at a network hospital of the insurance company.
If the Documents Sent are Incorrect or Incomplete

To get a cashless claim settlement, your network hospital will have to send a pre-authorization request to your insurer seeking permission for your cashless treatment. Along with the pre-authorization form, they are required to send the medical documents of the insured, including test reports, doctor’s prescriptions, etc.

In case the documents sent over to the insurer or TPA are incorrect or any of the documents are missing, then your cashless claim request will get denied.

People also read: List of Documents Required for Health Insurance
If Your Disease is Not Covered Under Your Health Policy

Your insurance company is liable to pay for your medical bills only for the diseases or medical conditions that are covered under your mediclaim policy. In case you are receiving treatment for a disease that is not covered by your insurance company, then your insurer will reject your cashless claim request.
If Your Illness is PED and Your Waiting Period is Not Over

Most health insurance plans cover pre-existing diseases after a waiting period. In case you are admitted to a network hospital for the treatment of a pre-existing disease, then your insurer will reject your cashless claim request if the PED waiting period is not over.

People also read: Pre-existing Disease (PED) Cover from Day One
If Your Pre-Authorization Request Was Delayed

When the insured gets admitted to a network hospital of an insurance company, the hospital is supposed to send them your pre-authorization form within a stipulated time period. In case the hospital fails to do so, then the insurance company has the right to reject your cashless claim request.
If Your Registered Contact Details Do Not Work or are Incomplete

In order to settle your claim request, the insurance company requires your contact details as well as your bank details. In case your contact details registered with the insurance company are incorrect or not incomplete, then the insurer may be unable to settle your claim. In that case, the insurance company may deny your cashless claim request.

What to Do If Your Cashless Health Insurance Claims Get Rejected?

In case your cashless claim request has been rejected by your health insurance company, then you can file a reimbursement claim after getting discharged from the network hospital. Check out the steps to file a reimbursement claim if your cashless hospitalization request has been denied:

Step 1: Inform the insurance company about your hospitalization

Step 2: Obtain treatment for the disease

Step 3: While getting discharged from the hospital, pay the entire hospital bill and collect all the documents, including medical reports and hospital bills.

Step 4: Fill up the health insurance claim form and submit it to the insurance company. You can find the claim form online.

Step 5: Submit the requested documents to the insurance company for claim settlement

Once the insurer receives these documents, your claim application will be reviewed. If the claim is accepted, the claim amount will be paid to you. If the claim is rejected, you will be notified.

Conclusion

Cashless claims are convenient and a great help during a medical emergency. It saves you from the hassle of arranging money to pay your hospital bills even if you plan to get them reimbursed later. But if you want a hassle-free cashless claim settlement, then carefully go through the above-mentioned reasons why your cashless claims may get denied.