Let's talk about the elephant in the room
You buy health insurance thinking it'll protect you when things go wrong. Then the hospital bill arrives, you file a claim, and... rejected.
It happens more often than you'd think. And most of the time, it's preventable.
After helping families navigate the claims process for years, we've seen the same mistakes over and over. Here's what actually causes rejections, and how to make sure it doesn't happen to you.
1. You didn't tell them about that "small" health issue
Here's the thing: insurance companies don't like surprises.
When you applied for the policy, there was a section asking about your health history. Maybe you skipped mentioning your blood pressure medication. Or that thyroid condition you've been managing for years. It seemed minor, right?
Wrong.
This is called non-disclosure, and it's the number one reason claims get rejected. Insurance companies have access to medical databases. When you file a claim, they investigate. And if they find something you didn't mention? Claim denied.
What to do instead: Tell them everything. Yes, even the stuff you think doesn't matter. A slightly higher premium beats a rejected claim when you actually need it.
2. You didn't wait long enough
Most policies have waiting periods:
- 30 days for general illnesses
- 2-4 years for pre-existing conditions
- 2 years for specific surgeries
If you file a claim during these periods, it won't be covered. Simple as that.
What to do instead: Know your waiting periods before you need them. Read your policy document (yes, the boring one) or ask us to explain it.
3. The treatment isn't covered
This one stings because nobody tells you upfront.
Many policies exclude things like:
- Dental work (unless it's from an accident)
- Fertility treatments
- Cosmetic procedures
- Alternative medicine
What to do instead: Before any planned treatment, check if it's covered. Call your insurer or your advisor. A 5-minute call can save you lakhs.
4. You went to the wrong hospital
Went to a hospital that's not in your insurer's network? Cashless claims won't work. Reimbursement claims might only be partially paid.
What to do instead: Keep your network hospital list handy. In emergencies, any hospital is fine.but for planned procedures, always check first.
5. The paperwork was a mess
Missing a single document can delay or reject your entire claim:
- Original bills (not photocopies)
- Doctor's prescription
- Discharge summary
- Lab reports
What to do instead: Collect everything. Make copies. Keep it organized. Or better yet, let your advisor handle it.
The real solution?
Work with someone who actually knows what they're doing.
That's what we do at YASHURE. We don't just sell you a policy and disappear. We're there when you need to file a claim.helping with paperwork, following up with insurers, and making sure you get what you paid for.
Because insurance shouldn't feel like a gamble.