Web Event: 4 Common Reasons Why Health Insurance Claims Get Rejected


We discuss the typical reasons why health insurance claims get rejected A lot of times health insurance claims get rejected because of things that policyholders do Why do medical insurance claims get rejected? Most of the time people don’t read the fine print of the policy People are not aware of health insurance policy conditions People invoke the health insurance policy when it is not due to them A claim made for a pre-existing disease in the first year will rejected since policies typically don’t cover them Typically, pre-existing diseases are excluded from the scope of the policy in the first three years There are certain treatments that are beyond health insurance policies such as cosmetic and dental treatments These diseases are excluded and are not part of the coverage Sometimes outpatient department or OPD costs are claimed This is again excluded under the policy Incomplete documentation is also another major reason for claim rejection Typically this is about forgetting to get the discharge summary and the claim history, among other things If documents are incomplete, you can’t get them later from the hospitals You need to know about the benefits of your health insurance policy i.e what it covers and what it doesn’t

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