Learn Why Health Insurance Claims Get Denied

Today, when there is a surge of health issues, having medical insurance can save any individual or family from financial ruin.

Everyone now realizes the importance of health insurance and is getting themselves secured with the best health insurance plan, which covers most of the things which are important. However, in this rush, people do not read the terms and conditions of the medical insurance put by the medical insurance company. This leads to insurance claims being rejected by the company at a time when you are in an emergency.  

Reasons for Rejection of Health Insurance Claims 

There are many reasons health insurance companies sometimes reject health insurance claims. Some of the reasons why term insurance claim gets rejected are –

• Time Limit – If you exceed the limit on health insurance policies, you will find your health insurance claim being rejected. You must apply for reimbursement within a particular time frame with the majority of health insurance policies. If there is a case of emergency admission, the period offered is 24 hours after the patient has been admitted; however, it may vary depending on the type of insurance you have chosen and the treatment you are receiving. Your claim may be denied if you do not apply within the required timeframe.
• Not Disclosing Proper Information – A health insurance policy requires the person to be truthful when it comes to filling their proposal form. Wrong or incomplete disclosures of crucial facts, including age, occupation, income, current insurance plans, serious diseases, or pre-existing medical problems, might result in an insurance claim being denied. The best way to solve this problem is to fill out forms quickly and accurately. It is very important to mention any kind of diseases or illnesses you are suffering from or had suffered from in these health insurance forms. 
• Exclusions – Many people, because of not reading the terms and conditions of their policy, forget the fact that some conditions and diseases are clearly not covered in medical insurance policies. These illnesses and conditions are listed as ‘not covered in the insurance. These are diseases for which you are unable to register a claim and are referred to as exclusions. However, if specific plans or policies cover such diseases, there would be a waiting time. As a result, if you make a cashless claim for an excluded sickness or medical condition, your health insurance claims will be denied.
• Sum Limits of The Policy – Every insurance policy has a sum limit assigned for the individual or the family. The sum limit depends on the health insurance policy you have gone for. If you go overboard with the sum limit of your health insurance policy in a year, your health insurance claims will be rejected by the health insurance company. However, if a portion of your sum guaranteed remains intact, the health insurance company may compensate you at a later date for the amount.
• Period Of The Insurance Policy – With most health insurance policies, they have a validity of one year from the date they have been issued by the health insurance company. At the end of the date, the health insurance policy will expire, which renders it completely useless. This makes it important to get a health insurance policy renewed before it expires. Many health insurance companies offer different kinds of benefits with the renewal of health insurance policies. This can include more sum limit or less premium to be paid each year for the health insurance policy. If you make an insurance claim with an expired policy, obviously, your health insurance claims will be rejected. 
• Waiting Periods – Waiting periods in health insurance policies are designed to make you wait before making an insurance claim. Some health insurance companies cover existing diseases and other conditions after a certain amount of waiting period has passed. This can be years. The duration of the waiting period is mentioned by the health insurance company when you are getting the policy. Any insurance claims which are made in the waiting period will be automatically rejected by the health insurance company.

How to Avoid Rejection of Insurance Claims

• Correct Information in Forms – As mentioned earlier, filling in wrong information in the health insurance form can lead to a rejection of your insurance claim later. You need to provide the right information to your provider or health insurance company at the time of filling your insurance form in order to avoid your claims being rejected. Sure, mentioning your pre-existing sickness or disease might lead to an increase in the premium which you have to pay, but at least your claim will be processed when you need it, unlike it being stuck in cases where these pre-existing conditions had not been mentioned. 
• Renewing On Time – Do not wait on the last date of your health insurance policy expiry to renew your health policy. Try to renew your health insurance policy a week or two before the expiry in order to avoid any kind of issues that you might face later in terms of paying. Some providers or health insurance companies might charge you extra for renewing your health insurance policy after its expiry. 
• Policy Provider – When choosing health insurance, it is important to go with the health insurance provider or company which is reliable and processes your claims when you need them. You need to do proper market research on all health insurance providers, sometimes the premium might be high with these reliable providers, but they surely help you in times of emergency without any kind of issues, and you will be able to make hassle-free claims.

Medical costs have risen dramatically in recent years, causing financial hardship for many individuals and families who have been touched by the covid epidemic. Medical insurance can help you avoid a financial disaster, but it is very important to choose carefully for which medical insurance policy you are going for. You need to choose a policy that covers a lot of things and a provider which is reliable and makes your insurance claim processing much easier.