Health insurance is meant to be your financial backup during tough times. It’s supposed to offer peace of mind when unexpected medical expenses arise. But this assurance can fail if your claim gets rejected when you need it most.
To avoid such disappointments, it’s important to understand the common reasons claims get rejected. Knowing these can help you avoid expensive mistakes and ensure that your policy works for you when it matters most. Here are some of the most common reasons SBI health insurance claims may be declined.
1. Pre-existing Medical Conditions
Health insurance generally covers future risks, not medical issues that already exist at the time you purchase the policy. These existing conditions, such as high blood pressure, arthritis, or kidney stones, are often excluded from immediate coverage. Many claims related to pre-existing illnesses are declined, especially if the policyholder tries to use the insurance for planned treatments soon after buying the plan.
2. Policy Exclusions
Each health insurance plan lists certain medical services or conditions that are not covered, known as exclusions. Unfortunately, many policyholders skip reading this part of their policy document. If you file a claim for any treatment or condition listed under exclusions, the insurer will likely reject it. Exclusions can vary between policies and providers, so always check the fine print.
3. Missed Policy Renewal
Health insurance typically runs every year and must be renewed before the expiration date. If you fail to renew the policy on time and a health emergency arises during the reverse period, the insurance will not cover any expenses. A missed renewal can leave you completely unprotected.
4. Errors in the Claim Process
Submitting a claim requires filling out forms and attaching supporting documents such as medical bills, prescriptions, and discharge summaries. If there are mistakes in the forms or if the documents are missing or incomplete, your claim may not go through. Accuracy and thoroughness are essential during this step.
5. Claiming More Than the Insured Amount or Sub-Limits
Every health insurance policy has a sum insured, the maximum amount you can claim. Also, there may be sub-limits on specific expenses like room rent, ambulance charges, or certain treatments. If your claim exceeds these limits, the extra amount won’t be reimbursed and may result in partial or full rejection.
6. Waiting Period Violations
Most health insurance policies include a waiting period, typically the first 30 days after the policy starts. During this time, claims are not accepted unless they are due to an accident. Certain conditions, like maternity benefits or critical illnesses, may have even longer waiting periods. Filing a claim during this time for non-accidental treatment will almost certainly be denied.
How to Avoid Claim Rejection
To make sure your health insurance supports you when you need it, it’s essential to understand what your policy covers and what it doesn’t. Always read your policy documents thoroughly, take note of the exclusions, and keep track of deadlines like renewals and hospitalization notifications. Knowing these details will help you make informed decisions and avoid claim denials.
Keep in mind: This content is for informative purposes only. For full details regarding policy terms, coverage limits, waiting periods, and exclusions, please refer to the Authorized Sales Brochure and Policy Wordings before making any purchase.