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Top 5 reasons , why claim are rejected in health insurance in India ?

Health insurance claim rejections in India can occur due to various reasons, but here are the top five common ones:

  1. Incorrect Information: Providing inaccurate or incomplete information during the application process can lead to claim rejection. This includes errors in personal details, medical history, or policy information. Ask you agent clearly about best practices of this step.
  2. Non-disclosure of Pre-existing Conditions: Failure to disclose pre-existing medical conditions at the time of policy purchase can result in claim rejection. Insurance companies may investigate claims thoroughly to ensure all relevant information was provided. Always declare your medical history.
  3. Policy Limitations and Exclusions: Many health insurance policies have limitations and exclusions regarding coverage for specific treatments, procedures, or medical conditions. Claims for treatments not covered under the policy may be rejected.
  4. Waiting Period: Some policies have waiting periods for certain treatments or conditions. If a claim is made within the waiting period, it may be rejected. Waiting periods typically apply to pre-existing conditions or specific treatments.
  5. Procedural Errors: Errors or omissions in claim documentation, such as missing invoices, medical reports, or other required paperwork, can lead to claim rejection. It’s important to ensure all necessary documents are provided accurately and completely when filing a claim.

It’s crucial for policyholders to thoroughly understand their insurance coverage, including any limitations, exclusions, waiting periods, and documentation requirements, to minimize the risk of claim rejection.

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