Many companies provide health insurance in India. In these, coverage is available according to different plans. After having health insurance, you can avail cashless treatment facility in many hospitals. The hospital where the health insurance company has a tie up. Generally you get the facility of cashless treatment there.
But in those where it is not available, you do not get the facility of cashless. You can take reimbursement for this. Insurance Regulator and Development Authority of India (IRDAI) has released data regarding insurance in the year 2024. In which it is said that this year only 71% of health insurance claims have been settled. That means the remaining claims have been rejected.
Under what circumstances can health insurance companies reject the claim? Where does one go wrong in taking a health insurance claim and the reason why the claim gets rejected? Let us tell you about this.
Let us tell you that in cases of rejection of health insurance claim, there can be not one but many reasons. If the expenses exceed the limit mentioned in the health insurance policy, then the claim can be rejected.
If claim is sought for any disease which is not covered in the policy. Then the claim gets rejected or you have given any wrong information during the claim or you have tried to hide any disease or any information. Or you have tried to claim the claim by submitting fake documents. So even in such cases the claims may be rejected.
According to the data released by IRDAI, 3 crore claims were made in the year 2024. Out of which only 2 crore 70 lakh claims have been settled. The Ombudsman has also received more than 34 thousand complaints in this matter.
Published at : 30 Dec 2024 06:18 PM (IST)
