5 Reasons for Your Health Insurance Claim to be Refused by the Company - OCSEHAT

5 Reasons for Your Health Insurance Claim to be Refused by the Company


The main purpose of using health insurance is to take the risk if one day you or your family experiences a health problem. Unfortunately, not a few participants complained that health insurance claims were rejected by insurance service providers when they were about to submit claims for reimbursement of medical expenses. Actually, what is the reason, huh?

Why are health insurance claims rejected?

The importance of fully understanding the insurance system that you are following, is not only useful to make it easier when using it. On the other hand, the process of filing a claim will also be ensured to be smoother without obstacles.

Yes, the convoluted claim processing process may not be entirely wrong with the insurance company. If you do not understand the terms of submitting a claim, the insurance company has the right to refuse to approve the claim that you submitted.

Therefore, you should avoid the following points if you do not want health insurance claims to be rejected:

1. Claims are not included in the insurance policy


The insurance policy that you receive when registering for insurance contains a number of rules and agreements that are borne by the insurance company. So before making a claim, first make sure that the health conditions that you want to claim are contained in the insurance policy.

Take for example, if your insurance policy is not willing to bear the congenital disease, then all conditions related to the disease are not the responsibility of the insurance party.

2. Submitting claims beyond the deadline


Another reason why health insurance claims are rejected is because the claim has passed the time limit stated in the insurance policy. Any health insurance company has generally set a certain time limit for handling claims.

Usually between 30-60 days after treatment, starting from the date of your initial agreement with the insurance company. Well, if the submission of a claim that you do has exceeded the provisions listed, then the insurance party does not hesitate to reject it.

3. Incomplete claim document


Make sure you complete all document requirements when making a claim, if you do not want health insurance claims rejected by the company.

This document includes receipts for payments during treatment; a certificate from a doctor which usually contains the name of the doctor, name of the patient, date of treatment, type of illness, type of medication, treatment technique; a letter of introduction from a general practitioner if you are referred to a specialist doctor; and others listed in the insurance policy.

4. Dishonest about history


Before you buy a health insurance policy, you will be asked to be honest about all information relating to the history of your illness. Avoid hiding certain diseases only so that the insurance company is willing to bear your medical condition later.

The reason is, if in the future you are proven to have a disease that has actually been experienced before buying an insurance policy, of course your health insurance claim will be rejected by the company. So, try to always explain honestly about your health condition before using health insurance.

5. The insurance policy is not active


Every health insurance company has a different premium payment period. That is why, when you pay a premium late, your insurance policy will be deemed inactive or suspended until you pay off the premium arrears.

You will also find it difficult if you want to make a claim, because the company must reject the claim. The new insurance policy can be active again if you have paid the premium payment, or in accordance with the agreement of the insurance company.

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