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Reasons Why Your Cashless Insurance Claim Could be Denied Research Team | Posted On Wednesday, July 03,2019, 05:35 PM

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Reasons Why Your Cashless Insurance Claim Could be Denied



A health insurance plan is very important these days. Costly hospitalization can empty your pockets. This is why you must never leave your home, without the health insurance plan.

Make sure to avail cashless health insurance policy, where your hospital bills are directly settled with the hospital, by the insurer. The medical bills must be within the sum assured limit. With a cashless health insurance plan, you don’t have to pay a single rupee from your pocket.

What is a Network Hospital?

The hospital, with which the insurer has a tie-up, is called network hospital. If you are admitted to a network hospital, you don’t have to pay a single rupee on having cashless health insurance. The insurer settles the medical bills with the hospital. Check network hospitals near your home, before availing cashless health insurance plan.

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Reasons Why Your Cashless Insurance Claim Could be Denied

1. Don’t Disclose Pre-Existing Diseases

If you don’t disclose pre-existing ailments when availing cashless health insurance, your claim could be denied. When going through the health insurance policy application, you will come across a section regarding pre-existing diseases.

This is a very important section, as the insurer decides your eligibility and the premium, based on this data. If you hide pre-existing diseases or make improper disclosures, the insurer is well within rights to deny the claim.

See Also: Health Insurance Benefits

2. Exceed Sum Assured

When you avail a cashless health insurance plan, you are insured up to a particular amount called sum assured. Both individual and family floater cashless plans have sum assured available on a yearly basis.

Now, if you exceed the sum assured in a particular year, any subsequent cashless claim is rejected. However, if part of the sum assured is intact, you can still make health insurance reimbursement claim.

3. Ignore Exclusions

There are many diseases which are not covered under health insurance. The health insurance plan clearly mentions “Not Covered”. Now, even if these diseases are covered, there is a waiting period. If you file a claim for a disease/medical condition which is excluded under health insurance plan, then cashless health insurance is denied.

See Also: Health Insurance Plans

4. Misrepresentation of Facts

Suppression or misrepresentation of facts; is a clear No, when availing cashless health insurance plan. Be honest when filling the health insurance proposal form, and make the right disclosures.

If you give the wrong age, incorrect salary/nature of job or don’t disclose pre-existing illness, cashless health insurance claim is denied.  You must be prompt and specific when filling health insurance proposal form.

See Also: Types of Health Insurance Plans in India

5. Non-Renewal of Health Insurance

The cashless health insurance plan is valid for a year. The health insurance plan expires at the end of this period. You would have to renew the health insurance plan, to keep it going. If you don’t renew health insurance plan in time, it lapses. Now, if cashless health insurance has lapsed and you raise a claim, it’s rejected. Check the expiry date of health insurance plan and renew it, to avoid rejection of health insurance plan.

See Also: Family Health Insurance Plan

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