Consumer VOICE

  Join Us Donate Now

Top reasons for health insurance claims getting rejected

Health insurance claims can be of two types - cashless or reimbursement. Cashless Health Insurance is a policy in which the hospital expenses are settled directly between the insurance company and the network hospital. In a non-networked hospital, treatment can be done with re-embarkation facility. But in several cases it has been found that health insurance claims get rejected when needed most. Here are some of the top reasons for your health insurance claims being denied:

Not giving correct information

One of the biggest reasons for claim being rejected is false or incorrect information from the insured. If you have concealed any information of previous disease or illness while purchasing the health insurance, then in all likelihood, the claim would be rejected.

Overcharging of treatment

Some hospitals charge higher and then there is a possibility of your claims getting rejected. The insurance company will pay at the rate determined by the General Insurance Council. If your claim is more than the fixed amount., then your claim can be cancelled.

Hospitalization for 24 hours or less

Many hospitals require you to admit yourself for atleast 24 hours to make a claim. If you are undergoing treatment at home or you have been in the hospital for less than 24hours, then your claim could be rejected.

Claim before waiting period

Generally, the waiting period of two moves in health insurance is fixed for the treatment of pre-existing disease. That is, after two or four years, you can claim the expenses on getting treatment for an already existing disease.

There are some other reasons because of which your claim could be dismissed. These include delay in delay in submitting the medical claim, delay in submitting the query documents and failure to submit the papers of first consultation and medical treatments taken for case history among others.

Consumer VOICE shares some valuable suggestions that can help you not getting your claim rejected. To learn more about it, get a copy of the latest digital magazine.

Divya Patwal


Translate »