4 ways to ensure your health insurance claim is not rejected

Charles Gardener
3 min readMar 28, 2022

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Taking a health insurance policy is one of the most responsible things to do at a time when pandemics are rife and lifestyle and critical illnesses are on the rise. You may have bought a plan recently, or may have enhanced the coverage on your existing policy. Chances are, you have never filed for a claim against the sum insured till date.

When you do file a claim, do make sure to follow these 4 points:

#1 Know what your policy includes and excludes.

Most people buying health insurance, especially for the first time, are so focused on knowing what the premium and sum assured amounts are, that they pay little attention to what the policy actually offers and does not. They might know that the policy covers hospitalisation expenses and that it also offers a cashless medical claim. However, there are certain mandatory exclusions in the policy as devised by the insurance provider. For instance, some policies do not have a daily hospital cash benefit, while others do. Or some do not have a critical illness component while others may. Go through the entire list of inclusions and exclusions at the time of buying the policy so that you are fully cognisant of what is liable for a claim or not. This helps prevents disputes with the provider after filing a claim. If you claim for certain items that are not included, your claim can get rejected in part or full.

#2 File the claim as directed by the insurer.

This is fairly straightforward, but it is astonishing how scores of people file the claim wrong. Every health insurance company has a claims force (you can get it online from their website or from their branch office) which clearly mentions which information is required from the claimant, and the list of supporting documents. The documents must be filed in the order mentioned and must contain the latest and updated information. Filing the claim erroneously may result in delays in processing (when the company gives some time to correct the inconsistencies/errors) or an outright rejection of the claim.

#3 Know which network hospitals are included for cashless claims.

If you have taken a cashless health insurance policy, you must know which hospitals the insurance provider has included in its network in your city. The policy document will have a separate section on the list of hospitals where cashless admission and treatment is allowed under that policy. You cannot go to any other hospital outside this list of hospitals and file a cashless medical claim.

#4 Check the deductible and how much you can claim.

Every policy has a deductible, i.e. an upper limit outside which the insurance provider does not pay the claim. Any claim over the deductible must be paid by the insured out of their own reserves. You cannot claim the entire amount as mentioned in the bill if it exceeds the deductible as mentioned in your insurance plan. Doing so will ensure a rejection of the claim.

Buy the plan from a trusted health insurance company

When you buy a health policy, you wish not just for financial protection for a future health event but also that you can avail of the plan’s benefits with complete peace of mind. You should not feel insecure about the plan, or that the insurance provider is less than transparent in its dealings with you. Thus, it helps to buy the plan from a reputed health insurance provider in India, with a high claims settlement and a bevy of top rated plans that offer you a wide range of features and benefits.

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