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Why are Health Insurance claims rejected?

Why are health Insurance claims rejected_ - (A) (1)

Health is wealth, as the old saying goes. Those golden words make the most sense when you feel the need to treat an illness. Stressful schedules, sedentary lifestyles, pollution, adulteration, and contamination of food have made health a great challenge, which is why everyone knows the importance of having health insurance. . But sometimes his claim is denied to his utter disbelief. While not revealing a pre-existing condition is a primary reason for rejection, there are other reasons for termination as well.

Here are the top five reasons why complaints are often rejected:

Incorrect information: Any discrepancy as to whether it is a real error when completing the form, eg. A spelling mistake or an actual attempt to hide information such as age, annual income, or lifestyle, and family health leads not only to the rejection of the application but also to the termination of the policy. Oftentimes, the insured amount is based on annual income, and providing incorrect income information to obtain a higher insured amount can also result in denial of claims.

Pre-existing disease: Policyholders sometimes buy insurance with future treatment in mind, but forget that pre-existing conditions are not covered and try to hide medical details, which may justify claim denial. Most insurance companies do not cover pre-existing conditions such as high blood pressure, so the medical costs associated with it are not covered. This is usually done to prevent people from purchasing insurance for an existing illness immediately prior to hospitalization.

Not knowing the exclusions: As with pre-existing conditions, there are other exclusions. Policyholders often forget to read the terms and conditions, which clearly state that an injury caused by drunkenness or adventure sports is not covered. There is also a waiting period of at least 30 days from the policy date before which no claim can be made. If it is an accident, the waiting time does not apply, but again, the accident should not have occurred due to intoxication. Exclusions (usually in fine print) should be counted before calling the insurer.

Policy expiration: There have also been cases where people took a week or a month to renew their insurance. At this stage, they got sick and were not eligible. This is because the policy expires on the last day. Even if you are hospitalized just one day later, your insurance won’t work. For this reason, it is important to renew the policy every year before the deadline.

Failure to notify the insurer in a timely manner: A fatal accident can be a traumatic experience in which a person or their family members may not immediately remember to notify the insurance provider. This mistake could add to your worries. Most health insurers clearly state that the insurer must be notified within 24 (or in some cases 48) hours after the hospital stay; otherwise, coverage will not be granted. Therefore, it is important to obtain the policy from a provider who is available 24 hours a day, 7 days a week, and responds quickly. You should also appoint an attorney who can inform the insurer and take care of the rest of the paperwork if the insured is unable to do so.


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