Things to watch out before filing a health insurance claim

More and more people are going for health insurance and the health insurance companies are increasingly promoting their products. But do all the health insurance claims get approved? The answer is No, many persons who have taken health insurance find that their claims are denied by the insuring companies. What are the points one should keep in mind so that the claim is not denied? Here are few important ones.

Give a real picture of your current health situation and if you are having any pre-existing disease or medical condition, disclose it to the insuring company. Health insurance firms generally do not insist on medical examination up to a certain age, as denominated in the policy terms, and expects the insurer to give accurate information about his health.

Almost all insurers have certain minimum hospitalization period clause to initiate a claim. Normally it is 24 hours of hospitalization. The conditions vary from company to company. So, if you are looking for a health insurance, which covers even routine medical checkups, it is advised to shop around and find the policy which offers such a facility.

With every insurer there is a clause which explicitly excludes any pre-existing diseases; however they may provide insurance for it if the policy is continued with them for more than a predefined period. For example some diseases like cataract, hernia and sinusitis may be covered only after two years. So, if you have not been able to get pre-existing disease coverage due to continuing renewal of the policy, your claim may be denied.

Health insurance companies have certain initial limits, which can vary from 30-60 days or more during which they do not offer any reimbursement of expenses for certain diseases and ailment.

Claims for post hospitalization benefits, if offered by the health insurance policy providing company, will in most case have a minimum duration of hospitalization clause attached to it. For example a continuous hospitalization of 5 days.

When it comes to surgery, there are well laid out conditions, for which the health insurance companies will reimburse the expenditure. For example, if more than one surgery is conducted under one anesthesia, the claim for the severest surgery is paid in full, while only 50% benefit is given for the second one. No claim would be paid for any subsequent surgery under the same anesthesia.

Another thing to keep in mind is that most health insurance companies would prefer original bills for claims settlement. This could cause a problem if a person wants to apply for claims from two different health insurance companies. In such a scenario it would be beneficial to ask the insurance company whether they would accept bills in duplicate or photocopy.

Keeping these things in mind, clarifying every doubt before settling for a particular health insurance company and following the claims procedure appropriately with all the documentation will go a long way in ensuring that the health insurance claims are not denied.

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