Learn Why Health Insurance Claims Get Denied

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Anyone can fall ill or can meet any medical emergency at any time. And in case of such a medical emergency, an individual requires health care coverage for himself and their family in case of any surprising medical emergency. If you do not have health insurance then these expenses put a monetary weight on your pocket. In case, whenever you have taken a health insurance plan, there are changes when your insurance claim can get rejected.

In Fact, it is not uncommon in the healthcare industry. Millions of claims get rejected every year, and there is a list of reasons for which an insurance provider will deny a claim. Based on some research, we have identified some lists you can do to have an insurance claim approved, even after it has been denied.

Exceeding the sum insured

Whether you have purchased a health insurance policy or a personal accident policy, an insured sum is always involved. Based on the plan you have chosen, the insured sum is the amount available to you or your family on a yearly basis. In case you have already used the sum and if some mishappening happens the same year then your plan will be rejected.

Delay in Intimation

When you face any kind of medical emergency, without any delay, immediately dial the toll-free number which is provided by the insurer/agent/broker for the further claim settlement process. The insurance firm can refuse your claim in case of any delay in intimation.

When you ignore the exclusions

When you are buying a health insurance plan there are several diseases for which there is no coverage. These are being mentioned as “not covered”. For such kinds of diseases, you cannot file a claim. However in several policies there which provides coverage of such diseases but there is a waiting period. So, for such claims which are excluded, the claims will surely be rejected.

Pre-existing diseases

There can be chances that you are having a disease before buying a plan and your health insurance policy does not cover that disease. In case you get hospitalized for such a disease and file a claim but since your disease is not covered and your claim will get rejected.

Giving wrong information

Many medical insurance claims are rejected because users provide wrong information to the policyholder. Many people do not provide all the necessary and correct information so that they have to pay less premium. And so at the time of claim due to false information the claim gets rejected. Especially during the time of COVID-19 Insurers usually find out such discrepancies sooner or later, therefore, avoid providing any incorrect details in your form.

Steps to be taken in Case your Policy Gets Rejected

File the Claim Again with all correct Data

First of all, Inform your insurer about claim rejection. Provide all the necessary information again.  Whenever you file the claim again then always seek help online from experts and make sure that there is no error in the data provided. It will ensure that your claim gets accepted the second time.

Submit proper medical document

While settling for your claim you need to provide original hospital bills, medical practitioner’s certificates, hospital discharge summary, etc. 

Proper document submission

In any case, if your claim is rejected because of any missing document, then provide the document in time. This will help you in future claim settlements.

Just try the above-mentioned points in case your claim gets rejected. Do not provide any wrong information and leave no scope of errors. If you avoid making the above mistakes then surely your claims will never be rejected.

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