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Health Insurance Claim

7 Ways To Avoid Health Insurance Claim Rejection

When you take out a health insurance policy, you are leaning on your insurer to cover the cost of medical treatments. To receive the benefits, you need to submit the insurance claim form to your insurer, listing down all the details as required by the provider. While the entire process seems fairly simple and easy, there have been many instances where companies have rejected policyholders’ claims. This usually happens when the insured individual fails to meet his or her end of the insurance agreement. To prevent such an unfortunate situation from arising, here are 7 ways to avoid health insurance claim rejection:

1. Fill out the application yourself

Many people tend to rely on insurance agents to fill their application forms. The major risk of having an agent fill up your form is that certain information could be misrepresented which in turn affects your claim eligibility. When you choose to fill the form yourself, you make sure it is error free. Thoroughly check the policy documents and verify the details before submitting them to the health insurer. When you depend on an agent for this task, there is every possibility that they can pen down incorrect information.

2. Know your policy

It has been seen that many customers are oblivious to the inclusions and exclusions of the health insurance plans they are availing. You must thoroughly understand the features, terms and conditions of the policy you are taking out. If you have difficulty understanding the insurance jargons, contact your health insurer. Most insurance policies come with a free look-in period of 15 days, during which you can go through the policy documents. If you feel that the insurance plan does completely suit your requirements, you can cancel the cover.

3. Disclose accurate information

Anything and everything that you think can have a bearing on your health insurance must be disclosed to the health insurer. Often times, people hide details about their pre-existing medical conditions in fears that the health insurer will not extend the coverage. If and when the insurance company finds out that a policyholder has withheld necessary information, they have the complete right to reject the policyholder’s claims. So when you, the policyholder, approach an insurer for a health cover, it is your responsibility to ensure that all necessary information such as past illnesses, smoking habits, income etc. are conveyed.

4. Treatment in Network Hospitals

Health insurance companies tie up with several hospitals for cashless treatments. Such hospitals are referred to as network hospital. Always try to avail services from a network hospital that your insurer has partnered with. Doing so will not only help speed up the claim process, it will significantly reduce the possibility of your claim getting rejected.

5. Opt for add-on covers

Many people choose to avail basic covers just so they can save money. But what they fail to realize is that these basic packages do not cover several kinds of medical conditions and treatments. Individuals who have opted for such packages must consider taking out add-on covers. Add-on plans help give better coverage at an affordable premium. Hospital cash cover, personal accident cover and critical illness cover are just some examples of add-on covers.

6. Renew your policy

Health insurance companies will only settle claims as long as the insurance policy is active. Timely renewal of policy is essential in retaining your cover at all times. If your policy lapses even by one day and you submit a claim, the health insurer will turn you down. To keep this from happening, enquire beforehand about when the policy ends so you can be prepared. In case you were to forget, insurance companies are known to send clients reminders a few days prior to their policy lapse date. Some insurers even provide grace period post the due date for premium payment. You can renew your cover during this period to continue enjoying the benefits.

7. Don’t delay in informing your insurance

When it comes to health insurance, you need to inform the insurer within a day or two of hospitalization. Delays can lead to rejection of insurance claims. Check your policy documents to see if any particular time frame has been mentioned wherein which you need to make the claim. For planned hospitalization, notify your insurer well in advance. In case of a medical emergency, you can proceed with the treatment and inform the insurer later, like in 2 or 3 days of hospitalization (check your policy documents).

If you are planning to buy a health insurance policy, one of the things to remember is not to buy one in a hurry. Take your time to go through the different options available in the market. At QuickBima, you can compare a list of health insurance policies and select one that best meets your needs. Make sure to go through the benefits as well as exclusions under each policy. The more informed you are while purchasing a plan, the lesser chance there is of your claim getting rejected.