The policyholder is protected financially from any medical costs, whether they are anticipated or unexpected. However, just because you have health insurance coverage doesn’t imply you won’t have any problems when disaster strikes. You may end up paying for all of your medical expenditures out of pocket if you aren’t careful, since your insurance company may reject your claim if you aren’t vigilant enough. Most of us protect ourselves from financial loss by investing in insurance. It’s a cushion for when the going gets hard so we can keep on going. All that work may be for nought if the insurance doesn’t pay off when it’s needed. Having a health insurance claim denied by the insurer right when you need the money the most is the worst possible scenario.
To avoid this kind of circumstance, you should be familiar with the most common causes of medical claim denials. This can assist you to avoid making the same mistakes twice and will remind you to exercise caution with specific aspects of the health insurance plan. To that end, let’s examine the most common explanations for being denied health insurance:
There is a delay
All health insurance policies include a 30-day waiting period during which they will not pay for any costs associated with the treatment of an illness. During this time, known as the “waiting period,” only claims that result from accidents will be evaluated. Pregnancy and critical illness benefits may also have lengthier waiting periods. Medicare claims submitted during this period will be denied.
Insurance payouts below the deductible or excess
The sum covered on a typical insurance policy is often unknown to the policyholder. The “sum insured” is the most money an insurer will pay out to a policyholder in the event of a covered loss, such as a hospital stay. Sub-limits can also be set for incidentals like hotel rent, etc. Insurers typically refuse to pay claims that are for more money than the policy’s total covered or any applicable sub-limits.
Claims Procedure Incomplete or Incorrect
In order to make a claim, you’ll need to fill out a number of forms and provide supporting documentation, such as medical bills and certifications. If you submit your health insurance claim without including the necessary supporting documentation, such as a receipt for your medical expenses, it will be denied.
Delaying the insurance renewal
One of the most common causes of Mediclaim denial is a lapse in coverage. Most health insurance policies last for a year and need to be renewed every year. If you failed to renew your coverage on time and became ill during that time, all claims you made would be denied.
Exclusions
Unread the policy’s exclusions are the most common oversight among policyholders. The term “exclusions” is used to describe medical costs that are not paid for by your insurance coverage. Plans and insurance companies may have different requirements. Your claim will be denied if you try to submit payment for anything that isn’t covered by your insurance.
Failing to timely notify the insurance company
If a claim needs to be filed, most insurance companies require that policyholders notify them within 24 to 48 hours following their hospitalisation. If you don’t, the insurance company can deny your claim.
Symptoms that have been present for some time
Insurance plans are a kind of risk management that may help you prepare for the unexpected. In contrast, pre-existing conditions are medical conditions that have already manifested themselves at the time health insurance coverage is purchased. Consequently, health insurance often does not cover the cost of treating pre-existing conditions. Because of this, customers can’t get insurance just before they need to start shelling out cash for expensive therapy. Thus, most claims involving any pre-existing condition, such as arthritis, kidney stones, high blood pressure, etc., are promptly denied.