Why My Claim Was Rejected By The General Insurance Company For Health Insurance?

by Rizwan Khan Professional Interior Designer

Due to increased technical development, there have been advancements in medical treatment for various illnesses. Hence, because of these treatments, the cost of advanced healthcare has been increased. Due to lack of funds, one may not always be able to afford the best treatment. Thus, health insurance is beneficial in such situations as these policies cover in-patient treatments, hospitalization expenses including pre and post-hospitalization expenses. With a good health insurance policy, you may feel financially secured like most other people. Although the steps and procedures required to claim a health insurance policy are quick and simple there are cases and instances where the claims are rejected. Since an individual has to pay medical expenses from his/her pocket, a claim rejection means a major financial loss to the one holding the policy that is a policyholder. The often reasons which are cited by the Insurers are known as EXCLUSIONS. Here are some of the reasons why your claim may be denied:

· Waiting period:

The period during which certain pre-specified illnesses are not covered is known as the waiting period. However, the medical expenses caused due to the accident do not have any waiting period. From the date of insurance, the medical insurance companies generally do not give cover for any treatment within a period of 30-to-90 days. For particular treatments and diseases like cysts, internal tumors, and surgery on tonsils and sinuses there is a waiting period around 2 years. Thus waiting period is one of the most common reasons why medical insurance claims denials occur.

· Providing inaccurate information:

Your claim may be denied if you do not provide accurate information or fail to disclose all facts to the nature of employment, pre-existing conditions and health conditions. An affordable health insurance policy should be planned in such a manner that it contains all the important disclosure of facts from the insurers that help the insurance companies to determine the health insurance premium and eligibility. One of the biggest health insurance claim denial reasons is the misrepresenting or hiding of crucial information and facts. There is no need to get disappointed if your claim is rejected. One will be able to find a solution and overcome claim rejection in various cases. Understanding all the terms and conditions as per the insurance policy is very important. In order to find more details, you can call your insurance company.

· Permanent exceptions:

There are various insurance policies that come with a list of illnesses that are never covered under them at almost all the times. Some of the common Permanent Exclusions include eye and ear examinations, cost of spectacles, routine medical care, infertility, hormone replacement therapies, birth control procedures, HIV-related diseases, AIDS etc. These Exclusions are considered as cosmetic surgeries and not genuine medical conditions and thus are included under Permanent Exclusions.

Hence, knowing the reasons behind the denial of your claim will help you to file an appeal. One must provide the required information in order to have a convenient and affordable health insurance policy. You may lodge a written complaint if your issue is unresolved.



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About Rizwan Khan Innovator   Professional Interior Designer

21 connections, 0 recommendations, 90 honor points.
Joined APSense since, August 28th, 2018, From Mumbai, India.

Created on Nov 23rd 2018 05:12. Viewed 738 times.


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