Why Health Insurance Claims Get Denied

All human beings are exposed to several health problems and thus, person requires a health insurance policy to safeguard himself/herself and his/her family against unexpected medical emergency or bodily injury. These emergencies may put a huge financial burden on your pocket. Therefore, once you have taken a health insurance, it is difficult to ensure that your claim doesn’t get denied during medical emergency.

Following are the premises on which an insurance firm can reject health claims:-

Delay in Intimation
During medical emergency, immediately dial toll free contact number provided by the insurer/agent/broker to expedite the claim settlement process. The insurance firm can refuse your claim in case of any delay in intimation.

Any costs that come under exclusions
Claim will get rejected if policyholder claims any expenses which come under exclusions. Moreover, any claim for diagnostic charges, hospitalization, investigation charges, which do not make sure about the illness or injury existence also might get refused by the insurance company. Expenses like fax, telephone, toiletries, food & beverages etc are generally excluded.

Diseases which are not listed under the policy
Read the documents carefully while purchasing the policy and make sure that you understand every detail related to the inclusions, exclusions, benefits, claim process and coverage. Clarify your all doubts about the health insurance plan and also declare pre-existing diseases, if any, while filling up the proposal form. If any disease is not listed under the policy, then your insurance firm might refuse your health claim.

Exhausted Sum Insured Limit
In case policyholder have already exhausted sum insured limit under his/her policy, then company might refuse your claim.

All kinds of fraud, misrepresentation or non-disclosure
Make sure that you answer all questions correctly while filling up the proposal form as insurance is a contract of good trust requiring the customer to open all material facts. If buyer thinks any fact is material, then please mention it.

The insurance shall become voidable at the option of the insurer, in case of any incorrect or untrue statement, non-disclosure in proposal form, misrepresentation, declaration, personal statement  or any other statement. If you withhold any material details, then the company might refuse your claim on that basis.

Maintain Regularity in Paper Work
Always submit all the essential documents along with original reports related to the policy to the insurance company. Ensure that medical bills have stamped and preferably numbered. Keep all the documents like policy, claim form, bills, discharge card/certificate, receipt and medical prescription to be in proper sequence.

If company finds any fraud intention during the procedure of claim settlement or investigation, then also company can deny your claim.

Source: http://www.articles.gappoo.com/2015-Article-Directory/why-health-insurance-claims-get-denied