Why your cashless claim could be denied

by Kiran Jhaa Finance

In this fast paced 21^st century, health insurance has become a necessity more than a luxury. With increased life expectancy due to the evolution of medicine and health care, the costs of the respective has increased sharply. The pockets of millions of people have taken a serious hit due to the increasing medical costs. When a person faces an unfortunate event, the most important aspect to help the person endure the tragedy is his/her financial economy. There is hardly anything that is possible without money in hand. This is where health insurance comes into picture. In the times of unfortunate events, not only does it provide you with financial stability but also protects your hard-earned savings from taking a serious hit.

The claims of health insurances are of two types; Reimbursement claims and cashless claims. Reimbursement claims are those where the policyholder bears the entire cost and after the ailment, the insurance company reimburses the amount to him/her whereas in cashless claims the entire cost is paid by the insurance company itself. Cashless claims are mostly effective when the diagnosis is done by a hospital which is a network of the insurance company. Sometimes your claims can be rejected due to various reasons which might leave you with no option but to bear the entire cost of the ailment. To shield you from such an event, here are a few reasons why your cashless claim could be denied.

1. Outside Network Hospital

This is the most common reason why many of the insurance claims are denied. Many times, during emergencies people forget to check which hospitals are in the network of the insurance company and end up getting admitted or treated by a non-network hospital. You can check online or get in touch with the insurer’s customer care to find out about the nearest network hospitals before you buy cashless health insurance.

2. Non-disclosure of Material Facts

Before the insurer settles your dues for you, they spend certain time verifying your claims and if they are appropriate. Any inappropriate or hidden fact is found or if any tampering with facts is done, the insurer may straight away disregard your claims. Hence, it is always advised that when you are submitting your application form when you buy cashless health insurance you truthfully disclose your existing medical conditions truthfully.

3. Claims for Permanent Exclusions

Some health insurance policies are exclusive of certain treatments for diseases which means that some policies do not cover ailments for certain diseases even if the hospital is a part of the insurer’s network. In such a case if you are admitted to the hospital for the listed exclusions, your cashless claim will be denied.

4. The policy is not live on the date of claim

It is very important to keep a track of the date when your policy expires. Most health insurances are annual in nature and the premium amount has to be paid before the tenure expires. Your cashless claim will be denied if your policy has expired on the day of admission to the hospital.