7 reasons why your health insurance claim may get rejected

The main reason for having a health insurance policy is to get a claim settlement during hospitalization. Depending on the type of policy, policyholders can make insurance claims either through the reimbursement mode or the cashless mode.

For instance, some policies offer the cashless facility to policyholders under networking hospitals, while in the case of non-networking hospitals, the facility is not offered. In such cases, the policyholder needs to pay for the expenses to the hospital and get the expenses reimbursed from the insurer by submitting the claim form.

Due to coronavirus, various insurance policies covering COVID-19 have recently been launched. Experts say to make sure that claims are not rejected, it’s important for policyholders to understand their claim parameters.

Here are some reasons why your insurance claim could be rejected:

Not Considering Exclusions: All insurance policies have exclusions mentioned in their policy. For instance, there are policies that mention that they do not cover pandemics. Hence, claims rising out of COVID-19 treatment may be rejected. Experts suggest if one is going to opt for a policy now that includes the COVID-19 treatment, look for policies that cover expenses for PPF kits such as masks, gloves, face shields, shoe covers, sanitizers, and disinfectants that are required for COVID-19.

Travel history: As a policyholder, if you or your family members have a recent travel history to any of the worst coronavirus affected countries or cities, the insurance company could reject the claim. Additionally, if the insured gets COVID-19 without traveling anywhere but from his/her family member who has a travel history to selected countries such as China, Japan, Kuwait, Italy, Hong Kong, Macau, Thailand, Singapore, and others, the policy claim could get rejected.

Making Claim in Waiting Period: Depending on the type of policies, the waiting period is allocated. Any claim made during the waiting period will not be considered by the insurer and typically the claim will get rejected. The waiting period is usually allotted for pre-existing diseases. Hence, if a policyholder has a disease prior to purchasing the policy, the claim for treating the disease can only be made after the waiting period is over, and the premiums are paid for that tenure.

Pre-existing disease: If the policyholder is an existing patient of any respiratory disease for the past 1 month or more than a month, then experts suggest that there is a high chance that both a coronavirus specific insurance policy or a basic health insurance policy might not get approved for the policyholder.

Pre-existing symptoms: If a policyholder has been suffering from cough, flu, respiratory issues, breathlessness, before opting for the policy and then goes for treatment, and finds out that the symptoms have transformed into coronavirus disease, there are chances that the health insurance company might reject the claim.

Timings: As the policyholder, if you or your family members are not hospitalized for a minimum of 24 hours and are discharged early by the hospital, the policy claim might get rejected.

Wrong information: Policyholders should keep in mind that hiding information or giving inaccurate information or miss-interpretation of any fact can also lead to rejection of their claims.

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