HOW TO AVOID HEALTH INSURANCE CLAIM REJECTION

Health insurance acts as an umbrella of protection for you and your family during medical emergencies. With healthcare costs continuously rising due to inflation, medical treatments are becoming increasingly expensive. Therefore, it’s crucial to ensure you get the maximum benefit from your Mediclaim policy. However, there are instances where claims get rejected, leaving you stressed in tough times. When a medical emergency occurs, a smooth and hassle-free claim process is what you need the most.

1. Furnish All Required Bills

One of the most common reasons for claim rejection is failure to submit all necessary bills and documents. Make sure to provide every bill — from diagnosis and hospitalization to surgery, medicines, and doctor prescriptions — to your insurer within the required time frame. Always keep both original and duplicate copies of all documents in one safe place. Submitting complete documentation promptly ensures quick and successful claim settlement.

2. Read the List of Exclusions Carefully

Never skip reading the list of exclusions mentioned in your policy. It includes all treatments and situations that are not covered under your insurance as per IRDA guidelines. Treatments such as weight reduction, dental care, infertility, or sexually transmitted diseases are typically excluded. Being aware of these exclusions beforehand will help you avoid unpleasant surprises and claim rejections later.

3. Intimate the Insurer Within the Stipulated Time

Informing your insurer about your hospitalization within the prescribed time limit is very important. Failing to do so can lead to claim denial. Always intimate your insurer immediately after hospitalization — along with a doctor’s prescription, hospital details, and initial bills. Timely intimation ensures a smooth and hassle-free claim settlement process.

4. Disclose Accurate Information

Incorrect or incomplete information in your application form is one of the main reasons for claim rejection. During claim processing, insurers review the information provided — and any mismatch can result in rejection. Always disclose your correct personal and medical details when applying for insurance. Even though it may slightly increase your premium, it ensures your insurer cannot deny your claim later due to false information.

5. Choose a Reliable Insurance Provider

Selecting a trustworthy and reputed insurance provider can significantly reduce the chances of claim rejection. Always research and compare insurers before making a choice. Opt for a company with a high claim settlement ratio, as it reflects their reliability and efficiency in processing claims.

6. Avoid Discrepancies in the Application Form

Discrepancies or errors in your insurance application are another major cause of claim rejection. Many people rely on agents or third parties to fill out their forms, which can lead to mistakes or mismatched information. To avoid this, try to fill the form yourself. If a third party assists you, review the form carefully to ensure all details match your documents and there are no discrepancies.

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