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Health Insurance 2749 views March 19, 2020
Policyholders often find their health insurance claims getting rejected. This means that policyholders would have to bear the medical bills accrued since hospitalization and medical treatment. However, it does not mean that health insurance companies look for ways to reject or deny health insurance claims made by their policyholders.
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Any and every kind of insurance is based on the Principle of Utmost Good Faith. This implies that the policy proposer must state all details regarding his health correctly. This is because the underwriting assesses the premium charges based on your risk profile. The insurance company before settling the claim finds out the cause of the claim made and the reason for treatment. On finding that the policyholder had been treated for some pre-existing disorder and had failed to mention the same while buying the policy, the insurer has the right to reject the claim.
There is a certain set of procedures prescribed by each insurance company concerning the health insurance claim settlement process. This involves:-
Filling the claim form incorrectly can also result in claim rejection.
Every insurance company mandates a waiting period for certain pre-existing illnesses. This may range from two to four years. Also, the illnesses included in this list may vary. These pre-existing disorders are treated only after a prescribed waiting period. The insurance company would deny or reject any claim raised for treating a health problem excluded during the waiting period.
Not all illnesses are covered under a health insurance scheme. Every health insurance company has an exclusion list containing lists of disorders or diseases excluded from the purview of treatment. These illnesses are termed “permanent exclusions” under the health insurance policy, and hence, any claim made towards their treatment would always stand rejected.
A lapsed health insurance policy document has no value. This means that any claim made on a lapsed policy will automatically be rejected.
In most cases, claims get rejected because policyholders have either failed to submit all the necessary documents or had missed reading details published in the policy document. Once your health insurance claims have been rejected, it is important to follow certain necessary steps to avoid rejection again during the policy period. These include:-