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Buying a health insurance policy? These scenarios can cause your claim to be rejected

Since health insurance is required late and claims are filed and denied during a pandemic, here are some factors that can lead to your health insurance being denied.

Given our times, it is advisable to have only health insurance because medical emergencies come without warning. Health insurance protects the insured and their family members from exorbitant medical costs in the event of an accident or illness or when a serious illness is diagnosed. The demand for health insurance plans has increased after the outbreak of a pandemic in the country.

The types found in the health insurance plans available in India include individual health insurance, family health insurance, critical illness insurance, critical illness insurance, senior health insurance plans, and group health insurance. One can choose from the above based on their purchasing need to avoid expensive hospital bills. Whether through reimbursement or cashless, the insured receives a claim for their health care policy.

As more and more companies produce health insurance products, they exclude some expenses or have preconditions for a valid claim to be made. There may be some specific costs that may not be covered in the plan, so it is important to read the document in fine print before purchasing a health insurance product.

These are some of the factors that could cause your claim to be denied

  • Exclusions: Almost all health insurance products will list exceptions, or things that the plans just don't cover. For example, if the health policy does not cover epidemics, the Covid-19 claim of the policyholder will be rejected. Insurance experts say that if the policy purchased before the pandemic can cover the disease, but can exclude the cost of consumables such as masks, gloves, gowns, face shields, shoe covers, disinfectants and disinfectants required for COVID-19. Some policies do not cover home care expenses and before or after hospital fees, such as the cost of a Covid-19 diagnosis.
  •  Travel Record: Insurance may deny your claim if you or your family members have a history of traveling to any of the cities or countries affected by the coronavirus. If the policyholder becomes infected without traveling anywhere other than a family member who has been to certain countries such as China, Japan, Kuwait, Italy, Hong Kong, Macau, Thailand, Singapore, etc., the claim can be rejected.
  • False documentation: Those looking to purchase health insurance should always make sure that all information provided to the insurance company is realistic. Deletion or misrepresentation may result in the denial of your claim. Care must also be taken to avoid false documentation with partial or false disclosure of important details such as age, medical history, profession, income, etc. Failure to provide the correct details may result in a claim denial.
  • Waiting Period: Each insurance policy has a specific waiting period for a pre-existing condition. The waiting period varies from policy to policy and any claim made during this period is subject to denial. Therefore, a claim with a pre-existing condition can only be submitted after the waiting period has expired and the premium for that period has been paid.
  • Time - Time is of the essence when claiming compensation for hospital bills. Most health insurance plans provide for claim costs if there is at least 24 hours of hospitalization. During an emergency, the insured can inform the insurance company within two to three days of hospitalization. In the event of a planned hospitalization, the insurance company can be notified in advance.
  • Pre-existing illness: In the event that the policy buyer has had a respiratory illness in the last month or more, a coronavirus or medical insurance policy will likely not be approved.