4 Reasons Your Health Insurance Claim May Get Rejected

Health Insurance, being one of the essential parts of our life these days, lack of complete information regarding its utilization, may lead to an odd situation. Things go even worse when you’re stuck with a huge medical bill and your claim gets rejected, keeping you clueless.
Unfortunately, all insurance plans include and exclude an array of terms and conditions that anyhow bind you and it varies insurer to insurer. These issues can be ease to some extent if a person buys a comprehensive health insurance plan from a renowned insurance company that designs their products, keeping in mind the health requirement of their customers. For example, you can consider SBI general health Insurance plan as well. Their products are the amalgamation of best services and facilities that the customers can enjoy their life to the fullest. However, no matter whatever plan you choose to buy, you should be updated with the rules it carries.

In a bid to make you familiar with some of the situations, that you are likely to face while claiming your insurance plan, here are the most common reasons for exclusion:

1. Claim Within 30-90 Days (Initial Waiting Period)One should always avoid making a claim within the initial waiting period. This includes from the date of purchase of a policy to 30-90 days, and any claim made by you’ll be rejected. However, it may consider the emergencies.
2. Claim for Pre-existing DiseaseAny claim made by you for the pre-existing disease may lead to the rejection. If a policyholder disclose any disease as a pre-existing condition while purchasing a health plan and make a claim for the treatment expenses, even after the initial period is over, his/her claim will be rejected as one cannot make a claim for pre-existing disease or a period of 1 year from the date of buying the policy.
3. Pre-set Cap on DiseaseLet’s say you spend INR 1 lakh in Asthma-related treatment including hospitalization, medicines, tests etc in a year and when the amount exceeds the pocket, you make a claim by submitting required documents. This time you keep in mind the waiting period and careful about the documents. But you might face the fact that your claim has been rejected, completely or partly. It is just that your policy carries a cap on the expenditure that can be claimed. In your case, if the cap is INR 50,000, you’ll be unable to claim the remaining amount and have to pay by own.
4. Cashless HospitalizationCashless hospitalization is quite common and famous term among the policyholders. But there is much confusion with the conception. While buying a policy, which offers cashless hospitalization, by saying this it only means that this facility is only applicable in network hospitals and thus, going to non-network hospitals and make a cashless claim against all the expenses made in the treatment, does not make any sense.

Well, many policyholders are dissatisfied with the services of medical insurance providers. The reason behind is the rejection of their claim, but nobody tries to consider the cause behind the rejection. Research says that many of the claims get rejected due to the wrong decision made by an individual or lack of proper knowledge about the plan. In most of the cases, we observe that people don’t go through the terms and conditions or they ignore it while buying a medical insurance plan. But these are the essential part of a policy to be pondered over. So, it is advisable that one should select a health insurance policy by considering all his/her medical needs, following all regulations so that medical claim doesn’t get rejected because having your health insurance claim denied is enough to make you feel seek all over again!