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5 simple ways to avoid rejection of your health insurance claim

Health insurance is your knight in shining armour. In fact, buying it is a must and one of the finest financial investments you can make for yourself and your family. Unfortunately, there are some situations when your health insurance can be rejected. And that can put you in a tight position. 

But don’t worry! This blog will walk you through 5 simple ways to avoid the rejection of your health insurance claim. 

1. Dive Deep into the Exclusion Criteria 

Health insurance does not cover everything. And thus, knowing what’s included and what’s excluded is a must, especially EXCLUSIONS. The claim will be denied if it is submitted without first meeting the requirements on this list. So, read the policy documentation to see what services are and are not covered by your health insurance. To give you an idea, the following are some of the exclusions that you may find:

  • Weight loss treatment
  • Infertility
  • Dental treatments
  • Sexually transmitted diseases

2. Claim on Time 

In order for the insurer to accept your claim for the treatment you received, you must submit it within the allotted time frame. Some insurance plans have a distinct deadline for submitting claims. Your claims can only be processed if they are submitted within the deadline established by the policy you have selected. You must also adhere to some rules. 

For instance, for emergencies, cashless claims need notification to the TPA or insurer within 24 hours of hospitalization. 

3. Check the Claim Settlement Ratio (CSR)

You don’t want your medical insurance claim denied, do you? Thus, while selecting a health insurance provider, it is essential to consider the CSR (claim settlement ratio). 

The CSR is derived by dividing the total number of claims paid out by the total number of claims received by the insurer during a given year. 

Insurers with a high CSR are more likely to pay out claims promptly, whereas those with a low CSR are more likely to reject claims for various reasons. Thus, choosing an insurer with a high CSR is prudent to reduce the likelihood of having a claim denied.

4. Understand Your Policy

Health insurances are full of jargon—waiting period, coinsurance, and whatnot. Thus, carefully reading the policy’s terms and conditions is always recommended. The consumer should do this throughout the look-in period to ensure the insurance is suitable. 

Furthermore, if you don’t understand something, the insurance company’s customer service department is always there to help you out. 

5. Disclose Relevant Information

Nondisclosure or misunderstanding of facts is a common reason for health insurance claims to be denied.

Since every health insurance policy is custom-crafted according to the information supplied by the policyholder, it is imperative that you always provide correct information about your age, employment, income, and medical history, including any pre-existing disorders, etc. This will help avoid any future obstacles during claim settlement. 

Wrapping Up

It’s not wise to gamble with your health, which is why most people get health insurance. Yet, after purchasing coverage, it is crucial to understand how claims are settled so that you and your loved ones are not rejected for the usual reasons. Follow through on the above-mentioned ways, and you can rest assured that your health insurance provides full coverage. 


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