Most Common Pitfalls in Health Insurance Claim

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3 min read

Updated on Nov 17, 2022

Your health insurance plan proves beneficial when it successfully settles your claim. It is at that time that you realise the importance of your health insurance plan. But what if you are unable to get your health insurance claim settled? Wouldn’t it be a nightmare?

There are times when your health insurance claims get rejected or are delayed. Most often than not, it is your fault which leads to any delay or rejection of your claim. You make mistakes with your claim process which creates a problem with your health insurance claim.

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Know some common pitfalls in health insurance claims and how you can avoid them:

  • Not following the intimation time-line

Health insurance companies have a particular timeline within which your health insurance claim should be notified to them. After notification of the claim, it is approved and the settlement is done. If you don’t follow the time-line your claim falls in jeopardy. To avoid this pitfall, intimate the insurance company in time. If it is a planned hospitalisation, inform the company 3-4 days in advance of such hospitalisation and avail approval. If it is an emergency case, intimation should be done within 24 hours of hospitalisation for easy settlement.

  • Submitting incomplete documents

Health insurance claims require a complete set of your medical documents and hospital bills. Failure to submit the required documents leads to claim rejection or delay. So, when you make a claim in your policy, make sure to obtain and submit all original medical bills and reports as required by the insurance company to process your claim.

  • Wrongly filled in claim form

Your claim form should specifically state the policy number, date of hospitalization, and other treatments, the reason for the claim, your name, and other personal details, etc. All the required information should be correctly filled and submitted. Wrongly filling in a claim form or incomplete form would result in the delay of your claim settlement.

  • Making a claim for an excluded expense

Every health insurance plan has exclusions. Expenses related to such exclusions are not paid by the company. So, if you make a claim for an excluded expense, your claim would be rejected. To avoid this mistake, read your policy document carefully. Understand the exclusions so that you know for what you are exactly covered under your health insurance plan.

  • Making a false claim

If you make a false claim, you are committing a fraud. The result would obviously be the rejection of your claim. In fact, the insurance company might also take punitive action against you for making a false claim.

Health insurance claim process is simple. It just requires you to follow some basic steps. If you follow the steps and avoid the above-mentioned pitfalls, your claim would be settled easily and also quickly.

Choose wisely!

Also read: IRDA Health Insurance Claim Settlement Ratio 2022 for Top Health Insurance Companies

Mar 18, 2021
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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