Know why Health Insurance might be Rejected - Greyfont

Reasons For Health Insurance Claim Rejection

Insuring your health with a good medical insurance plan is a must to ensure you don’t have to bear the expenses out of your pocket. Especially, with the rising medical costs, having a health insurance plan ensures you peace of mind and financial safety. However, buying a health insurance plan also means that there are chances that your insurer would reject your claim. If you are thinking about why this would happen even when you are paying the premium, then it is important for you to know that your insurer can reject your claims on the following grounds.


Read this article to know about the reasons for health insurance claim rejection.


  • Not disclosing pre-existing diseases: Health insurance companies do not provide cover for pre-existing diseases from the initial period. For instance, if you are suffering from high blood pressure and if you are diagnosed with any ailment due to the high pressure, then you are not eligible to receive coverage for the disease in the first few years. Under a health insurance policy, pre-existing diseases are covered only after a waiting period of 3-4 years. Hence, it is mandatory that if you are suffering from any pre-existing diseases at the time of policy purchase, you disclose the facts well. There are high chances of your claim getting rejected if you do not disclose anything about your pre-existing disease.


  • Waiting period: Health insurance policies come with a waiting period, covering specific diseases, pre-existing diseases and maternity after a certain number of years. Usually, the waiting period for pre-existing diseases and maternity cover is 3-4 years, but it may differ from insurer to insurer.


  • Policy expiry: Health insurance policy is valid for one year. If you have not renewed your health plan less than 30 days after the period of expiry, then you will not be eligible to receive any coverage. Remember, an expired health insurance policy holds no value. If you are not aware of the policy expiry date and you raise the claim, your health insurance claim will get rejected.


  • Room Rent limit: Room Rent is the limit imposed on using the hospital room. Your health insurance plan comes with a room rent limit that you are supposed to use at the time of hospitalization. If you are admitted in a room that is above the room rent mentioned in your policy, then there are chances that your health claim will be rejected. It is important to note that charges of your insurance claim are directly related to the room rent limit. Hence, the charges of a deluxe room would be more in comparison to the shared room. So if you have a plan with a room limit of 4000 and stay in a room with a rent of 6000, then you will have to bear the room charges along with the nursing expenses, operational charges, etc. It is always advisable to opt for a policy that has higher room rent limit or no room rent limit at all.


  • Exclusions: Every health insurance plan comes with a list of exclusions, meaning that you cannot raise a claim. If you raise a claim against the exclusion, then it will get rejected. To avoid such a situation, it is important that you read the policy documents carefully. And if you are unable to understand any points, then it is best you get in touch with the insurance company or the broker to get detailed information about the same.


The above factors often lead to customer dissatisfaction, giving rise to customer grievances even when the insurance company makes it clear about these facts. It is highly recommended that you read all the terms and conditions carefully.


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