WHY HEALTH INSURANCE CLAIMS ARE REJECTED
There are many complaints from people to Insurance companies faulting the latter payment issues. Most of the time, clients do not know the rules and how to make a claim.
- Going for higher rates than your policy
When you go to a more expensive hospital than your policy, the company is not liable to pay for you. The insurance will only pay the amount you have insured against, and you pay the excess.
Before choosing a hospital or a hospital room, consider the cost and whether it will fit into your policy.
- Failure to disclose pre-existing conditions
Many disputes arise after a claim is rejected or not fully paid because you did not mention a past condition or illness from which you may suffer.
You should disclose all your health-related issues when taking up a health policy. Everything matters, from a disease you suffered 10yrs ago to that minor attack you had of hypertension.
Disclose any long-term illness like diabetes you have.
Don’t give the insurance company ground to deny your health policy.
- Unreasonable charges
“Reasonable and customary charges” is a clause in health insurance.
Insurance companies will not just settle any bill the hospital will charge.
The hospital should charge in line with other hospitals of the same category in line with the location.
If treatment is supposed to be charged $100 and the hospital charges you $150, the insurance may fail to pay the whole amount or partially. Be on the lookout that you are not overcharged, as you might end up paying the bill from your pocket.
Always spend as if you are the one paying to avoid disputes with the insurer.
- Failure to cover for “consumables.”
Consumables are small necessities used during a medical procedure. They are like syringes, cotton wool, masks, x-ray film needles, and many others. The consumables should be included in the room bill and not charged separately.
The consumables only take a small amount of the bill, although, during covid, hospitals charged more.
- Unnecessary claims
The insurance will not pay for unnecessary medical procedures.
If you are only going for a check-up or monitoring a situation, but there is no major issue, the insurance will not pay.
Check-ups and monitoring are not a treatment and, therefore, not a requirement.
Sometimes the hospitals will take advantage of healthy people to receive payment.
Some minor health issues you can take care of at home without hospitalization.
Conclusion
To avoid denial while making a claim, always remember the following,
_ Always have the prescription letter from the doctor for all the procedures you do, e.g., for the test, surgery, and medication,
_Get a dated receipt with a stamp, and lastly,
_ Get a medical report for all the tests.
Send all the documents so that you can get a reimbursement.
Always get all the information from the insurance company when taking a cover. Understand the hospitals you can go to and what is covered in the policy.
