As the saying goes: "Prevention is better than cure". Likewise for our
insurance. It is better to avoid rejection of insurance claims than to be
bothered later.
There are various reasons that can cause an insurance company to reject our
claim. One of these things can happen because we do medical treatment at the
non-partner hospital of the insurance concerned. It could also be because we
ignore the exception conditions that have been written in the guidebook.
Whether we realize it or not, there are still many of us who often ignore
the small guidebook of insurance policies. In fact, it is the manual that
describes our rights and obligations as policyholders. It is not impossible,
due to our negligence and negligence, can make insurance claims rejected.
Therefore, it is important for us to know the reasons why an insurance claim
can be rejected. That way, we can take preventative steps to prevent this
from happening.
4 Reasons for Rejected Insurance Claims
For more details, please see 4 reasons why insurance claims can be rejected.
1. The Risks Are Not Covered By Insurance
Each insurance product has different benefits, and all of them are listed in
the insurance policy.
Let's say there is health insurance that has only inpatient and outpatient
coverage benefits, and there are those that have both benefits.
It is very important to understand what the benefits are, as well as the
types of risks that are borne by our insurance.
2. Does not comply with the requirements of the policy
Please note, every insurance plan has conditions for the disease covered.
Well, it could be, there are some diseases that are not covered by health
insurance or critical illnesses that make insurance claims rejected.
There is also a provision for a waiting period or waiting period on a health
insurance policy. If the policyholder makes an insurance claim before
reaching the waiting period, the insurance claim will be rejected.
Likewise, critical illness insurance for diseases such as stroke generally
stipulates a waiting period and also a survival period. Survival period is
the period when the Insured survives from being sentenced to a critical
illness until he dies, which usually ranges from 7 days, 14 days, or 30 days
specifically for health insurance or group life insurance.
If the Insured submits an Insurance claim for less than the survival period,
the claim will automatically be rejected.
3. The data received by the insurance company does not match
It is very likely that the health data of the customer concerned in the
Request for Life Insurance or Request for Health Insurance, is incorrect.
Let's just say, someone has a history of serious illness in a certain period
of time or has had surgery. But when filling out the request letter, he was
not honest.
Indeed, the contents of the Request for Life Insurance and Request for
Health Insurance will greatly affect the value of the premium to be paid.
Dishonesty in filling out the form can actually cause the insurance claim to
be rejected.
4. Exceeding the Deadline
In a health insurance policy, we are required to apply for reimbursement
within a certain period of time in accordance with the policy provisions. If
you don't submit within the specified time, your insurance claim can be
rejected.
It is also important to understand the flow of the insurance claim
submission process. In Manulife Indonesia, for example, submitting an
insurance claim only goes through 2 easy procedures.
First, fill in the claim form and prepare the required documents.
Second, use the MiEClaim service to file your claim. The claim process
through MiEClaim is easy, because customers just need to upload a soft copy
of the form and scanned documents. Complete information about MiEClaim can
be read here.
As a final note, keep all medical care documents, including pre- and
post-hospitalization costs, hospitalization medical records, diagnostic
tests, discharge letters, and more. Documents can be very important if the
insurance company needs them at any time for clarification purposes.
Based on the four reasons above, we must have a good understanding of health
insurance policies, ideally from the time of applying for the policy at the
beginning. So, when submitting a claim, rejection will not occur.
