5 Reasons why your medical claim got rejected

5 Reasons why your medical claim got rejected

“Why did your medical claim get rejected?” The most common fear among the health policyholders is about claim rejection.

You approach a hospital for your treatment, get admitted, assigned under the best doctors, diagnostic tests take place, and there you have a huge medical bill. With the support of your health insurance policy, you apply for a claim. But it got rejected!

Your insurance claim can get rejected anytime. Reasons may range from something that you might not have been aware of or you did not focus on the terms & conditions of your health policy.

We can give you possible scenarios about why your claim might have got rejected with these 5 reasons:

1. You were not honest about your medical record

If your claim got rejected, you might not have been honest to your insurer about your medical record. While filling the proposal form at the time of buying a policy, you have to disclose your medical record clearly in the form. For example, if you suffer from Diabetes, you need to mention it in the form, otherwise, this fact won’t be covered by your insurer who will prepare your policy and premiums accordingly. The insurance company will decide your coverage based on what information you disclose. Hiding any of the demographic information and serious medical conditions can lead to the rejection of your claim.

Some of the pre-existing diseases that you have to disclose to your insurer to avoid claim rejections are:

    • Hypertension
    • Asthma
    • Epilepsy
    • Cancer
    • Depression

2. For some diseases, you have a waiting period

If you are receiving treatment for pre-existing disease and you apply for a claim before the provided waiting period, your claim will be denied. This is because many pre-existing diseases have a waiting period ranging from 2-4 years and can only be covered after the specified time.

3. You missed the deadline for claim submission

You missed the deadline for claim submission because of which your claim got rejected. You have to inform your insurance company regarding the claim within 24 hours of admission to the hospital or depending upon what your policy says. If you miss the deadline for claim submission, there are high chances that your claim will get rejected.

Even if you exceed this time frame, several insurance companies may ask you to follow certain procedures. However, it is best to apply for a claim as soon as possible within the given time limit.

4. You forgot about your policy renewal

What if you forgot about your policy renewal? Policy renewal means that you want to continue with your policy further. You have to apply for it after a certain date. If you forgot to file for the renewal, your claim for the treatments beyond that date will get rejected. It becomes the responsibility of the insured to take care of such details as the insurance companies usually keep sending updates and reminders to the customers.

5. It is difficult to understand the Terms & Conditions of the policy

Going through the terms & conditions of the health policy is necessary. Several technical jargon and legal terms may make it difficult for you to understand what your policy is trying to say. Ignoring such terms may lead to claim rejections in the future as you may not have been aware of certain facts.

For example, you might have failed to notice the exclusion list of your policy due to which your claim got rejected.

As a policyholder, you have to be aware of how health insurance companies work. Without the required amount of knowledge, possibilities of claim rejections usually increase.

How can ClaimTherapist help you?

We work on our simple motto of ‘Decoding Insurance’. We are here to decode your policy and make you understand the terms & conditions of your health insurance. This can help you in knowing what your policy includes and excludes.

Also, working with our experts will reduce the chances of your claim rejections as our experienced team and specialists will be working on your claim processing. Contact us for a hassle-free claim experience.