HEALTH INSURANCE CLAIM REJECTION REASONS
Nearly 70% health claim users opting for reimbursement mode don't have enough liquid savings to pay bills: Survey
A recent study highlighted challenges faced by health insurance policyholders opting for reimbursement, often resorting to borrowing or dipping into savings for medical bills. Despite expanded coverage, 68% lacked adequate savings for expenses. Cashless treatment remains preferred, with 89% satisfaction, compared to 79% for reimbursements. Delays post-discharge also impact satisfaction.
Is your medical claim stuck? Find out why you face problems in health insurance claim settlement and how to avoid them
While health insurers can sometimes be blamed putting customers through unending hardship in clearing claims, many a times it’s the policyholder who is at fault. A significant portion of these health insurance claim rejections can be prevented by asking the right questions during policy selection, carefully reviewing policy documents, and conducting thorough research. This article explores common health insurance claim rejection scenarios and explains how to avoid them.
6 questions to ask while buying a health insurance policy to avoid claim rejections later
How to buy the right health insurance policy that will pay for your claims on time? You can avert claim rejections by asking the important questions at the time of buying health insurance and reading the policy details and fine print carefully. Ask these questions while purchasing a health plan or at the time of filling a proposal form.
6 recent health insurance claim rule changes every policyholder should know
Insurers will have to clear a health insurance claim within three hours of receiving it from the hospital during discharge. Irdai has also given a window of one hour for clearing cashless claim requests at the time of admission. All you need to know about the recent health insurance claim norm changes by the insurance regulator.
Star Health looking to grow 18%, improve claims ratio by 50 bps: Anand Roy, CEO
Star Health & Allied Insurance expects 18-20% growth in gross written premiums this year, aiming to double premium income in four years. CEO Anand Roy discussed the company's strategies with Shilpy Sinha.
All insurers must offer basic cover, meet settlement deadlines: IRDAI
IRDAI announced customer-centric measures, requiring general insurance companies to offer basic insurance products with clear coverage details on their websites for easy comparison and customization.
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NCLT rejects JAL's claim of liquidity crunch due to delay in govt approvals, litigations
JAL has submitted that it is an "asset rich company", even after sale of cement plants to resolve the loans under Bucket 1 and Bucket 2A, assets like Real Estate Business - Noida and Greater Noida (about 11,000 flats) will remain with the company. Besides, it had other assets such as two 5 Five Star Hotels/Resort in Delhi, and one in Agra, two Golf Courses in Noida and Greater Noida, a Formula One Sports Complex and Cricket Stadium with Real Estate.
Cashless claims to be cleared in 3 hours
Irdai has also mandated the insurer to decide on the cashless authorisation within one hour of receipt of the request.
Health insurance premiums can be reduced if you don’t make a claim, policy cancellations to be less costly and more: 5 rule changes
Health insurance rule changes: To make health insurance policy more inclusive, flexible and customer-friendly, IRDAI has recently released a master circular on health insurance business. The regulator introduces new measures regarding cancellation charges, standardising no-claim bonus, and increasing claim settlement transparency. ET Wealth Online explores how these regulations empower policyholders and improve their health insurance experience.
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I will highlight two-three points over here. One is definitely a size advantage that a Quant would have, so I am talking about a thousand crore fund versus a 35,000 crore fund, so that helps in the agility of the fund manager to actively manage.
Improvement in tech, backend processes & team strength needed to achieve IRDA objective: Shweta Rajani
It is welcoming move what IRDA has done because it now means that one within three hours in a normal case the insurance company has to authorize the entire documentation and the claim approval has to go through, not only that they are also emphasising that there should be a 100% claim and any claim rejection by the insurance company would internally need internal explanations and approvals.
Health insurance claim rule change: Cashless claims must be cleared in 3 hours; insurer to pay hospital charges for delay in discharge, says IRDAI
Health insurance: The Insurance Regulatory and Development Authority of India (IRDAI) has released a master circular to streamline health insurance claim process. Previously, delays in claim approvals forced patients to stay in hospitals longer. Now, insurers have three hours to approve cashless discharge requests. Additionally, insurers will be liable for extra hospital charges due to delays.
Empowering senior citizens: The crucial role of health insurance in India
Recent IRDAI regulations in India aim to empower senior citizens through accessible health insurance options, including coverage for Ayush treatments, aggregate deductibles for cost-sharing, and comprehensive rider packages for additional benefits. Assessing needs and selecting the right plan are essential for personalized and comprehensive health coverage.
Sanjiv Bajaj on right way to go in getting health insurance, rising premia & more
Sanjiv Bajaj elaborates on the factors contributing to premium increases, including health inflation and GST. He also provides insights on the health insurance porting process, emphasizing the importance of policy porting and health declarations.
Health insurance claim rejection: Widow fights, wins Rs 28 lakh damage; pre-existing disease can't be free pass for claim denial
The Delhi State Consumer Commission ruled that an insurer cannot reject a health insurance claim solely based on pre-existing diseases if they weren't the cause of death. The commission directed HDFC Life (previously known as HDFC Standard LIC Co. Ltd.) to pay Rs 19.4 lakh along with the interest to a woman whose husband's claim was rejected for not disclosing diabetes. The insurer also has to pay Rs 1,00,000 for mental harassment of the complainant along with the litigation cost. This is a relief for those with common lifestyle diseases like diabetes. Read the full case and verdict in details. What do you need to keep in mind while buying health insurance policy to avoid claim rejection later. Find out here.
