Health insurance has become more sought after an emergency scare. Different health insurance companies offer a variety of claims depending on your need and contribution yearly or monthly. However, medical bills have become an increasingly expensive affair, not forgetting to mention the medication part. Due to such factors and other unforeseen circumstances, it is wise to have a health insurance policy in place. Sometimes, the health insurance claim rejects a policy due to reasons, you as the client, are not aware of and may not know how to deal with them. This is why clients keep in touch with their insurance companies every once in a while, to avoid inconveniences. Below are the reasons why they reject your health insurance claims.
Zero-Knowledge of the pre-existing illnesses
According to many health insurance contracts, there is usually a clause to name any pre-existing illness that one might have. Pre-existing illnesses are like diabetes, hypertension, cataract, fibroids the list is endless. It is important to note that different health insurance providers have specific rules governing pre-existing diseases unless you are in the Medicare advantage plans 2021 cover. Thereby, claiming insurance on a health plan that does not support pre-existing illness might be very hard to claim.
The terms and conditions of the policy
Before purchasing any health insurance policy, it is important to take time to read through the terms and conditions of the policy. However, these policies are in complex legal language that might not be easy for the client to understand. In such instances, going through the health policy with your attorney is very much advisable. Clarification of the different parts of the policy should be done early in advance. Also before the signing of any legal documents of the policy. Terms such as exclusions, coverage limits, and other conditions should be self-explanatory to the client. This will help the client in the decision making of the policy whether it fits their needs or not.
Lack of correct information
The type of information provided to the insurance company should be correct information as this might be another reason why your claim is a reject. In some instances, the insurance agent fills the application form. The insurance agent tends to be guided by the information you provide as a client. Information such as the hospital bills, the name of both the patient and the doctor, the name of the hospital, and any other relevant information should be correct. Incorrect information will lead to the cancelation of your claim, and this will mean the claim will delay too. Therefore, the right filling of the health claim form is important, as this will benefit you in the long run.
Forgetting to renew the health insurance
A client should remember to check when their health insurance policy expires and renew before the due date. Most health insurance companies usually send renewal reminders to their clients in advance to remind you of the pending payment. Although it is wise as the client to remember the start date, end date, and when you are expecting to renew the policy. The Delay of renewal policy is usually not taken into consideration and mostly leads to your claim having a cancelation or a rejection. However, this leads to clients having file escalations against the insurance companies leading to tedious battles in courts. Thereby, to avoid such situations, the client should have thorough knowledge about the health insurance company in question.
Coverage exclusion or exhaustion
Many health insurance companies provide a list to their customers of the various services that they do not cover. Thereby, such services can be a gastric bypass, pre-existing diseases, cosmetic surgery, and some infertility treatment. Therefore, you will find some help plans have limitations on the number of services they do cover. The client should be aware that upon submitting a claim. If the benefits are lesser or higher than the claim, the insurance company can decide not to approve it. Therefore, for a client to prevent such a situation, it is wise for the client to go through the plans, and the premiums been laid out by the health insurance company and select what favors him most.
Lack of progress
In some rare cases, you find a patient condition requires extensive care or needs long term hospital care. A patient such as this who is receiving long term care and yet is producing less positive results most health insurance companies tend to deny their continued hospital coverage. In such instances, if the health insurance company refuses to negotiate with the client, the client is forced to go into a legal battle with the insurance company. Subsequently, these legal battles are both tedious and consume money for both the client and the health insurance provider. Thus, a client needs to go through the different insurance claims being laid out by the insurance companies to avoid such risky situations.
Lack of proper authorization
Many fake health insurance companies do not tell the clients the kind of expectations they have for them. For instance, a patient is required by the insurance company to get pre-authorization of services before treatment. These non-routine services include surgeries, inpatient care, and behavioral care. When a client goes through these services without the proper authorization, the health insurance claim does not go through. Henceforth, the customer must ensure that the health insurance policy does not have a frustrating level of requirements.
To summarize, there is a wide variety of health insurance companies offering different premiums and plans. A customer should take their time with their partners or family members to go through these premiums and plans and see what best fits their situation. However, due to the complex legal wordings in some insurance company contracts, the customers are highly advised to seek legal interpretation from their lawyer. No one knows what tomorrow has in store for us, and that is why having a good health insurance claim is the best thing one can do for you and your family.
