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What to Do When Your Health Insurance Gets Rejected
[Posted by: InsuringIndia Blog on 12-Feb-2016]

Most people like to take a things in life for granted because they think once they've initiated something things will take care of themselves. If an insurance cover is bought with this attitude, then there are high chances that something may go wrong because most likely you may accidentally miss some important points resulting in loss of financial cover and most importantly the security net that you thought would protect you and your family. 


There can be a number of reasons why your insurance claim may be rejected. Here, we will explore why this may happen and what you can do when faced with this situation. 


Likely causes of insurance claim rejection 


The most obvious reason would be defaulting on payment of your premium. 

·        A lapsed policy can also be the reason for your claim's rejection.

·        It’s wise to fill out your health insurance policy rather than leaving the details to someone else. Else, you risk some vital facts or sections being missed/ misinterpreted or wrongly filled. 

·        A technical glitch on your part will land you in trouble. For instance, in the event of a crisis, you get so busy handling all aspects concerning a health crisis that you do not file a claim within the stipulated period as mentioned in your policy. A late claim submission is a strong reason for any insurance company to reject it. 

·        Non disclosure of facts while buying a health insurance policy can be yet another major reason that may make things tough for you. As per existing rules, it's important for both the insurance company and the insurance buyer to disclose all facts to each other. In a nutshell, it means you should not conceal any facts- like your age, details of your profession, a pre-existing medical condition and even a regular health check up, if your health policy so requires.

·        If you haven't read and understood the terms and conditions while buying your insurance policy then you're definitely asking for trouble. A lot of policies may include and exclude certain medical requirements, facilities and diseases. Being unaware of what exactly you've bought is a sure sign that you're headed for trouble. 

·        Many policy buyers are ignorant about the fact that cashless facility can be availed only in network hospitals and thus, going to non-network hospitals to seek treatment on cashless basis will definitely result in rejection of claim.





Claim rejected, what next?


Do not panic. All may not be lost, as some timely measures can still salvage the situation for you. Remember regardless of which policy you've taken, there's a stipulated or defined time period within which you can seek a re-scrutiny.  Here are a few points to consider:


·        Get in touch with the insurance company to find out exactly why your claim was rejected 

·        If you submitted incomplete information and your claim was rejected, then immediately drop a mail to the insurance company regarding this. It's a good idea to keep a record of the correspondence between you and the insurer. 

·        If you have not furnished some requisite documents to the insurance company then you need to immediately get in touch and do the needful. Submit all documents once again. Also, resubmit the correctly filed documents.


It is, therefore, a good idea that an individual should choose a health insurance plan carefully, after considering all his healthcare needs. One should also read all the terms and conditions properly and should understand their plan so that they do not feel guilty over their choice later. All these issues can be alleviated to some extent if a person buys a comprehensive health insurance plan from a reputed provider that takes care of health needs of people while designing their products. One of the best ways of making an informed choice is to buy your health insurance online, where you can compare the features and benefits of plans offered by different insurance companies. With the power to choose, also comes responsibility. Use it wisely. 

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*This is based on the difference between the highest and lowest premium's for a single person, age 25, looking for an individual health policy with the sum insured of Rs. 5 lakhs.
**This is based on the difference between the highest and lowest premium's for a single person, age 25, looking for a term plan, with the sum insured of Rs. 30 lakhs, and the premium paying term of 30 years.
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