Health Insurance Rejection: Expectations Versus Reality Decoded

Author : danielmartinss202
Publish Date : 2021-02-08 08:00:52


Health Insurance Rejection: Expectations Versus Reality Decoded

Healthcare insurance policies provide the much-needed financial safety to the insured and their family in case a medical emergency strikes. In such situations, the health insurance rejection could come as a rude shock and may rob the insured of their financial safety net. Here we focus on some causes for health insurance rejection and also some common myths that might be prevalent.

 

What Is Medical Insurance Rejection?

When an insurance company declines the insured’s request to pay for the medical services or hospital expenses that have been incurred by the insured, it is known as health insurance rejection. Though in recent times, buying a medical insurance policy has become easy, filing a claim can still be challenging.

Insurance claims are rejected due to many errors that are made at the time of buying the policy or at the time of filing the claim. Sometimes your insurance claim gets rejected due to ignorance.

Why Are Medical Insurance Claims Rejected?

Health insurance rejections may happen due to various reasons, here we discuss the most common reasons for rejection of medical claims:

  1. Claim Goes Beyond the Sum Insured:
    All health insurance policies have a sum assured; this the amount available to the individual or the family in a year. If the entire amount available to the insured has already been utilised in one financial year, then any more cashless claims made in that year will be rejected.
     
  2. Not Paying Attention To Exclusions::
    Health insurance policies have exclusions mentioned in the policy document, insured needs to be aware of these exclusions. Exclusions are diseases/ailments for which a claim cannot be filed by the insured. Claims filed for ailments that are in the exclusion list are rejected by the insurance company.
     
  3. Misrepresentation Or Hiding Of Facts:
    One of the most common causes of claim rejection is the non-disclosure or partial disclosure of facts or misrepresentation of facts at the time of buying the policy. It may be done inadvertently or in some cases, intentionally too. This could pertain to aspects like age, income, occupation, existing insurance cover, pre-existing ailments; any discrepancy in these aspects could lead to claim rejection.
     
  4. Filing a Claim In The Waiting Period:
    Some policies may have a waiting period during which a claim cannot be filed, and the waiting period is usually fixed in the case of pre-existing illnesses. Claims filed for a pre-existing condition during the waiting period are not accepted by the insurance company.
     
  5. Not Filing A Claim Within The Stipulated Time:
    Insurance companies require the claims for reimbursement to be made within a certain time frame. This time frame could be 24 hours in case of emergencies and may vary depending on the policy type and the insurance companies’ policies. Not applying within the given time could lead to claim rejection.

Health Insurance Rejection: Expectation Versus Reality

We discussed a few reasons of claim rejection above; often the insured may have certain pre-existing notions and assumptions about health insurance rejection; some of these may not be accurate regarding the rejection of an insurance claim. Let us try and focus on a few of these:

Expectation: Minimum of 24 hours of hospitalisation is required for filing a medical claim

Reality:  Often, the insured believe that unless there is a hospitalisation of at least 24 hours, a claim cannot be filed. However, it does not hold in all cases. Due to advances made in the medical fields, many procedures do not require overnight stay in hospitals anymore. Therefore, many such procedures including dialysis, radiation, chemotherapy, eye surgeries are covered even if the stay in the hospital is less than 24 hours.

 

Expectation: The Policy Will Cover Pre-existing Diseases Are Covered From Day One

Reality: This may appear to be unfair to the insured when he/she is not aware of this clause when buying the policy. Generally, all health insurance policies come with a 30-day waiting period, except in the case of accidents. For pre-existing diseases, there may be a waiting period of 2-4 years. Before buying get clarity on this aspect; compare different policies before making a choice.

 

Expectation: Denial of cashless claim is the end of the road:

Reality: Denial of a cashless claim may appear like a big disappointment; the insured is burdened with paying for the treatment despite having an insurance policy. While it does put one in a tough spot, it is not a reason to despair. It may be because the insurance provider requires more details, after which they may reimburse the hospitalisation expenses.

 

Expectation: Nothing Can Be Done Once A Claim is Denied:

Reality: Rejection of a health insurance claim is not final in all instances. If the policy was bought by providing wrong or incomplete details, then nothing can be done to reverse the decision. When the claim is rejected owing to incomplete documentation, errors in filing the claim or some missing information, then the insured person can file the claim again after making the necessary corrections. The first step is to identify the reason for rejection and the act accordingly.

 

Expectation: The Hospital Made An Error:

Reality: Claim rejection may often lead to the insured blaming the hospital, but most often, this is not the case. The reasons are usually inadequate understating of the policy terms or aspects like not disclosing a pre-existing condition at the time of buying the policy or misrepresentation of facts at the time of buying the policy.

 

Conclusion:

Buying the right medical insurance policy can provide you and your financial protection in your hour of need. You must research well and make the right choice after going through all the policy details.

We realise that not having the right financial support to take care of your loved ones could be traumatic. Crowdfunding platforms allows you to crowdsource funds so that you can provide your loved ones with the necessary medical aid. Crowdfunding makes raising funds simply. You can start a fundraiser in just five minutes. We provide you with all the help and support needed to start your fundraiser.

 



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