6 Reasons Your Health Insurance Claims May Be Denied

Imagine facing a medical emergency or a sudden property loss, only to have your insurance claim denied. Disappointing, right? Unfortunately, this happens more often than we would like. But here’s the good news: it can often be avoided. By taking a proactive approach, you can significantly reduce the risk of your claim being rejected.

Also Read: 30% People Don’t Buy Health Insurance Due To High Premium: Study

It’s crucial for policyholders to thoroughly understand their insurance policies, disclose all relevant information truthfully and follow the necessary procedures when filing a claim to minimise the risk of denial.

Health insurance claims can be denied for various reasons and here are six common ones:

• Pre-existing Conditions: If the medical condition for which the claim is filed falls under the pre-existing conditions clause of the insurance policy and was not disclosed at the time of purchasing the policy, the claim might be denied. Insurance companies typically have a waiting period before covering pre-existing conditions.
• Non-Disclosure or Misrepresentation: If the insured individual fails to disclose or misrepresents their medical history or any other relevant information at the time of purchasing the policy, the insurance company might deny the claim. Be honest about your medical history when applying for insurance. Hiding pre-existing conditions can lead to claim denial.
• Policy Exclusions: Health insurance policies don’t cover everything. Read the fine print carefully to understand what’s excluded, like cosmetic procedures or injuries from dangerous activities. Insurance policies have specific exclusions, such as certain treatments, procedures, or medical conditions that are not covered. If the treatment or medical condition falls under these exclusions, the claim may be denied.
• Documentation and Procedure Errors: Incomplete or incorrect documentation, such as missing medical records, improper filling of claim forms, or failure to follow the required claim procedures, can lead to claim denials. When filing a claim, ensure you have all the necessary documents, like bills and medical records. Incomplete submissions can delay or reject your claim.
• Policy Lapses or Non-Payment of Premiums: If the policyholder fails to pay premiums on time, resulting in policy lapses or discontinuation, any claims made during that period may be denied. It’s essential to keep the policy active by paying premiums regularly. Paying your premiums on time is crucial. A lapsed policy means you have no coverage, and any claims during that period will be rejected.
• Waiting Period Violations: There are often waiting periods before you can claim for certain things. Make sure you understand these and plan accordingly.