World Heart Day 2024: These Mistakes Can Get Your Insurance Claim Rejected

India is a major contributor to cardiovascular disease-related deaths and disabilities globally, according to a Lancet survey. Early onset of heart disease can result in higher treatment costs but can be covered under comprehensive health insurance. However, claims related to heart disease treatment are often rejected due to various factors, which highlight the importance of understanding them on World Heart Day 2024. 

Health insurance claims, particularly those related to heart disease treatments, can be rejected due to non-disclosure of pre-existing diseases, waiting periods, and treatment exclusions. 

Non-Disclosure Of Pre-Existing Diseases 

Experts advise people to disclose their pre-existing health conditions when taking health insurance, as failure may lead to future claim rejections. High cholesterol, hypertension, and high blood sugar levels, if not disclosed, may become a reason for insurance claim rejection. 

Insurance companies may reject claims due to non-disclosure of pre-existing conditions, such as heart conditions or medical histories related to the heart, if the individual has not disclosed them to the insurance company. 

Claim During A Waiting period 

Health insurance policies have waiting periods for specific diseases, including cardiovascular conditions, and claims made before the completion of this period are rejected. Insurance companies may not consider claims favourable if made within the waiting period. For example, a claim for a heart condition can be rejected if the insurance company sets a three-year waiting period. Individuals with a medical history are advised to carefully evaluate the waiting period before obtaining insurance and explore the possibility of reducing it through riders. 

Inclusions And Exclusions 

Insurance exclusions are crucial in defining coverage limits, preventing misunderstandings and disputes during claims, and ensuring insurers manage risk effectively. They help maintain affordable premiums and ensure coverage remains viable. Understanding exclusions also aids consumers in making informed choices, enabling them to select appropriate policies or additional coverage for specific risks. Exclusions balance the needs of insurers and insured parties, promoting transparency and trust. 

How Can You Minimise The Risk Of Claim Rejection? 

Experts suggest reducing claim rejections related to heart disease treatment by ensuring complete disclosure of health conditions, understanding policy coverage, understanding the waiting period, opting for specialised health insurance, and choosing network hospitals for treatment, among other strategies. 

In Case Of Rejection 

If your health insurance claim is rejected, it's crucial to review the rejection letter to understand the reason, which could be due to missing documentation or policy-related issues. You can appeal to your insurer for additional documentation or corrections if clarity isn't provided. If policyholders are still unsatisfied, they can contact the Insurance Ombudsman or take the matter to court.