2:57 AM
Why Is My Health Insurance Claim Rejected??
The worst part of the game is people learn the features, terms and
conditions and limitations of a health insurance plan only when they are making
a claim, whereas the main motive of health insurance is to stay tension free
while you are hospitalized and concentrate on getting better.
The policy is liable to pay only what is written in the brochure
or in the policy wordings. But, what happens is, 90% of the people don’t read
the T&C while they are actually purchasing the policy. This leads to
rejections, denials etc.
We often compare health insurance premium wise. But what we don’t
compare is policy exclusions, wordings, sub-limits etc.
“How much is it going to cost me” is not a main thing..
“What all does it exclude and what all does it cover” is of much
more significance
Points
to note or never to miss while you buy a Health Insurance
·
What are the EXCLUSIONS??
Its most important to read out the treatments which are excluded in your plan, such as naturopathy, homeopathy, unani etc.
Its most important to read out the treatments which are excluded in your plan, such as naturopathy, homeopathy, unani etc.
·
What are the SUB-LIMITS??
Many plans have sub limits or the admissible limits such as Limits on Room Rent, Doctors fees, ICU Charges, Cataract Charges, OPD Charges etc. So, you have to select a sum assured wherein you are sure that the charges don’t exceed the limits mentioned in the plan for a particular sum assured.
Eg: If you select a sum assured of 2,00,000/- the room rent payable may only be Rs. 2000/- per day. And if you chose a room which has a room rent of 3000/- per day, the Plan is liable to pay only Rs.2000/- and you have to bear the remaining 1000/- per day.
Many plans have sub limits or the admissible limits such as Limits on Room Rent, Doctors fees, ICU Charges, Cataract Charges, OPD Charges etc. So, you have to select a sum assured wherein you are sure that the charges don’t exceed the limits mentioned in the plan for a particular sum assured.
Eg: If you select a sum assured of 2,00,000/- the room rent payable may only be Rs. 2000/- per day. And if you chose a room which has a room rent of 3000/- per day, the Plan is liable to pay only Rs.2000/- and you have to bear the remaining 1000/- per day.
·
What are the Terms & Conditions??
An Insurance plan has many conditions, such as,
1. Minimum 24 hrs hospitalisation
2. Admission in hospital having a minimum of 15 beds,
3. T&C on Dental treatments
4. Declaration of Pre Existing diseases / ailments / injuries etc
5. Co-Payment clauses where the insured has to bear a specified limit of claim amount.
An Insurance plan has many conditions, such as,
1. Minimum 24 hrs hospitalisation
2. Admission in hospital having a minimum of 15 beds,
3. T&C on Dental treatments
4. Declaration of Pre Existing diseases / ailments / injuries etc
5. Co-Payment clauses where the insured has to bear a specified limit of claim amount.
Remember, in case you haven't or couldn't avail a cashless treatment then it is very important that you preserve every document. The prescriptions, bills, medical reports, doctors advice for admission in hospital and other documents related to treatment.
We have seen that most of the people having health insurance are under insured. choose appropriate sum assured instead of enhancing your sum assured in later years. REMEMBER, the enhanced sum assured again has a waiting period and many companies will never even accept the enhancement at an older age. The Insurance company will never deny claims if the pre existing conditions / material health facts etc are declared while buying the health insurance policy. Never sign a unfilled proposal form. the proposal form is the only evidential document which will be necessary in case the insurance company avoids claims even after you have followed the above points. Always read the policy document carefully before buying. Read and understand all the inclusions/ exclusions / terms & Conditions / Sub limits and plan features so that you don’t have to be tensed while making a claim, because the main thing to concentrate while you are in hospital is how to get better faster, and not how to file a claim.
We have seen that most of the people having health insurance are under insured. choose appropriate sum assured instead of enhancing your sum assured in later years. REMEMBER, the enhanced sum assured again has a waiting period and many companies will never even accept the enhancement at an older age. The Insurance company will never deny claims if the pre existing conditions / material health facts etc are declared while buying the health insurance policy. Never sign a unfilled proposal form. the proposal form is the only evidential document which will be necessary in case the insurance company avoids claims even after you have followed the above points. Always read the policy document carefully before buying. Read and understand all the inclusions/ exclusions / terms & Conditions / Sub limits and plan features so that you don’t have to be tensed while making a claim, because the main thing to concentrate while you are in hospital is how to get better faster, and not how to file a claim.