What should be the criteria for selecting the right kind of term plan? Dinesh Dilip Bhoi answers
There are chances of some sickness coming up or some disease coming up in the future which might hamper the person to take a life plan or which might increase, there would be a loading on his premiums with the premiums would get higher and higher and build a hole in his pocket.
Health insurance premium shot up over 25% last year for 52% policyholders, finds survey; here's how the impact can be reduced
Health insurance: Premiums of health insurance policies went up by more than 25% for 52% policyholders in India over the last 12 months. In this article we tell you how this will impact senior citizens and others and how you can take steps to reduce its impact if you are a new health insurance policy buyer.
HDFC Ergo withdraws 3 health insurance policies: How will it impact policyholders? Will premiums increase?
In a move impacting existing policyholders, HDFC Ergo discontinues its my:health Suraksha health insurance plans. The insurer will migrate customers to alternative policy. Key concerns for existing customers include changes in premiums, coverage details, and potential loss of renewal benefits. ET Wealth Online delves into how this will affect renewals, benefits, and the migration process. Customers of HDFC Ergo my:health Suraksha health plans must know these details
Health Insurance Claim: 43% policyholders faced difficulties, some had to wait an extra day at hospital, survey
Health Insurance claim: Many people in India are facing difficulties in getting their health insurance claim processed. "43% health insurance policyholders who filed a claim in the last three years struggled with getting it processed," as per a report by LocalCircles.
Health insurance rules changed for senior citizens: Be ready for a 10-15% hike in health insurance premiums
In a major reform, Insurance Regulatory and Development Authority of India (IRDAI) has removed the ceiling of 65 years for a person to buy a health insurance policy. Additionally, the waiting period for pre-existing conditions has been reduced from four to three years. Both these rules have been effective from April 1, 2024. Will these new rules help uninsured senior citizens get health coverage? How easy is it now to buy a health insurance policy for the first time at the age of, say, 70? Find out here
Why you should renew your car insurance policy on time?
Renew car insurance promptly to comply with the law, avoid financial burdens, and maintain benefits like no-claim bonuses. Online services simplify the process, ensuring continuous coverage and hassle-free renewals.
Latest health and general insurance claim settlement ratio released in 2024
Do you know how good is your insurer is in settling claims and how long it takes for your health or general insurer to settle claims? Or how many claims did they reject last year? It is important to keep track of the claim settlement performance of your insurer. IRDAI has recently released the claim payment details of general and health insurance companies. Check here
Husband wins Rs 1.57 crore health insurance claim against LIC after a 5-year fight
LIC health insurance claim: Life Insurance Corporation of India (LIC) was ordered by NCDRC to pay Rs 1.57 crore to the husband of deceased policy holder who died from Breast Cancer in 2017. The said policy was approved by LIC in 2016 after eco and medical tests were done by the policyholder.
70% choose health as a reason for buying health insurance over tax savings; ICICI Lombard study
ICICI Lombard’s report on emerging trends in health insurance with focus on taxation benefit”, offered a comprehensive analysis of the financial behaviour of individuals who have made at least one tax-saving financial investment and own health insurance or have an intention to purchase.
Daughter wins health insurance claim fight against LIC after 8 years, to get Rs 1.6 lakh as against Rs 17,100 paid by the insurer
LIC Jeevan Arogya: Life Insurance Corporation of India (LIC) was ordered by National Consumer Disputes Redressal Commission (NCDRC) to pay Rs 1.6 lakh to a policyholder of LIC Jeevan Arogya health insurance policy. The policyholder's father underwent an hernia surgery in Apollo Hospitals, Chennai and incurred more than Rs 2 lakh in 2016, however LIC paid the policyholder only Rs 17,100.
Health insurance rule change: Cashless treatment at any hospital from today; how to get it, charges
Till now, a health insurance policyholder can get cashless treatment only at network hospitals with whom the insurance company has tied up. If it is a non-network hospital, the policyholder has to pay the entire amount from his pocket and then go through the cumbersome claim reimbursement process. The General Insurance Council in consultation with general and health insurance companies has launched 'Cashless Everywhere' to extend the cashless treatment at all hospitals. What is the new rule? How to get cashless treatment at any hospital? Know here
How good is your health insurer? Latest incurred claim ratio of general, health insurance companies in India
If you are planning to buy a new insurance policy or port your existing health insurance policy to a new insurer, do remember to check the latest claim settlement ratio of all insurers before finalising one. Irdai has released the claims payment details of general and health insurance companies for the financial year 2022-23.
Not disclosing pre-existing health conditions main reason for claim rejection
Insurers frequently reject health insurance claims, with approximately 25% facing rejection due to the policyholder's non-disclosure of pre-existing conditions such as diabetes or hypertension during purchase. An additional 25% of rejections occur when policyholders are unaware of coverage terms and attempt to claim for outpatient department (OPD) or other treatments not covered by the policy.
Court orders Star Health Insurance to pay Rs 35,000 to customer for rejecting viral fever claim
The Ludhiana district consumer disputes redressal commission has ruled in favor of a customer whose son's hospitalization claim was rejected by an insurance company. The commission has directed Star Health and Allied Insurance Company Limited to pay Rs 10,000 to the customer and the approved claim amount of Rs 24,497 within 30 days.
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