10 सबसे आम गलतियाँ जिनकी वजह से Reimbursement Health Insurance Claims रिजेक्ट हो जाते हैं।
1. Incomplete or Incorrect Documentation. – अधूरी या गलत डॉक्युमेंटेशन।
One of the most common reasons for rejection is missing or incorrect documents. Make sure you submit original bills, discharge summary, investigation reports, and prescriptions with other required documents – not photocopies.
2. Claim Submitted After Deadline. – Claim Submit मैं देरी करना।
Every insurance company has a time limit for reimbursement claim submission – usually between 7 to 30 days after discharge. Submitting late without a valid reason can lead to rejection.
3. Treatment Not Covered by Your Policy. – इलाज पॉलिसी में कवर नहीं है।
Procedures like cosmetic surgery, dental work, or outpatient treatments (OPD) are often excluded unless specifically covered. If the treatment you have taken is not covered under your health insurance policy. Always check your policy before making a claim.
4. Policy Not Active or Within Waiting Period. – पॉलिसी एक्टिव नहीं या वेटिंग पीरियड चल रहा है।
Your insurer will not approve the claims if it is made during the waiting period, or when the policy is lapsed. For example pre-existing conditions may have a 2- to 4-year waiting period.
5. Errors or Mismatch in Personal Details. – डॉक्युमेंट्स में नाम या जानकारी में गलती।
Spelling mistakes in your name, age, gender, or policy number across documents can lead to confusion and rejection. Double-check all forms and reports for consistency.
6. Treatment at a Blacklisted Hospital or Non-Recognized Hospital. – इलाज ऐसे अस्पताल में हुआ जो मान्यता प्राप्त नहीं है।
If the treatment was taken at a non-registered or blacklisted hospital, the insurer may reject the health claim outright.
7. No Doctor’s Prescription Before Hospitalization. – डॉक्टर की सिफारिश के बिना भर्ती।
For planned admissions, a doctor’s recommendation is often required. Admitting yourself without medical advice may be seen as unnecessary and unjustified hospitalisation. Health insurance claims can be denied by the insurer under these circumstances.
8. Claiming Non-Medical Expenses. – नॉन-मेडिकल खर्चों का क्लेम करना।
Items like gloves, masks, sanitizers, food, and administrative charges are not covered under most policies. Including them can reduce your approved claim amount or trigger a rejection.
9. Not Disclosing Multiple Policies. – एक से ज्यादा पॉलिसी होने पर सही जानकारी न देना।
If you have more than one health insurance policy and fail to inform insurers, your claim can be rejected. Always follow the proper process under the contribution clause.
10. Providing False Information or Fake Documents. फर्जी जानकारी या डॉक्युमेंट देना।
Any attempt to submit manipulated bills, false dates, or incorrect data will get your claim rejected. Misrepresentation of information or documents may also lead to even blacklisting.
Note:- Always keep a complete set of photocopies or digital scans of all claim-related documents before submission.
Having a backup helps in case documents are misplaced, lost in transit, or if the insurer requests additional copies during claim processing.
Note:- यदि आप इन 10 गलतियों से बचते हैं और स्वास्थ्य बीमा पॉलिसी की अन्य महत्वपूर्ण शर्तों व सावधानियों का पालन करते हैंए तो आपके क्लेम के स्वीकृत होने की संभावना काफी बढ़ जाती है
Conclusion.
Navigating a health insurance claim can feel overwhelming. Awareness of these common mistakes puts you in a much stronger position. A well-prepared and timely claim, supported by the right documents and an understanding of your policy, significantly increases your chances of approval.
Remember, health insurance is not just a safety net — it’s a system that requires clarity, accuracy, and trust. By avoiding these pitfalls, you protect not only your finances but also your peace of mind during a challenging time.
Remember, health insurance is not just a safety net — it’s a system that requires clarity, accuracy, and trust. By avoiding these pitfalls, you protect not only your finances but also your peace of mind during a challenging time.
Very goood
Very Nice.