9 Health Insurance Rejection Reasons You Should Know

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9 Health Insurance Rejection Reasons You Should Know- Health Insurance Rejection Reasons are unknown to many, and that is because the majority of us have the habit of ignoring the fine print of a health insurance policy. It is not just about getting a health insurance policy. It is about knowing the full importance of taking it and the possible consequences if the insurance policy terms are not met.

The truth is, your laxity towards your health insurance can get your claim rejected at the time you need it the most. This is why it is essential you know the reasons for which a claim can be denied. Therefore, this piece exposes you to several claim rejection reasons and some preventive measures.

Health Insurance Policy Rejection Reasons

The reasons why health insurance claims are denied are as follows:

1.    Wrong Information: Any contradiction will result in not only the claim being rejected but also the policy is terminated, whether it be a sincere error made when filling out the form, such as a spelling error, or a genuine attempt to conceal information like age, annual income, lifestyle, and family health details. The amount insured is frequently based on yearly income, so supplying fictitious income information to obtain a higher amount covered may also result in claims being denied.
2.    Going beyond the Sum Insured: Have you ever heard of Sum Insured? Whether you choose a family policy or individual medical insurance, there is an insured sum. This is one of the 9 Health Insurance Rejection Reasons You Should Know. The sum insured is the annual amount you or your family can access, depending on your chosen plan. If you use up all your allowance for a given year, your subsequent cashless claims will be denied. However, the insurance might reimburse you in the future if some of your assured sums are still intact.

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3.    Pre-existing illness: sometimes, policyholders buy insurance to cover their future medical treatment but forget that pre-existing diseases are not covered by insurance. Therefore, if you got an insurance policy and don’t include your medical history, your insurance claims might be denied if you get sick because of these pre-existing illnesses. For instance, if you suffer from blood pressure and hide the medical details from your insurance company if you get sick again. It was confirmed that it was your pre-existing disease. Your insurance company will not cover any medical expenses incurred due to that. This is one of the claim rejection reasons and is done to prevent people from insurance policies for guarantee.
4.    Waiting period: Regardless of the insurance provider, health insurance policies do not cover any costs associated with treating any ailment within the first 30 days after purchasing the policy. This is one of the most typical health insurance denial reasons. This is because, during the waiting period, only claims resulting from accidents may be considered. This waiting period may be extended for some severe illnesses or maternity benefits. Medicare claims that are submitted within this waiting period are rejected.

Make sure you equip yourself with accurate knowledge if you do not want to suffer from denied medical insurance claims. Read the fine print in your health insurance policy and familiarize yourself with the coverage and all applicable terms and restrictions.

5.    Not renewing the policy on time: another claim rejection reason is this. It is one of the biggest reasons for health insurance policy rejection. Health insurance contracts are often only good for a year and must be renewed yearly. If you refused to renew the insurance on time as at when due and became ill within that period, your coverage would be rendered useless, and any claims you made would be denied.
6.    Exclusion: you get rejected health insurance claims because of this reason. One of the biggest mistakes the majority of policyholder commits is that they don’t read their insurance policy documents well. Thus, they become ignorant of some facts. The exclusion is the healthcare expenses that are not covered under a particular policy you sign up for and wouldn’t be borne out by you. These exclusions are specifically mentioned in your insurance policy manual as “not covered.” They vary from insurer to insurer and from plan to plan. Therefore, if you file a claim for expenses or medical conditions excluded from your policy, your insurance claims will be rejected.         
7.    Not informing the insurance company on time is also a health insurance policy rejection. Traumatic events like tragic accidents can make it difficult for the victim or their family to remember to contact the insurance company immediately. This error can make their problems worse. In addition, most health insurance policies expressly state that for coverage to be provided, the insurer must be notified within 24 (or, in certain situations, 48) hours after the hospitalization. Failure to adhere to the policy could lead to health insurance denials. Therefore, you must get coverage from an insurance company that is available around the clock and provides prompt service. This is why you won’t have your insurance claims rejected.
8.    Incorrect or incomplete claim process: You must adhere to specific steps when filing a claim with your health insurance. These steps represent the company’s established procedures. It entails notifying the insurance company of the emergencies and the treatment you are receiving at an accredited hospital. In addition, the claim form must be completed and treatment records included. You will fill out multiple forms, and supporting papers such as hospital bills and certificates must be submitted as part of the claim procedure. That is why this is one of the 9 Health Insurance Rejection Reasons You Should Know. if you submit inaccurate or incomplete information on the claim form or fail to include the necessary proof of expense.
9.    Incorrect Information or Details: False information could also be one of the causes of your health insurance rejected claims. Ensure the information you offer at the time of the proposal is accurate and sincere. The insurer’s names, ages, earnings, and addresses must be precise. In addition, the insured’s income and lifestyle information must be accurate. The exact details, including name and age, must be included when filing a claim. Any discrepancy with the data given at the time of the claim may result in the policy’s rejection.

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How Can You Prevent Your Health Insurance Claim from Being Rejected?

  • Pay your health insurance premium promptly each month to maintain coverage
  • Take notice of the terms and conditions, exclusions, deductibles, and co-payments by carefully reading the policy document.
  • Ensure all of your information—such as your name, address, etc.—is consistent throughout the documents.
  • At the time of hospitalisation, gather all the required paperwork and supporting documentation, such as medical bills and medicines.
  • Make sure you submit the claim request within the allotted time frame, typically 30-90 days from the date of hospitalization.
  • Send all medical records and paperwork to the third-party administrator (TPA), and in the case of post-hospitalisation expenses, do so within 90 days of the hospitalisation.
  • Always make copies of all the paperwork you provide to the TPA and the claim form for future purposes.
  • Ensure the insurance claim form is filled out completely and accurately before submitting it. Even better, keep several records available if you need to fill one out again due to an error.

Frequently Asked Questions9 Health Insurance Rejection Reasons You Should Know

Can health insurance deny pre-existing conditions?

Pre-existing conditions, including pregnancy, diabetes, cancer, or asthma, can no longer be reasons for health insurers to raise premiums or refuse to cover you or your child. However, they cannot exclude such conditions from receiving benefits either.

Once you have insurance, no one can deny you coverage for pre-existing condition care. However, you must state your pre-existing illness when registering for a policy. Failure to include the illness might result in some insurers offering you insurance rejection.

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Why was my health insurance claim denied?

Those mentioned above are some health insurance rejection reasons. You can read through to see if any is the reason you got your insurance claims rejected.

Why can health insurance companies deny coverage?

Health insurance companies can deny coverage for a wide range of reasons. Some are due to coverage issuers, errors, and other reasons.

What are the health insurance claim rejections with auto accidents?

Some health insurance claim rejections related to auto accidents include insufficient insurance coverage, driver exclusion from policy, delay in medical treatment, and many more.

Why is it illegal not to have health insurance?

There is no federal law that makes health insurance a legal requirement. However, a few states in the United States made it compulsory. So all you need do is check whether your state law made it a legal requirement.

Can you be denied health insurance because of weight?

Under the Affordable Care Act, you cannot be charged different rates or have your health insurance cancelled because of your weight.

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How often do insurance companies deny claims, and how many health insurance claims are denied each year?

Health Insurance claims denial rarely occurs as over 90 to 95% of health insurance companies in the United States approve claims yearly.

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