The COVID-19 pandemic has changed the health insurance landscape in the country in several ways. People are now taking health insurance more seriously than ever before. The sales of health insurance policies are zooming with more and more individuals and businesses continuing to buy tailor-made covers to combat the COVID-19 pandemic. Insurers believe that the new trends that have surfaced in the last couple of months will continue even in the post-COVID era. This is the reason why insurance companies are bringing in specific policies to cover hospitalisation and treatment charges, on account of hospitalisation due to the novel coronavirus, or even home care.
Not covering some costs
While claims for overhead charges such as personal protective equipment (PPE) kit costs are being approved by a few insurers on the directions of the IRDAI, there are still a few expenses – such as those for sanitisation and sterilisation, plus items such as sanitisers and gloves – are being rejected by the insurers during the claim. In the last few months, it has been observed that many people who already have insurance for the past few years and even those who have recently bought insurance are struggling to get their insurers to pay up and this is mostly because consumers are not fully aware of the inclusions and exclusions in a health insurance policy. There have been instances where even those with comprehensive health insurance policies had to shell out funds from their own pockets, as many insurers refused to cover overhead charges under the insurance claim. It is the responsibility of both – the insurer and the consumer – to rightly inform and understand what is included and what is excluded under a health insurance policy. As a policyholder, here are the precautions that you can take at your end to avoid claim rejections.
Ways to avoid claim rejection
The first and foremost thing to keep in mind to avoid any claim rejection is to go through all the policy wordings, apart from the terms and conditions, in a detailed manner. Being unaware of exclusions, deductibles, claim processes and other critical details will end up getting you confused or regretting the decision of taking the wrong policy. Moreover, as a consumer, it is important for you that when it comes to filling the application form, the details provided should be correct by all means. Wrong information or not filling the form properly in regards to the medical history are the prominent reasons which lead to claim rejection as the insurer ultimately finds out the discrepancy.
For planned hospitalisation, it’s better to ask for the insurer’s approval in advance. However, in case of a medical emergency, one can proceed with the treatment and inform the insurer within 2-3 days of hospitalisation. Also, as a consumer, you are entitled to get the cashless claim only when you are hospitalized in network hospitals. Network hospitals are the pre-approved hospitals that have tie-ups with insurance companies. You are not entitled to cashless claim in case if you get hospitalized in any non-approved hospital. You can check from the list of network hospitals near your residence.
Recently, the number of customer complaints against health insurers has significantly gone up primarily on account of dissatisfaction with the claim settlement process. However, after proper investigation and examination, it’s often found that many times it’s the consumer who is at fault while at times, it’s the insurer’s fault. Some of the prominent reasons for rejection of claims are not properly disclosing what is covered or excluded under the policy wordings and not covering pre-existing diseases even after serving the notice period.
As a policyholder, it is significantly important for you to understand that your job doesn’t end at selecting the insurer with the highest claims ratio. It’s much more than that! Health insurers these days are exercising extreme caution. The underwriting processes have become much more stringent, resulting in increased proposal rejections. This is the reason why policy seekers need to be extra careful while buying a health insurance policy.
As a policyholder, it is a must for you to know the various inclusions and exclusions under your health insurance policy. Often people assume that their health insurance policy covers the expenses incurred including doctor consultation fees and cost of medicines. Though there are policies that cover the insured for OPD expenses, not all covers do. Do buy a policy that covers OPD expenses too, along with day-care procedures.
(The writer is Health Business Head, Policybazaar.com)