Non-disclosure of pre-existing diseases while filling the form is one of the common reasons for claim rejection. You have purchased a health insurance policy and because of this, you are now mentally prepared to deal with any sudden medical emergency. But, somewhere in your mind worries about the claim settlement process remains. Therefore, it is important to understand the reasons why the insurance company may reject your claim or partially pay your claim.
Here are some common regions:
Non-disclosure of pre-existing diseases while filling the form is one of the common reasons for rejection of claim. So it is important that you do not depend on your agent to fill the form. Instead, take your time and fill in all the required details in detail so that it cannot be used against you later while making a claim. You also need to keep all the prescriptions in one place so that you can prove your point to an insurance company in case of any need in future.
Many times some people get admitted to the hospital even when there is no need as a precaution. It is important to know that insurers tend to reject claims where hospitalization is not required. In such cases, it is the responsibility of the insurance holder to convince the insurance company that it is impossible to treat him without hospitalization.
In case of non-availability of beds, the insurance company will reimburse you for home treatment only if beds are not available in the hospital in your area. So, before going for home treatment, contact your insurer so that they know and can tell you about the documents required to be submitted for the same. Many a times claims get rejected if the insurance company is not informed about the home treatment. Hence, before taking home treatment, always inform your insurer.
It is important to understand that coverage in health insurance policies does not start immediately. There is a waiting period of 15-30 days even after purchasing the policy. For example, Basic Comprehensive policies come with a waiting period of 30 days. Similarly, there is a waiting period of 2-4 years for pre-existing diseases, which has to be disclosed at the time of buying the policy. There is also a time limit for some diseases like diabetes and hypertension. Similarly, if any pre-existing condition is not disclosed at the time of purchase of the policy, it may lead to claim rejection.
Insurers often complain that the documents submitted are either not updated or are incorrect. Hence, sometimes it becomes difficult for the insurers to approve the claim on the basis of only the documents submitted. For example, insurance companies say that it becomes difficult to gauge the seriousness of the matter by looking at the Kovid test report only. Hence, they need more documents to approve the claim.