Top reasons for health insurance claims rejection in India
As per the regulations laid down by IRDA, the repudiation of any claim is the prerogative of the insurance company and only they can decide if a claim is payable or not. Second, the insurance company cannot randomly reject claims of any patient, without adhering to the terms and conditions of the policy opted for by the insured. Hence the insured should go through the policy terms and conditions and know what their policy covers and what it excluded. Hence it is not true that most of the claims filed are rejected by the insurance company / hospital.
First and foremost it should be clearly understood by every person who has a Health Insurance policy or planning to buy one that it is not the hospitals who reject claims. Also, most individuals who file for a reimbursement claim feel that insurance companies take very long to settle such claims and find frivolous reasons to deny settling what the insured believes is a genuine claim. If the insured files their claim accurately by providing all the relevant information on the claim form, submits all bills and documents pertaining to the hospital visit and treatment, there is no reason for the insurer to delay settling the claim. Most insurers in India process claims in a matter of 7-10 days from receiving the complete claim application.