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Top 5 Reasons Your Health Insurance Claims Could Get Rejected

Team AckoJan 17, 2024

Purchasing a health insurance policy is an amazing way to safeguard your finances in case you need to avail medical treatments. Nowadays, this process has become easy thanks to online health insurance. A policy can be bought easily, but when claims are raised, are they always settled? There could be various reason due to which a claim might get rejected. In this article, we will discuss these possible reasons. Make yourself aware of the reasons by reading ahead and avoid claim rejection.



Reasons For Health Insurance Claim Rejection

1 Claim process

Since your health insurance policy is a contract between you and your insurance company, you need to follow the claim process diligently. There may be instances of incompletely/incorrectly filled application forms, lack of documentation, etc. It is advisable to get in touch with the insurance company to understand their health insurance claim process. This will reduce the chances of claim rejection.

2 Pre-existing diseases

Some health insurance plans do not cover any diseases you already might have while buying the policy. If you fall ill due to these diseases and require hospitalization, your health insurance company will not be able to cover you for the cost of treatment. Thus, if you raise a health insurance claim, there are high chances that it will get rejected.

3 Policy period

A health insurance policy is usually valid for a period of one year. At the end of one year, the policy will expire. As a policyholder, an expired health insurance policy is of no use. Thus, you need to get the policy renewed. Renewal will provide other benefits as well. For example, you might have to pay a lesser premium. But if you do not renew your health insurance policy, it will lapse. If you are not aware that your policy has expired and you raise a claim, it will get rejected. Thus, make sure to check the expiry date of your health insurance policy.

4 Waiting period

A waiting period with respect to a health insurance plan means you need to wait for a certain period of time to avail the insurance cover. For example, some insurers cover pre-existing diseases or maternity benefits after a waiting period of a couple of years. The duration depends upon the terms and condition of the insurance company. Your claim will get rejected in case you raise it for a condition on which a certain waiting period is applicable.

5 Exclusions

Health insurance provides a financial cover if you fall ill and require medical assistance. However, there are certain conditions under which you cannot raise a claim. These conditions are called exclusions. If you raise a claim against an exclusion of your policy, it will be rejected. To avoid this situation, you must always read the policy document thoroughly. If you have a doubt or do not understand any part of your policy document, you should get in touch with the health insurance company and get it clarified.

Also read: Health insurance for family

Frequently Asked Question

What are network hospitals?


Network hospitals are those hospitals with which your health insurance company can directly coordinate. If you avail medical treatment in a network hospital, you do not have to go through the hassle of arranging paperwork and then raise a claim. You simply need to inform your health insurance company that you are availing medical treatment from a network hospital.

What is a cashless treatment?


You can avail cashless treatment from a network hospital. A cashless treatment is when you do not have to pay the entire bill amount. You only have to bear the deductibles and your health insurance company will bear the major part of the hospital bill. Since you do not have to collect a lot of paperwork or pay the entire bill, the treatment is called cashless treatment.

What are the common types of health insurance policies?


Depending upon your need you can either choose from individual health insurance plans, family floaters, group mediclaim policysenior citizen plans, or critical illness covers. You can know more about the health insurance plans offered by your insurance company by getting in touch with them by visiting their online health insurance site.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.


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