In today’s fast track world, if you have a health insurance plan, you can get easy access to the best medical care and treatment and also financially protected. Whenever there is a medical emergency, a health insurance policy guarantees peace of mind and ensures that you and your family will receive the best treatment at the hospital of your choice. However, there are several reasons why health insurance claims are denied. What is Health Insurance Plan? What are the possible ways insurance company can reject your health insurance claim? What are the various ways to avoid health insurance claim rejection or denial? How should we handle if an insurance claim is denied?
Also Read: Top Health Insurance plans for your parents or Senior Citizens
What is Health Insurance Plan?
Health insurance is an insurance that covers your medical and surgical expenses. It reimburses the expense incurred due to injury or illness and pays, the care provider of the insured individual directly. According to the terms of insurance coverage, either insurance company directly reimburses the hospital or the insured pays the cost by himself and subsequently reimbursed by insurance companies. While the increase in food and clothing prices are in single digit medical care costs usually increased in double digits.
Do we need a health insurance plan?
According to the recent study, a heart surgery performed today @ ₹ 2 lakhs will cost over ₹ 3.22 lakhs after five years and after 10 years, it will be ₹ 5.19 and ₹ 8.35 lakhs after 15 years.
For an individual who has not saved that much amount of money, paying for funds in the case of emergency can be very difficult. This is very problematic for senior citizens who are more prone to medical care. One way to provide for health related medical emergencies is by taking up health insurance plan. Health insurance offers huge help and flexibility when it comes to disease and ailment coverage. For example, some health insurance plans cover for more than 30 critical illness and over 80 surgical procedures.
With health insurance individual is assured of a more secure future, both health wise and money wise and this makes health insurance very important and critical for individuals and especially if they are responsible for the financial well being of the family.
There are several common reasons for medical claim denials. However, I would discuss about top reasons medical claims denied in this article and how we can avoid them.
6 Ways to avoid Health Insurance Claim rejection
The most critical and important time in the tenure of a health insurance policy is when an individual files for a claim. It always remains a matter of concern whether the insurer will give the insurance claim or not. It is human tendency to focus only on the price of the premiums or the tax benefits one can avail. We rarely scrutinize the features of the policy and its limitations and which becomes a major reason for a claim to be rejected. Instead of understanding health insurance claim denial reasons at later point of time, you can try to avoid them.
While taking a health insurance plan one need to be careful of a number of important aspects so that they ensure they would not get into a bad situation.
1) You or your family should fill claim form
To have the insurance form filled by the policy holder themselves so that the policy is not underwritten with incorrect details. The policyholder should also thoroughly check the policy documents before submitting them to the insurer to ensure that the information provided in it is correct and is not misrepresented because when it comes to filling up the form, we depend on the agent or hospital attendant to do it and sometimes they fill up wrong information in the form.
2) Read the conditions of Health Insurance Plan before you buy
Policy holders should read the terms and conditions of the policy thoroughly because in many conditions the policy holder don’t even know what features are included and excluded from the policy. Since policy terms and conditions are written in complicated manner policy holder should take out time to go through them thoroughly. Individuals should check online and review cases, which are rejected in the past and the reason behind the rejection.
3) Disclose all facts in Health Insurance Plan
I indicated earlier on this blog that my health insurance plan, I indicated clearly that I have asthma. I have been issued health insurance plan. Now, in future, if I am hospitalized due to asthma, the insurance company has to accept my claim and cannot reject. Policy holders should always disclose information accurately to the insurer so that later they claim does not get rejected. Policy holders should not hide their health history in terms of pre-existing medical illness or major disease.
4) Avoid unnecessary medical procedures / tests at the hospital
In many cases, medical centres perform procedures that may not be required by the patient, but in order to have more business these centres offer them, which is taken by the patient thinking that it will be covered in the medical claim. However, if these procedures are not in line with the medical history of the patient and is necessarily required during the course of their medication, there are many chances that the claim might be rejected. However, you may have limited say on this as if Doctor prescribes to know the advanced condition of the patient, we cannot argue with them.
Also Read: Best Medical Insurance Plans that comes with good features and low premiums
5) Go for cashless claims
Most health policies offered these days has a list of hospitals to provide cashless treatment. Policy holders should thoroughly scrutinize the list of hospitals mentioned in the policy to avoid discomfort in the case of the emergency. On the date of joining the hospital or put a claim, the hospital can get pre-approval for cashless claims. This way, your total amount required for medical treatment is approved and later when the final bill comes, the insurance company would not reject your claim.
6) Take a comprehensive health insurance plan
If you observe, there are several companies or banks who would offer a health insurance plan for low premiums. These contain several terms and conditions and would not be useful when required. Health insurance policies with low premiums should be avoided by individuals because agents and insurance companies in order to have a more business offer such schemes. These low premium packages do not cover incidental loses or loss of money in case of accident or critical medical emergency. As a result, due to low premium the full benefits of the policy cannot be redeemed.
Conclusion: Health Insurance Plan is good for secured life and healthy future. If you can consider these tips, you can avoid health insurance claim rejections.
Readers, any time your health insurance claim got rejected? How you managed the situation then?
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Suresh
How to avoid health insurance claim rejections
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