Friday, 17 June 2016

Tips to Prevent a Health Insurance Claim Rejection

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Unexpected, medical emergencies can arise anytime; therefore, everyone should be prepared physically, mentally, and financially to tackle them. Having a health insurance plan gives you the peace of mind that you are financially ready to face an unforeseen medical emergency.
It would be a nightmare when you apply for a claim and the insurance company; whom you have paid premiums to get help in medical emergencies, unreasonably denies your health insurance claim request. This is for your kind information that insurance marketplace around the globe runs under very strict guidelines issued by the nations; there are the authorities who monitor all activities of insurers and these authorities have the right to terminate the licenses of insurers; if they do not comply with the rules and regulations. Therefore, forget that your insurance company can deny your claim request unreasonably.
Health Insurance Claim Tips
In this post, we’ve listed some tips that can help you get a smooth claim settlement. In a health plan, you have two options to avail health services: a) cashless basis, and b) reimbursement basis. You can get cashless treatment services within the network-of-hospitals and it is highly likely to get your claim approval if you obtain health services within the empanelled hospitals; because in reimbursement claims you need to produce all original bills and diagnosis reports. Scroll down to read more tips for an easy claim settlement.

Tips to Get Health Insurance Claim Approval

Disclose All The Facts:

Insurance works on utmost good faith; both parties (Insured and Insurer) need to disclose all facts clearly. It is immensely important that policyholders fill all the information on the proposal form themselves; and disclose all the facts asked by insurance company. If your insurer finds that, you suppressed the facts while buying insurance, at the time of claim investigation then the insurer may refuse to honour your claim. In that case, you may not appeal to any insurance regulatory authority; because you did not comply with the policy.

Read Your Policy Document:

Many of us believe whatever benefits a health insurance advisor tells us about our health insurance plan. I would like to tell you that don’t trust anyone, just read benefits illustrated on your policy document; because you will be entitled to avail health services that are listed in your policy document. After buying a health plan, whenever you receive your policy documents just read them carefully and ask to your insurer if you have any doubt regarding your health plan. You have the right to reject your policy Read More; if benefits described by your agent are not listed in policy brochure. In India, policyholders get 14days to return a policy in case of mis-selling.

Cashless Hospitals List:

Download list of network of hospitals from your insurer’s website or ask your insurer to provide it; so, in medical emergencies you can visit your nearest empanelled hospital.

Keep Documents with You:

Insurer issues a health card to avail cashless treatment facilities within the network of hospitals. Therefore, keep all documents with you such as; Health Card, Policy Document etc., whenever you are going to get medical treatment.

File Claim:

You need to produce your policy documents and health card when you’re availing treatment within the network. If you are getting treatment from out-of-network hospital then you have to follow a claim procedure for example; Inform about insured person within 24 hours of admission; lest, your claim may face rejection, collect all original bills and discharge certificate etc read “How to Submit a Health Insurance Claim?

Prefer to Visit Empanelled Hospital:

Getting treatment from network hospital is always beneficial. Prefer to visit empanelled hospital for planned hospitalization and emergency hospitalization. Remember some health insurance plans do not provide reimbursement options; therefore, before going to avail medical services from non-empanelled hospitals check whether your policy allows you to do so.

Keep Yourself Updated:

To keep yourself updated, register for email alerts or SMS notifications. By doing this, you can get latest updates from your insurer regarding policy terms and conditions; and also insurers send latest list of network of hospitals; if they add new hospitals in their network or remove hospitals from their network. Time-to-time insured person needs to renew his/her health card, therefore, renew your health card timely; if it is required.


Health insurance protects us from financial loss caused by an injury or illness; therefore, to live a hassle free life everyone should have a health plan. It is advised that follow all the instructions provided by your insurer to keep your health insurance policy in force. For simple and stress-free claim settlement, follow all the guidelines provided by your health insurance company to submit a claim.
You must clearly understand what does your policy cover and doesn’t cover, procedure to submit a claim.

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