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5 Reasons Why Your Health Insurance Claim Is Being Rejected

By Author: Neha Sharma
Total Articles: 135

In case you have a health insurance plan, you can rest easy as your policy will be paying all your medical bills and expenses. Having a health insurance policy is considered an incredibly important part of health care. However, if your insurance claim is rejected, it might come as a shock to you and your finances may take a direct hit because of that. In order to avoid such a situation, it is imperative that you know and understand why your health insurance claim might be rejected-

• Delay in filing claims- Every health insurance provider has a specific time period within which you will have to make your insurance claim. In case of emergency hospitalization, you will have to inform your insurer about it within 24 hours, if you wish to avail your policy benefits. However, in case of planned hospitalization, you will have to notify your insurer days or weeks in advance. If you fail to do so, your health insurance claim will be rejected.

• Your policy has expired- If you forget to renew your policy when the time comes, you will not be able to avail its benefits. It is only when you renew it on a routine basis and pay your premiums on time that you will be able to file an insurance claim and get your money.


• Your ailment is not included in your policy- Every health insurance plan has its own set of inclusions and exclusions so make sure that you go through the lists thoroughly before you sign on the dotted line. If the disease or ailment, for which you have been hospitalized, is not included in your health insurance plan, then your claim will be rejected. Some of the conditions, which a health insurance plan does not cover in general, are a suicidal attempt, drug use, alcohol abuse, self-harm wounds or injuries, injuries caused due to radioactive substances etc.

• Incorrect information- When you purchase a health insurance plan, it is mandatory to fill out a proposal form and submit it along with your premium. It is important to fill out your form with accurate information, as your insurer will provide you with the policy based on what you have written in your form. If you choose to provide incorrect and vague information, your insurance provider has every right to reject it, if they deem fit.


• Failure to submit all necessary medical documents- When you file for a health insurance claim, your insurance provider might ask you to provide medical records, in case your claim needs extra documentation to determine its authenticity. Some of the medical documents or records that your insurance provider might ask for are patient’s physical reports, patient’s discharge summaries, operative reports, radiology reports, physician consultation reports, and patient’s medical history. If you fail to submit what your insurer asks of you, your claim might be rejected.

Claim rejection can cause you a lot of stress and unnecessary hassles, which is something you would naturally not want to experience. Therefore, before you finalize your health insurance plan, read it thoroughly to avoid any problems in the future.

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