Possible reasons for Health Insurance Claim rejection

Possible reasons for Health Insurance Claim rejection

By Ann Maria Cleetus
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Health Insurance Claim rejection

When you approach insurance agents for a health insurance plan that best suits your needs, they make it sound very easy but on the other side, getting your insurance claim approval can turn out to be a real pain at times. Below we have listed some reasons as to why health insurance claim gets rejected.

Incorrect medical information

If you provide wrong medical information while taking the policy it can lead to rejection of claims. Any information regarding your medical history, pre-existing illness, tests or medical examination conducted, genetic or hereditary illness must be revealed without any hindrance to the insurance provider while taking the policy. While taking the policy, get your medical done at a hospital which your insurance provider approves so you are on the safe side.

False information

Giving out misleading information about your annual income, financial status, health, lifestyle etc. to get a policy that pays off a lesser premium and a higher sum secured can lead to health Insurance claim rejection.

Do paper works on your own

If your agent asked you to fill out all your paperwork, deny him with a smile and do them on your own. They can sometimes put in wrong information or may be overlook some which can cause havoc and deny you the insurance claim. Your premium is charged based on the information you fill in the form, so don’t alter any information for monetary benefits and always double check your papers before submitting them.

Policy is lapsed

You will only get the claim for your insurance if the policy is still active and in effect. If you do not pay your premium regularly, that can lead to your policy becoming lapsed or inactive. And so if you approach the insurance agents for claim, they will reject the same since the policy have been lapsed.

Waiting period

During the waiting period time, no coverage will be provided for any ailment, if you request for the claim before the waiting period ends then no coverage will be offered.

Inaccurate Nominee details

Always update your nominee details, when single your parents will be your nominee but during the years as you get married your nominee must be updated to your spouse. Because, your parents might be no more as years pass by and your nominee details were not up to date as well; so while requesting for insurance claim it might lead to rejection.

Late claim

Depending on the type of insurance, each claim may have a time frame within which one needs to inform the insurance agents about the medical emergency or hospitalization for the claim to be processed. If you delay or do not inform them on time, it can lead to rejection of claim.

Not reading the policy thoroughly

To take the necessary actions at the right time, you must have a thorough knowledge about the norms and procedures prescribed in the policy without which your insurance claim can be rejected.

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2 COMMENTS

  1. Making your claim too late to be covered is very easy to do when you have been sick or had an operation in hospital, because the recovery period is so long. As this article suggests, get some help to make your claim - it will not only assure that the claim is filed on time, but the details of the claim are correct (people get confused when they have been ill).

  2. When you are ill it gets more difficult to do your paperwork in time but keep in mind to stay updated with your policy to prevent a rejection with no justification. This step is very important because we are talking about health insurance and there is a chance you can be hospitalized so you need to be covered and confident about the actions to take by your insurance company.

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