Purchasing health insurance may sound simple, but ensuring your claim goes through and you get reimbursed in time isn't easy. Here's what you should look out for.
Over the years, the disease burden has increased at a global level. Even in a country like India, which has the second-largest population in the world, health risks are on the rise. This could be attributed to a significant shift in our lifestyles. Unlike earlier, there is an increased dependence on processed food, and our sleep schedules have gone for a toss. Moreover, with work from home being the norm today, our lives have become more sedentary than ever.
In this scenario, investing in a health insurance policy is a necessity. That's because you could end up burning a hole in your pocket, if you do not have adequate protection. When you have the support of a health insurance policy, you know that your insurance provider will extend financial help when there's a crisis. But when you file a claim with your insurance provider, are they always obligated to pay you?
Well, the answer is no. There could be certain reasons why your claim could be rejected.
Here's why your claims could be rejected
• If you have used up your sum insured
When you invest in a health insurance policy, there is a certain sum insured that you receive, in case of an unfortunate event that is covered by your insurance provider. In case your sum insured has been completely exhausted in that particular year, your claims could get rejected.
• If your claim has been filed in a wrong manner
While getting coverage for a certain incident is a part of the plan, remember you will not get reimbursed if you do not file your claim correctly. So, make sure you know all the rules and complete the documentation as per protocol. Also, it is critical to opt for treatment at an accredited hospital, and have all the reports and receipts handy. If you fail to do these things, you may lose out on your claims.
• If you have submitted incorrect information
When you purchase a health insurance policy, you are bound to fill in a few details – but these must be correct. At that point, the insurer conducts underwriting to evaluate the risk they have to take, based on the information you have provided.
When you submit your claims, all the information is verified. In case you have not revealed everything properly or withheld something important, your claim could be rejected.
• If you claim for illnesses that are not specified
Every health insurance policy has a list of terms and conditions that also specify the illnesses that will be covered. In case you file a claim pertaining to an instance that is excluded from the policy, your claim will get rejected.
Also, there are certain pre-existing conditions that are only covered after a certain waiting period. In case your illness falls under that category, and you file a claim, it will get rejected at all costs.
• If you go beyond the specified time limit
Every policy lays down certain guidelines, when it comes to filing a claim. There's a specific duration that must be followed to claim reimbursement for your medical expenses. For instance, regarding a patient who has been admitted in an emergency, the time period is 24 hours. This could vary based on the kind of policy and illness you are suffering from. In case you fail to submit your claim on time, you are likely to face a rejection of your claim.
The last word
All in all, getting reimbursed for your medical expenses is not a difficult task. You just need to be mindful about filling in the right information and submitting all the correct documents. If everything is done properly, there's nothing to worry about!