Health concerns are of utmost priority to senior citizens.
In this context, health insurance offers them and their family a much-needed financial security and mental peace. But what happens when there is a medical need and you make the claim only to find it being rejected by the insurance company?
For sure, it would be a bitter experience.
Well, there could be several reasons for rejecting a claim. So, here are five main reasons that you should be careful of to avoid a claim rejection.
Whatever policy you are buying, make sure to read the policy document, its terms and conditions, claim process, documents required to make the claim, time period to make a claim, and exclusions, among others. At times, it may happen that one takes the policy under the influence of the agent without reading the conditions, and later, the claim gets rejected, because it was mentioned as ‘exclusion’ in the policy.
Exclusion means that the illnesses which are not covered by the insurer under the insurance policy.
So, it is very important that you carefully read the policy document. It may be difficult to understand it at first, because of the complex language, but dedicate some time to read and confirm that it is offering what you are looking for in the policy.
The free look-in period in the policy serves this very purpose. If you do not feel satisfied, you may cancel the policy within the free-look period.
The information filled in at the time of buying the policy should be the same when one makes the claim. For instance, if the date of birth is filled in wrongly at the time of buying the policy and you overlooked it, the claim could be rejected on technical grounds due to the information mismatch.
This is one of the main reason for claim rejection.
Every policy is underwritten differently, and if there is misleading information about health and other critical factors, such as age, occupation, medical history, pre-existing illnesses, etc., the chances are high that the claim will be rejected. So, always disclose accurate and complete information when buying an insurance policy.
The hospital network is one crucial aspect that you should check before buying a policy. If the hospital close to your house is not affiliated with the insurance company’s network of hospitals, you will face issues with the claim.
No doubt, when there is an emergency, one would approach the hospital or clinic nearest to one’s home for treatment. But as medical expenses can make a large hole in the pocket, so one must ensure that the hospital that one is getting admitted to, is included in the network of hospitals mentioned in the policy, or the claim may get rejected.
Another important point one must not forget is the ‘time frame’ to make the claim.
Insurance companies mention in their policy documents the time frame within which one must raise the claim. Usually, it is within 30 days from the date of hospitalisation.
If a claim is raised after the stipulated period, the insurance company may reject it.
To avoid instances of claim rejection, one needs to carefully follow the instruction written in the policy documents and understand and follow them.
In spite all of this, in case your claim is rejected, find out the reason for the rejection, rectify it if possible, and inform your insurer.
