Avoid Mediclaim Policy Rejection with 5 Tips

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Avoid Mediclaim Policy Rejection with 5 Tips

Avoid Mediclaim Policy Rejection with 5 Tips

SC PP   ¦    Feb 03, 2021 06:15:12 PM (IST)

In the case of a medical emergency, Mediclaim policy acts as an umbrella offering you financial cover for you and your family. As inflation has affected the healthcare industry, much like any other industry, the costs of medical services are soaring, making it unaffordable. However, before you buy any Mediclaim policy, you must be confident that you can make the most of your chosen plan.

There are many scenarios where the application for medical claims may get denied. Therefore, you must read this blog to know how you can prevent claim denials for your Mediclaim policies. But, before we talk about the grounds for denial of the claims, let us first understand what Mediclaim policies are? And how to determine medical insurance premium for yourself?

Avoid Mediclaim Policy Rejection with 5 Tips-1
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A Mediclaim policy is an insurance cover that protects you and your loved ones against the rising hospitalization and medical costs while also offers financial security and peace of mind during medical emergencies. For hospitalization due to sickness or an accident, it provides financial backing. Now, how to determine a suitable mediclaim premium for yourself?

One can easily avail of the many benefits that Mediclaim policies bring by paying a monthly, quarterly, half-yearly, or yearly fee. Usually, the higher the sum insured, the higher the premium would be. Depending on your affordability, personal preference, and suitability, you will be able to select a specific sum insured. There are different types of Mediclaim policies for individuals, groups, senior citizens, overseas travel, critical illness, available at different premiums.

Features and Benefits of Mediclaim Policies
So, how do Mediclaim policies benefit you? To help you understand, here are some common features of Mediclaim policies that you must know about:

  • Mediclaim policies include the comfort of cashless hospitalization. 
  • Ease of payment by online health insurance firms 
  • Provides exemptions from taxes. 
  • Avail, cost-effective healthcare services. 
  • Option to choose comprehensive protection for the whole family as well as on an individual basis. 
  • Acts as a shield against financial burden during emergencies. 
  • Mediclaim policies eliminate expenditures paid out of your savings account.

Tips On How To Avoid The Mediclaim Policy Rejections
While it is advised that you do your research, a few expert tips can make it easy for you to understand one of the most critical aspects of Mediclaim policies – Claim requests and rejections.

  • Find Out The List of Policy Exclusions
    Never ignore the list of exclusions while buying Mediclaim policies. According to guidelines provided by the IRDA, all the circumstances and cases that are not protected under the claim policy needs to be mentioned under the list of exclusions. So, make sure you have gone through all the exclusions to keep your claim request from being refused. 
  • Obtain Pre-Authorization
    Insurance firms may demand that the physician send a request for pre-authorization detailing the need for a medical procedure. That is increasingly prevalent as pre-authorization is required for several examinations, procedures, and drugs to assess medical eligibility before service.
    Ask in advance if pre-authorization is needed for a test or procedure and if your scheduled hospital stay has been approved. Know if referrals for services such as seeing a specialist are necessary for your surgery.
  • Care in Network Hospitals
    You are only entitled to obtain the claim while you are hospitalized in hospitals that are part of your chosen insurance brands’ tie-ups. The pre-approved hospitals that have tie-ups with insurance providers are known as network hospitals.
    If you get admitted to any non-approved hospital, you are not entitled to file a case. You can search and start your treatment from the list of network hospitals near your residence.
  • Avoid Policy getting lapsed
    Insurers only settle claims if the policy is active. Missing the due date of the payment can result in denial of claims. A good tip is to always pay the premiums on time, as the insurance providers provide prompt reminders to pay the premium, so the policyholder should be responsible enough to pay premiums on time. Never Conceal Pre-existing Disease Knowledge
    Any kind of information about your pre-existing medical condition must never be concealed. Informing the insurer about the history of a pre-existing condition, if any, is always right. If your insurer comes to know about your pre-existing condition during scrutiny, then your claim will be rejected.

The bottom line is that Mediclaim policies a form of health insurance where you can either be reimbursed for hospitalization expenses or use the cashless option to cover your hospitalization costs. Additionally, under Section 80D of the Income Tax Act 1961, the premium you pay is eligible for tax exemption, making it a successful investment. There are various renowned insurance companies like TATA AIG, providing you several options of Mediclaim policies to choose from. Remember that during any medical emergency, such Mediclaim policies act as a boon for you and your family, ensuring security in a time of crisis.

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