Prevent rejection in a health insurance claim
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Published on: Mar 4, 2016
Transcripts - Prevent rejection in a health insurance claim
How to prevent rejection in a health insurance claimYou should thoroughly go through the policy conditions and seek clarification about crypticclauses to avoid claim rejection. Document submission should happen in an orderlymanner on time. The solution is to limit the procedures to fulfill the conditions stipulatedwhen you buy health insurance.Numerous factors can contribute towards rejection of health insurance claim. An insightinto them will lead to adoption of proper means to steer clear of such hurdles.Deficiency of knowledgeCustomers are caught unawares about the policy exclusions as they are disinclined to poreover the health coverage plans’ terms and conditions during purchasing. This costlymistake drives your attention away from policy term when you specifically act in disregardto it. The agent in haste to make commissions often keeps you in dark about the limitations.You should thoroughly go through the policy conditions and seek clarification about crypticclauses to avoid claim rejection. You should utilize the free look up period offered byinsurance company to cancel the policy if you discover that the policy terms deviates fromthe understanding instilled in you by the agent.Facts not disclosedA significant contributor for denial of insurance cover is non-disclosure/partial or wrongdisclosure of facts pertaining to existing diseases, occupation, income, medical conditionsetc. Any deviation from facts stated on the proposal form at the time of filling often leads todeclining of coverage.The solution lies in understanding the consequences of hiding or providing incorrectinformation when applying for a product. Every health policy operates based onunderwriting principles that draw the information furnished by you. If you are prospectinga suitable policy, divulging all relevant information is crucial.Proposal form disparitiesInadvertent errors creep in the proposal form owing to the dependence of customers onintermediaries for filling up the proposal form. The intermediary is unaware of accuratedetails and blunders happen in the declaration form. When you buy health insurance withincorrect representation of materially vital facts, the insurer rejects your claim uponverification of the same in detail.The solution lies in filling up the declaration form by yourself rather than relying on theexpertise of agents. Only authentic documents should be submitted while purchasing thepolicy. Document submission should happen in an orderly manner on time. After receivingthe policy papers bundled up with photocopies of the application form and relevantdocuments, go through them intently to check the veracity of papers filed with the
insurance company. Any discrepancy should be brought to the notice of company andrectified instantly. Remember, laws also enable insurer to repudiate the claim if it provesthat any vital information has been withheld by the policyholder during renewal orpurchase of policy.Excess expendituresInsurance company often reject claim stating that the medical procedure undergone wasnot mandatory. It has now become a trend, earnestly followed by private medical facilitiesto subject the patient to unnecessary medical procedures in pursuit of more revenues. Itassumes a more severe form if the facility comes to know that the patient is paying healthinsurance premium. The policyholder assumes on misunderstood grounds that the entireexpenses would be borne by the insurer. Certain consumers also present inflated claimsthrough the doctors by outrageously distorting the actual expenditures incurred. Theirregularities float in sight upon investigations conducted by the health plans provider.The solution is to limit the procedures to fulfill the conditions stipulated when you buyhealth insurance.