Producer: Priyanka Das Editor: Nisha Dubey
It’s crucial for policyholders to thoroughly understand their insurance policies, disclose all relevant information truthfully and follow the necessary procedures when filing a claim to minimise the risk of denial.
Health insurance claims can be denied for various reasons and here are the six common ones.
Pre-existing Conditions: If the medical condition for which the claim is filed falls under the pre-existing conditions clause of the policy and was not disclosed at the time of purchasing the policy, the claim might be denied.
Non-Disclosure or Misrepresentation: If the insured individual fails to disclose or misrepresents their medical history or any other relevant information at the time of purchasing the policy, the insurance company might deny the claim.
Policy Exclusions: Health insurance policies don’t cover everything. Read the fine print carefully to understand what’s excluded, like cosmetic procedures or injuries from dangerous activities.
Documentation and Procedure Errors: Incomplete or incorrect documentation, such as missing medical records, improper filling of claim forms, or failure to follow the required claim procedures, can lead to claim denials.
Policy Lapses or Non-Payment of Premiums: If the policyholder fails to pay premiums on time, resulting in policy lapses or discontinuation, any claims made during that period may be denied. Paying your premiums on time is crucial.
Waiting Period Violations: There are often waiting periods before you can claim for certain things. Make sure you understand these and plan accordingly.