How to make sure that health insurance claims are not denied amid a pandemic?

But what if your claim is denied by your insurer?

Although the insurance company endeavors to fulfill the claims raised, there are certain instances which might result in a denial of claim settlement or settlement with a few deductions. You should be proactive enough and circumvent the deduction or denial of your health insurance claim. Though you can’t avoid all probable causes, there are precautions you should take to diminish the possibility that your bill will be denied fully or partially.

Before you purchase the insurance cover, you should read the policy document and all terms and conditions completely. You should ensure that you know everything about the policy. It is imperative to know what the policy covers, what it excludes and what are waiting periods applicable for certain illnesses. Some policies do have a cap on room rent; few policies cover specific treatment at home like chemotherapy, infectious treatment like Dengue; while other policies may not cover certain procedures.

Coordination of benefits could also result in confusion if you have more than one insurance carrier; for instance when you and your spouse are covered under two or more policies. In that case, ask both of the insurance companies about their coordination of benefits rules.

This is because your claim may be redundant if the order in which it is submitted to the carriers is deemed incorrect. Fill out the coordination of benefits form to ensure that your claims are paid correctly by identifying the health benefits available to you.

While buying the insurance policy, you should disclose all the requisite details. Several times claims are rejected because at the time of buying the policy, all facts were not revealed or partial information was given to the insurer. State every personal detail asked, even if it is unfavorable in your well-being.

Information can be associated with the spelling of the name, age, type of occupation, pre-existing medical conditions, income and disclosure of any other policies currently with the customer. If you obscure pertinent information at the time of buying the policy, the claim settlement may be impacted.

The premium payable depends on the related information you provide to the insurer.

Though you might not face a claim as soon as you purchase a health plan, when an emergency strikes, you might need a compelling plan to disburse the allied expenses. Hence, you should renew your plan every year to ensure continuous coverage and reap the benefits like no-claim bonus, continuity of waiting period and the benefits in the policy.

While most of the insurance companies provide for a grace period of 30 days to renew the policy, however the detail to keep in mind is that the renewal within the grace period only ensures continuity benefits and is not a cover period. It is also vital to check if the cover for hospitalization requires a minimum of 24 hours or more/less than that duration for you to be eligible to claim under the policy.

Health insurance companies may perhaps ask the proposed insured to undergo medical tests to determine the present medical condition of the buyer. Some proposers try to steer clear of medical tests, as they fear that the tests may divulge a medical condition which may cause the insurance company to raise the premium amount or even reject the insurance proposal.

By undergoing all the necessary medical examinations as asked by the insurer, the possibility for claim rejection on pre-existing medical conditions reduces. Hence, it is advisable not to avoid medical tests.

After you buy the plan, you should be completely acquainted with the steps to follow for raising a valid claim. The insurance policy will have a list of partner clinics and network hospitals. If you seek out treatment within the insurance company’s partner network, then you must follow the procedure to request for cashless treatment.

The bills to the amount of the cover will be settled by the insurer if all documentation is in place. If you are not seeking treatment in a network hospital, you should update the insurer regarding the hospitalization and follow the claim process.

Given the present scenario, amidst the corona outbreak, most health insurance companies have started selling insurance using the telemedical mode. This provides convenience to the customer to buy health insurance policies from their home given the challenges/ fear of going to the diagnostic centre for doing a medical examination.

Use this opportunity to buy health insurance online with proper disclosures in case you do not have cover currently or your cover is less than ten lakh.

In summary, a few precautionary measures may just save you from all the dilemmas and distress of having your claim rejected.