Why are claims rejected?

While it is true that claim rejection adds to the existing trauma, insurance companies too have valid justifications for turning down some claims. A few of the scenarios are as below:

• Ailment not being covered in the health insurance policy
• Improper claim form filled
• Procedure deemed medically unnecessary
• Claim not filed in time (7-15 days)

What should one do to avoid claim rejection?

To safeguard oneself against possible claim rejection, the insured should read policy contract terms & conditions carefully and understand them well. When in doubt, you should not hesitate to seek clarifications from the advisor or the insurer. If required use the free-look period (usually 15 days) to cancel or alter the contract if you find that the contract is different from what you had understood it to be.

Different products have varied features, benefits, exclusions, sub-limits and terms of the contract and hence the focus should be on what is being bought, what risks, diseases and medical procedures will be covered and what will not, so that there are no surprises and disputes at the time of the settlement of claims.

Further you can alert your doctor about what's covered under your policy and try to make sure that she knows when prior approval is required. Take utmost care not to include the costs that are not covered under the policy when filing for claims.

Once you file a claim or you have asked for a pre-approval of a treatment, keep all of the records such as provider bills, explanations of benefit notices from your insurer etc in a folder or paper-clipped together, so that you can review them at a glance if the need arises.

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