Reasons Why Your Cashless Health Claims Can Get Denied

Cashless health Insurance claims are a convenient way to handle medical expenses without the hassle of upfront payments. However, there are several reasons why your cashless claim might be denied, regardless of your insurance provider. In this blog, we'll discuss the common reasons for claim denial with Bajaj General Insurance Company’s cashless health insurance policy and its claim procedures.

Understanding Bajaj General Insurance Limited Cashless Health Claim Policy

Bajaj General offers a comprehensive cashless health insurance policy to provide financial security during medical emergencies. With a network of over 18,400 hospitals across India, the policy ensures hassle-free access to quality healthcare without the burden of upfront payments. The cashless feature lets the insurance company directly settle medical bills with network hospitals, alleviating the financial strain on policyholders. Key benefits include coverage for pre-hospitalisation expenses for up to 60 days and post-hospitalisation expenses for up to 90 days, in-patient costs, ambulance services, daycare treatments, and routine medical check-ups. The cashless health insurance policy boasts an impressive claim settlement ratio of 98%, reflecting its reliability and efficiency in processing claims. Additionally, Bajaj General has an in-house health administration team dedicated to handling claims, ensuring a smoother and faster settlement process.

8 Reasons why your Bajaj General Cashless Health Claims Can be Rejected

Cashless health insurance is a convenient way to handle medical expenses without the hassle of upfront payments. However, there are several reasons why your cashless health claim might be denied. Understanding these reasons can help avoid common pitfalls and ensure a smoother claims process.

1. Treatment at a Non-Network Hospital

Cashless claims are typically only valid at hospitals within your insurer's network. If you choose a hospital outside this network, you may need to pay upfront and then seek reimbursement. Bajaj General has a vast network of over 18,400 hospitals in India, so finding a network provider is usually straightforward.

2. Lack of Pre-Authorisation

It is crucial to get pre-authorisation from the insurance company for planned treatments. Pre-authorisation is when the insurance provider approves the therapy and the associated costs before it begins. Please obtain this approval to avoid claim denial. This step is often bypassed in emergencies, but it's still essential to inform the insurer as soon as possible.

3. Policy Exclusions

Every health insurance policy, including those from Bajaj General, has exclusions. These are specific conditions or treatments not covered. Common exclusions might include cosmetic procedures, certain alternative therapies, or pre-existing conditions within a specified waiting period. Carefully review your policy to understand what's covered and what's not.

4. Incomplete or Incorrect Documentation

Accurate and complete documentation is essential for a successful claim. This typically includes a cashless claim form, original hospital bills, discharge summary, medical reports, and doctor's consultation letters. With Bajaj General, you can initiate the claim process online or offline, and they provide detailed guidelines on the required documentation.

5. Discrepancies in Information

Discrepancies in the information provided can also be reasons for health insurance claim rejection. This includes differences in the details given at the time of buying the policy and those provided at the time of making a claim. Ensure that all information regarding the patient's medical history, treatment, and personal details are accurate and consistent.

6. Delay in Informing the Insurer

Timely notification of your insurer is vital, especially in emergency situations. Bajaj General generally allows a specific timeframe (check your policy) after hospitalisation to inform them. Delays can complicate the claims process and may lead to denial

7. Claim Amount Exceeds Sum Insured

If the cost of your treatment surpasses your policy's sum insured, you'll be responsible for the remaining amount. Choose a policy with a sufficient sum insured to cover potential medical expenses adequately.

8. Non-Disclosure of Pre-Existing Conditions

Non-disclosure or incorrect disclosure of pre-existing conditions when purchasing the policy can lead to claim denial. Insurers must fully disclose your health status to determine policy terms and coverage. Hiding or falsifying information can be one of the reasons for health insurance claim rejection.

Wrapping Up

While cashless health insurance claims can provide substantial financial relief during medical emergencies, it is crucial to be aware of the common pitfalls that can lead to claim denials. Bajaj General's cashless health insurance policy offers extensive coverage and a high claim settlement ratio, making it a reliable choice for policyholders. However, understanding the reasons for potential claim rejections is essential. By being proactive and careful about these aspects, you can ensure a smoother and more successful claims process, thereby maximising the benefits of your cashless health insurance policy. Always read your policy documents carefully, maintain accurate records, and communicate promptly with your insurer to avoid any unexpected claim denials.

*Standard T&C Apply Claims are subject to terms and conditions set forth under the health insurance policy. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale. *The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.