5 Ways to Avoid Medical Insurance Claim Rejection


5 Ways to Avoid Medical Insurance Claim Rejection

Health insurance is an umbrella that protects you and your family in the event of a medical emergency. Where healthcare inflation is continuously increasing, medical treatment costs are becoming unaffordable. This is why you have to be sure that you should make the most out of your mediclaim policy. However, there are situations where your medical insurance claim gets rejected. Therefore, in this blog, you can read how you can avoid claim rejection situations. But, before talking about the claim rejection grounds, let’s first understand the ways how you can get the claim? 

How You Can Get the Claim?

Under your health insurance policy, you can get the claim in two ways-cashless and reimbursement. 

  • In a cashless facility, your bills for pre and post hospitalization, treatment, and medicines directly to the hospital.
  • In case of reimbursement, you get compensation against the expenses you have incurred for your treatment during hospitalization after you submit your medical bills to the claim management team. 

How to Avoid Medical Insurance Claim Rejection?

When you stuck with a medical emergency, the first thing you need is a hassle-free claim settlement. Therefore, read below the ways to avoid the chances of medical insurance claim rejection.

Read Exclusions List

Never ignore the exclusion list. It has all the situations and cases that are not covered under the claim policy according to the guidelines given by IRDAI. Treatment costs for weight reduction, dental treatment, infertility, transmitted diseases, etc. are not admissible for claim. So, make sure you have gone through all exclusions to avoid rejection over your mediclaim.

Furnish Required Bills

This is another common situation where there are chances that your claim gets immediately rejected. You have to furnish all your bills from diagnosis to hospitalization, surgery, medicines, and doctor’s prescriptions to the claim management team for timely claim settlement, failure of which results in claim rejection. Thus, it’s advisable to keep the original and duplicate copies of all the required documents at one place and produce them within the stipulated period for quick claim settlement. 

Intimate within Stipulated Time

Intimation about your hospitalization after stipulated time results in no claim. For smooth claim settlement, it is important to intimate customer support team about your hospitalization along with doctor’s prescription, hospital, and medical bills immediately or within stipulated time. Timely intimation helps you to get the claim easily without any complications.

Never Hide Information about Pre-existing Disease

You should never hide any information about your pre-existing disease. It’s always good to inform about the history of pre-existing disease if any. During scrutiny, your claim can be denied on the grounds no prior intimation about pre-existing disease,

Treatment in Network Hospitals

You are entitled to get the claim only when you hospitalized in the network hospitals. Network hospitals are the pre-approved hospitals. You are not entitled to claim in case if you hospitalized in any non-approved hospital. You can check from the list of network hospitals near to your residence and start your treatment to avail claim.

Bottom line

The skyrocketing medical inflation can burn a hole in your pockets and drain all your savings. A right health insurance policy such as offered by Care Health Insurance protects you and your family during any medical emergency. Check the claim settlement ratio before opting for medical insurance and also read these ways to get the claim timely and stress-free.

>> Also Read Things You Should Remember After Filing Health Insurance Claim

Disclaimer: Please read the brochure and prospectus to know more about our health insurance plans cover as conditions may vary.


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