{"id":318396,"date":"2023-12-12T07:26:07","date_gmt":"2023-12-12T07:26:07","guid":{"rendered":"https:\/\/popularindinews.com\/?p=318396"},"modified":"2023-12-12T07:26:07","modified_gmt":"2023-12-12T07:26:07","slug":"avoid-mistakes-in-health-insurance-claim","status":"publish","type":"post","link":"https:\/\/popularindinews.com\/celebrity\/avoid-mistakes-in-health-insurance-claim\/","title":{"rendered":"Avoid Mistakes In Health Insurance Claim"},"content":{"rendered":"

Policy owners need to avoid errors on their part to prevent claims from being denied.<\/strong><\/p>\n

Four factors are responsible for the majority of claim rejections in health insurance, according to Policybazaar.<\/p>\n

A recent study done by this insurance platform showed that about 25 per cent of claims were denied due to policyholders not disclosing pre-existing ailments.<\/p>\n

Another 25 per cent got rejected because policyholders were not aware of what the policy covered and what it excluded.<\/p>\n

Another 18 per cent got rejected because the claim was filed before the waiting period had ended, while another 16 per cent got rejected due to failure to reply to the insurer’s query.<\/p>\n

This analysis was based on 200,000 claims filed between April and September 2023, of which 30,000 had been rejected.<\/p>\n

Policy owners need to avoid errors on their part to prevent claims from being denied.<\/p>\n

Non-disclosure of pre-existing diseases<\/strong><\/p>\n

Non-disclosure refers to a customer’s failure to accurately disclose critical information while purchasing a policy.<\/p>\n

While filling out the proposal form, the customer, or her\/his agent, may not (at times deliberately) provide details of the customer’s medical history accurately.<\/p>\n

“An insurance contract operates on the principle of utmost good faith, requiring both the insured and the insurer to be honest and transparent.<\/p>\n

“When an applicant withholds or misrepresents information, it breaches this principle,” says Priya Gilbile, chief operating officer, ManipalCigna Health Insurance.<\/p>\n

According to Gilbile, this can lead to several consequences like policy denial, withdrawal, premium adjustment, claim rejection, and in cases of intentional fraud, even legal action, both civil and criminal.<\/p>\n

Advice<\/strong>: Often, agents fill up the proposal form and then encourage customers to sign on the dotted line. This should be avoided.<\/p>\n

“Buyers should either fill up the proposal form themselves or review it thoroughly if it was filled by someone else,” says Amit Chhabra, chief business officer, health insurance, Policybazaar.com.<\/p>\n

Upon receiving the policy document, the buyer should check to ensure that all medical disclosures are accurately recorded in the policy.<\/p>\n