One important thing that policyholders need to know is that from maintaining
documents to maintaining claims, this record plays a vital role in ensuring
financial security.
While having
medical insurance
can help you meet medical expenses, there is a chance that an insurance claim
may be rejected for various reasons. A recent report released by online
insurance service Policipasaar has revealed important information regarding
rejection of medical insurance claims. These data also indicate the need for
beneficiaries to have greater understanding of medical policies.
Incomplete
or inaccurate information, This can include errors in the policyholder's
information, such as their name, address, or date of birth. It can also
include errors in the claim form, such as missing or inaccurate dates of
service, provider information, or procedural codes.
Pre-existing conditions, If a policyholder has a pre-existing condition that
is not covered by their policy, their claim for treatment of that condition
will be denied. This is because pre-existing conditions are not considered to
be new or unexpected illnesses.
Policy exclusions, Most health insurance policies have a number of exclusions,
which are services or conditions that are not covered by the policy. If a
policyholder seeks treatment for an excluded service or condition, their claim
will be denied.
Procedural errors, Sometimes, claims are denied due to procedural errors, such
as not submitting the claim within the required timeframe or not providing the
necessary documentation.
Fraud or abuse, In some cases, claims may be denied if the insurer suspects
that the policyholder or provider has engaged in fraud or abuse. This could
include submitting false or inflated charges, or billing for services that
were not actually provided.
If your medical insurance claim has been rejected, it is important to review
the Explanation of Benefits (EOB) to understand the reason for the denial. You
can then contact your insurer to discuss the denial and appeal the decision if
you believe it was in error.
How to Enroll for this free Ayushman Insurance Plan
Ayushman Bharat is a comprehensive health protection scheme launched by the
Government of India in 2018. It aims to provide free access to essential
healthcare services to over 10 crore poor and vulnerable families
(approximately 50 crore beneficiaries) across India. The scheme covers
hospitalization expenses up to ₹5 lakh per family per year for secondary and
tertiary care procedures.
more detail.
Free call number, 1455
Apps link;
play store
Website, pmjay.gov.in