Why do medical insurance claims get partly paid or rejected


Coping with out-of-pocket hospital bills is tough enough, and it seems all of the more confounding when you could have to do it despite having a medical insurance policy in place. There are several grounds on the premise of which your claim can lead you straight to rejection or partial settlement.

Given the ascending pace of medical inflation, especially after the pandemic, even a small portion of the bill can translate to an enormous financial burden. To spare yourself the distress, it’s essential to have a watertight approach towards the aspects that may impact your coverage and the steps you may need to take to foolproof it.

For example, one such lesser-known critical element added to hospital bills after the pandemic is consumable items. Consumables confer with single-use items including PPE Kits, syringes, and sanitization products amongst many others. Before the Covid-19 outbreak, these things would make up only 5-7% of the medical bill. Nonetheless, the pandemic necessitated an in depth usage of these things which implies now these constitute a whopping 15-20% of the bill and never knowing about it could possibly cost you dearly on the time of claim settlement.

Fortunately, now there are plans that adequately cover all such costs and in addition offer a smooth claim settlement. A claim settlement ratio of at the very least 95-99% is of utmost importance while selecting a policy. There are recent products which have higher claim settlement ratio and due to this fact, higher payouts. Here’s all you have to learn about them.

Go for add-ons for more holistic coverage

The elongated span of the pandemic has triggered a spur of infection and hospitalisation. Going by the recurring waves brought on by recent variants, it looks as if we’ll need to live with the virus within the near future too. To sail through these difficult times financially, one needs a sturdy coverage of their medical insurance. Also, considering the rising medical inflation, medical insurance plans now include riders that provide enhanced protection over and above your base plan. You possibly can go for these riders along along with your base plan to avail of its profit.

For example, Bajaj’s Health Prime rider is an ideal add-on to your policy. For a small additional premium, the policyholder gets many advantages to boost their coverage. Teleconsultations, which have develop into the brand new way of healthcare in the course of the pandemic, are also covered under this rider. Aside from this, you may also get coverage for doctor consultations that should not covered normally under any plan.

The rider also covers annual health check-ups thereby specializing in preventive healthcare as well. Moreover, pathology and radiology expenses are also covered under this profit. The rider might be opted for in each individual and family floater medical insurance plans. One may even avail of discounts on this rider if the relations are covered under individual plan or if one has a multi-year policy and in addition on the net purchase of the policy.

Comprehensive coverage leads to raised payouts

When you go for comprehensive coverage – including high sum assured, useful riders and features – you won’t need to repent on the time of claim settlement. In case your existing policy doesn’t offer riders of your alternative or as per your needs, you’ll be able to at all times port your policy. It’s indicative that choosing extensive coverage results in 10-20% higher payouts. If we speak about consumables, they definitely impact the claim settlement ratio. The recent data trends suggest that policyholders who go for consumables riders fall under the ambit of those that have at the very least 11% higher payout ratio than those that don’t.

Keeping the brand new Covid variants in mind, these numbers could go up or stay this manner for a very long time. Thus, it becomes vital to have maximum protection through your medical insurance. For example, Care Shield rider, which costs 5% of the bottom plan premium, provides coverage against non-payable items and has no impact on NCB if the claim amount is inside a certain limit as per the policy. So, it’s definitely higher to go for such features and a sound financial statement within the long-run.

(By Amit Chhabra, Head-Health Insurance, Policybazaar.com)


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