Common reasons why claims for health insurance are rejected

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According to the old saying, health is wealth. When you are unable to feel the pinch, these golden words become more logical. Health insurance is essential because of the many challenges that life brings. Sometimes, however, you may be shocked to learn that your claim request is denied. Although not disclosing pre-existing diseases is the main reason for rejection, there are other reasons.

These are the top five reasons claims are generally rejected.

Incorrect information: Any discrepancy in the claim form, whether it is a mistake made while spelling or an attempt to conceal information such as age, family health, lifestyle, and annual income, will result in the rejection of the claim and the termination of the policy. False income details can lead to rejection of claims.

Pre-existing Condition: Some policy holders buy insurance thinking they will be able to get treatment later on. However, they forget that pre-existing conditions are not covered. They also try to conceal medical information which could lead to rejection of claims. Pre-existing conditions such as high blood pressure are not covered by most insurance companies. Therefore, medical expenses incurred because of this will not be covered. This is done to stop people from getting insurance before they are admitted to hospital for an existing condition.

Not being aware of the exclusions. Just as with pre-existing conditions, there are also exclusions. Many policy holders fail to read the terms and conditions, which clearly state that injuries sustained while drinking or participating in dangerous sports are not covered. There is also a waiting period of 30 days before any claim can be made. The waiting period does not apply to an accident case. However, it should be noted that the accident should not have occurred due to intoxication. Before calling an insurer, one must count the exclusions (often in fine print).

Policy lapse - There have been instances where people have taken a week or more to renew their insurance. They have become ill and were denied a claim. The policy expires on the last day. Even if one is admitted to the hospital within a day, their insurance won't work. It is important to renew your policy every year before the deadline.

Not informing the insurance company: A fatal injury can cause a lot of grief and a person, or their family members, may not remember to notify the policy provider. This could increase their anxiety. Many policies that cover health insurance stipulate that the insurer must inform them within 24 hours (or sometimes 48) of any hospitalization. Otherwise, no coverage will be provided. It is crucial to get the policy from someone who is available 24/7 and can respond quickly. In the event that the policy holder is unable to do so, designate a nominee to notify the insurer and handle the paperwork.

Disclaimer: This information is only for illustration purposes. Before concluding sales, please consult the prospectus and policy wordings.

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