Why do insurance providers reject COVID-19 health insurance claims?
COVID-19 cases are increasing day by day in India, and many people don’t know how to deal with the medical expenses as they are expensive. As a result, insurance companies offer special coverage for them, allowing them to overcome them easily. They provide health insurance with Covid coverage, thereby showing ways to claim amounts for various services. Buying an insurance policy enables policyholders to get high-quality treatments in approved hospitals that will help restore the conditions. However, it is necessary to keep certain things in mind before purchasing a new policy from the market.
Most companies offer two types of health insurance plans for those who want to get coverage for COVID-19. They are standard basic plans that give methods to ensure more protection from high medical expenses. Not only that, they are affordable, enabling a person to provide financial security against medical inflation. While choosing a policy from an insurance company, customers should know more about the claiming process in detail. This, in turn, paves ways to avoid rejections and disputes. In addition, a person should understand the inclusions and exclusions in detail before purchasing a COVID-19 insurance plan.
Top 10 Reasons why insurance companies reject COVID-19 claims
IRDA recently said that many insurance companies reject several claims of COVID-19, and the numbers are increasing. Therefore, policyholders should know the health insurance policy rejection reasons properly that will help to resolve them at the earliest.
- Mild Covid Symptoms
- Pre-Existing Illnesses
- Home Treatments
- Income Loophole
- Blaming Policyholders
- High volume of claims
- Waiting Period
- Documentation Issues
- Lapsed Policy
- Cashless and Reimbursement Claim
Let’s read about the top 10 reasons that can lead to the rejection of a COVID-19 claim as mentioned below:-
1. Mild Covid Symptoms
Mild Covid symptoms are one of the main reasons for claim rejections. Many hospitals don’t recommend hospitalization for policyholders when they suffer from mild symptoms. Apart from that, most doctors say that insurance companies can’t judge the severity of COVID-19 symptoms when it comes to hospitalization. As a result, the claim gets rejected by a company without any notice.
2. Pre-Existing Illnesses
Pre-existing illness is another reason for claim insurance rejection, which indicates one or more health disorders. Insurers will reject claims even though they provide coverage for them. When a patient needs hospitalization, it is necessary to check whether it has any special instructions with an insurance company. In some cases, an insurer denies claims due to past illnesses and significant disorders.
3. Home Treatments
With the increasing number of COVID-19 cases in India, some hospitals face difficulties accommodating them due to a shortage of rooms. As a result, doctors suggest home treatments for policyholders to get relief from the condition. While Corona Kavach’s policy provides coverage for home treatments and the purchase of self-equipment, some insurers reject the claims without any valid explanation. No concrete reasons are available for the rejection that will affect a policyholder in various ways.
4. Income Loophole
Income loophole is also one of the reasons why an insurer may deny an insurance claim. For instance, insurance companies now reject policyholders’ claims when an insured person’s income doesn’t meet specific parameters on the sum offered amount. They even reject claims by citing improper paperwork that will result in trouble.
5. Blaming Policyholders
Some insurance companies blame policyholders for not being careful when they contact COVID-19 patients despite knowing the risk. However, such rejections happen in a family when they get infected. On the other hand, the ground reality is that a family can’t avoid contact with others until the COVID-19 test results.
6. High volume of claims
The primary reason why COVID-19 coverage gets rejected is due to a high volume of claims received by the insurers. Many insurance companies find it challenging to deal with all COVID-19 claims where patients didn’t require hospitalization. Some policyholders will also opt for hospitalization without consulting a doctor, which ultimately results in rejection.
7. Waiting Period
Most insurance companies offer health insurance for COVID-19 with a minimum waiting period of 15 days. At the same time, some policyholders will file a claim without knowing the waiting period that will result in rejections. Therefore, a policyholder should evaluate the waiting period with more attention before buying a policy from the markets.
8. Documentation Issues
Documentation is necessary for health insurance claims, and many hospitals don’t share sufficient details with an insurance company. They will send only the positive test reports, which are not enough for the claims. Not only that, but policyholders will also make some mistakes in the documentation process by filling incorrect details and insufficient documents that will result in rejection. While filing a claim, it is necessary to submit a claim with proper bills, discharge summary, medical reports, diagnostic reports, doctor’s prescriptions, and other things.
9. Lapsed Policy
A policyholder should keep his/her policy active to make claims as soon as possible. Most insurance companies will reject a claim due to lapsed policy, and policyholders should pay their premiums on time.
10. Cashless and Reimbursement Claim
Although many companies offer cashless claims for COVID-19, they will reject a claim as soon as possible. Hence, it is wise to check whether such a facility is available in a hospital. This, in turn, provides ways to avoid rejections and other problems. Some insurers will reject the reimbursement claim citing some reasons that will affect an insured person.
Buying new health insurance involves several challenges, and one should consider doing proper research from different sources, including online. At the same time, it is imperative to know how to avoid claim denials that will help overcome unwanted problems. When a claim gets rejected, a policyholder should evaluate the reasons to fix them quickly. He/she should contact an insurer immediately to know the solutions for the problem. If the problem is not solved, then policyholders should file a complaint to the IGMS authority. This will help a lot to get a solution as early as possible to accomplish goals in the coverage process. In addition, a policy buyer should evaluate the pros and cons of an insurance plan. Also, he /she know how to get a claim for significant illnesses, including COVID-19, to avoid the financial burden.
