How to Avoid Medical Insurance Claim Rejection


How to Avoid Medical Insurance Claim Rejection

How to Avoid Rejection of your Medical Insurance Claim?

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. Therefore, you must 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 pays your bills for in-patient hospitalization, treatment, and medicines directly to the hospital.
  • In case of reimbursement, you get compensation against the expenses you have made for your treatment during hospitalization after you submit your medical bills. 

5 Ways 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 IRDA. Treatment costs for weight reduction, dental treatment, infertility, transmitted diseases, etc. are not admissible for the 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 must furnish all your bills from diagnosis to hospitalization, surgery, medicines, and doctor’s prescriptions 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 in one place and produce them within the stipulated period for quick claim settlement. 

Intimation 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 your insurer about the history of pre-existing disease if any. During scrutiny, if your insurer comes to know about your pre-existing disease, then your claim can be denied.

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 where you can get cashless hospitalization facility. You can file for reimbursement claim in case if you hospitalized in any non-network 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 protects you and your family during any medical emergency. Check the claim settlement ratio before opting for medical insurance and read these ways to get the claim timely and stress-free.

>> Also Read About These 5 Common Health Insurance Distresses

Disclaimer: Plan features, benefits, coverage, and underwriting of claims may vary. Please refer to the brochure, sales prospectus, terms and conditions carefully.

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