5 Situations When Your Health Insurance Provider Can Turn Down Your Claim - IFFCO Tokio


5 Situations When Your Health Insurance Provider Can Turn Down Your Claim

5 Situations When Your Health Insurance Provider Can Turn Down Your Claim

5 Situations When Your Health Insurance Provider Can Turn Down Your Claim

Most people think that having health insurance means that you will be covered for every medical problem that you come across. Unfortunately, this common perception is far from accurate.

Your health insurance plan will not cover each and every medical expense of yours, as every health plan comes with a list of inclusions (covered perils) and exclusions (perils that are not covered). Exclusions are the ones that can give you bad surprises, if you are not aware of them beforehand.

Claim rejection can be a really disheartening experience, as it nullifies the whole purpose of having a health policy in the first place. To avoid such distressing situations, start with knowing about these 5 situations when your claim can be turned down: -

1.       Incorrect Information in the Policy or Claim Form

One of the most common reasons for an insurance claim getting turned down is providing incorrect or incomplete information while buying the policy. Never hide your medical history from the insurer; doing so would put you at a loss as you won’t be covered for the illness upon making a claim. Enter the name of the patient and doctor correctly when filing a claim; otherwise it may lead to unnecessary hassles. Also, the documents, such as hospital bills, reports and prescriptions, should have the correct information to ensure quick and easy claim settlement.

2.       Overlooking the Prior Authorization Requirement

Many benefits of a health insurance plan may require prior authorization in order to avail them. For instance, non-emergency-related benefits may require prior authorization. Some insurers require you to get prior authorization for availing cashless hospitalization. If you were to undergo any medical service without prior authorization from your insurer, it is highly likely that your claim will be denied.

3.       Not being aware of the Excluded Perils

Exclusions are the perils that are not covered under a health insurance plan. If you file a claim for any peril that is not covered by your health insurance, it would certainly be denied. Hence, it is always important to check the exclusions of a policy before you make a purchase. Pre-existing conditions, healthcare services related to dental, hearing and vision, cosmetic surgery, and alternative treatments, are some of the common excluded perils in a health insurance policy.

4.       Waiting too long to file the Claim

You must inform your insurer about any medical services that you have availed, and file a claim as soon as you can. Waiting too long is another common reason that leads to claim rejection. Usually, insurers allow 60 to 90 days from the time of availing healthcare service to file a claim. To avoid rejection of your claim, it is important to register your claim in time.

5.       Waiting Period Exclusions

All policies have a waiting period for pre-existing ailments. Waiting period is the period at the end of which the pre-existing medical conditions will be covered under the policy. Health insurance policies have a waiting period of around 3 or 4 years. Hence, before filing a claim, check whether the illness falls in exclusion, or a waiting period applies.

When you buy a policy, it is obvious for you to think that it will cover you against each and every health issue. But only upon making a claim do you come to realize that your health insurance has specific coverage. Hence, when you purchase a health insurance plan, make sure that you read the fine print carefully; after all, no one needs unwelcome surprises upon filing a claim.

**To understand exactly about the policy coverage, exclusions etc read the Policy Wordings carefully.**



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