The health insurance is supposed to safeguard you in case of a medical crisis. Nevertheless, a significant number of policyholders experience losses when claiming benefits when they are in need the most. Rejection of claim does not only result in stress but may also mean huge out-of-pocket costs. The pleasant part is that, most claims rejections are preventable in case you know the usual causes and take the proper precautions beforehand. This blog will discuss how to prevent the reasons of claim rejection in health insurance and have a hassle-free claim process.
1. Share All Medical Data Truthfully.
Non-disclosure or the misrepresentation of pre-existing diseases is one of the largest causes of health insurance claim rejection. A lot of individuals conceal the existence of diabetes, hypertension, asthma or previous surgeries to receive a less expensive premium.
How to avoid it:
Never conceal your full medical history when purchasing the policy. Even some minor health problems should be brought up. Medical records are checked by the insurers when settlements of claims are provided and concealment of information can cause rejection as such.
2. Get Waiting Periods Clear.
All health insurance policies come with waiting periods such as pre-existing diseases, particular treatments, maternity benefits, and other types of surgery. Any claims that are made during such waiting periods are normally turned away.
How to avoid it:
Review the policy document and record every waiting period. Arrange elective treatments upon the expiry of the waiting period. When you already have a medical condition, a policy with a shorter waiting period should be taken.
3. Select the appropriate Network Hospital.
Cashless claims are not permitted in other hospitals that are not in the network of your insurer. Treatment in a non-network hospital would result in inefficiencies in terms of delays or half-claims rejection unless well documented.
How to avoid it:
Research the network hospital list of the insurer before hospitalization. During emergencies, report to the insurer immediately in case of admission in the non-network hospital and take careful consideration of the reimbursement rules.
4. Give Notice to the Insurer Within the Stipulated Time.
Another typical cause of the claim rejection is delayed intimation. Insurers will insist that you report the same to them within a time period of about 24-48 hours in case of emergency hospitalization.
How to avoid it:
Keep the customer care number of your insurer and notify them instantly in case you are hospitalized. Under planned treatments, it is wise to inform the insurer in advance in order to receive pre-authorization.
5. Read Carefully Policy Exclusions.
Health insurance policies do not cover many treatments and costs like cosmetic surgery, experimental treatment, self-injury and some alternative treatments.
How to avoid it:
Read the exclusions carefully before the purchase of the policy. In case of necessity, use add-on covers to minimize exclusions. Being aware of what is not will assist in avoiding unrealistic expectations and claim rejection.
6. Make sure that it is well documented.
Unfinished or wrongly filled documents may result in denial of claim or procrastination. Late bills, wrong patient information, and wrong diagnosis data usually cause problems.
How to avoid it:
Keep all original records such as hospital bills, prescription, discharge summary, diagnostic reports and receipts of payment. Check to ensure everything is correct prior to submission.
7. Prevent Policy Lapse because of Non-payment of Premium.
When your policy lapses due to late payment of premiums then the claims that are made within the period of lapse are automatically declined.
How to avoid it:
Make the premiums on time and create reminders or have auto-debit. You need to renew your policy before the date to maintain your cover and other benefits such as no-claim bonus.
8. Choose Adequate Sum Insured
A small amount insured can lead to the partial settlement of the claims that will leave you paying the remaining amount.
How to avoid it:
Select an amount in the insured that corresponds to the escalating healthcare expenses and family requirements. Think about top-up or super-top up plans to get more coverage at reasonable costs.
9. Keep Policy Documents Handy
Insufficient policy knowledge is likely to lead to errors in filing claims.
How to avoid it:
Have both copies of your policies, both digital and hard copies, readily available. Knowledge of such terms as sub-limits, co-payment and room rent limit will help to prevent uncomplimentary surprises.
Conclusion
Rejection of health insurance claims can be emotionally and financially taxing to go through yet majority of the rejections occur because they are caused by preventable errors. By telling the truth when buying a policy, knowing what is in the policy, telling insurers in good time, and having the right paperwork will go a long way in eliminating the chances of being denied on the claim. A small wake up call and planning can make sure that your health insurance is really there when you need it the most.
