Health insurance hone ke baad bhi jab claim reject ho jata hai, to patient aur family dono ke liye yeh bahut frustrating hota hai. Aksar rejection ka reason policy ki kami nahi, balki process ki galti hoti hai. Is article me hum claim rejection ke sabse common reasons aur unke practical solutions samjhenge—taaki aapka claim safe rahe.
Claim Rejection Kyun Hota Hai?
Insurance ek legal contract hota hai. Agar policy terms follow na ho, to insurer claim deny kar sakta hai. Achhi baat yeh hai ki zyadatar rejections avoidable hote hain.
Top 10 Claim Rejection Reasons
Waiting Period Complete Nahi Hua
Pre-existing diseases ke liye 2–4 saal ka waiting period hota hai.
Fix: Policy buy karte waqt waiting period check karein aur time complete hone ke baad hi claim karein.
Medical History Non-Disclosure
Policy lete waqt purani bimaari chhupana sabse bada risk hai.
Fix: Proposal form me saari medical details honestly disclose karein.
Non-Covered Treatment
Har policy me kuch treatments exclude hote hain.
Fix: Hospital admission se pehle policy exclusions list check karein.
Late Intimation to Insurer
Emergency ke baad insurer ko time par inform na karna.
Fix: Admission ke 24–48 ghante ke andar insurer/TPA ko inform karein.
Room Rent Limit Violation
Higher room lene par proportionate deduction ya rejection ho sakta hai.
Fix: No-room-rent-limit policy choose karein ya allowed room hi select karein.
Incomplete Documents
Missing bills, reports, ya discharge summary.
Fix: Ek checklist bana kar saare documents submit karein.
OPD / Daycare Confusion
OPD expenses aksar covered nahi hote.
Fix: Daycare procedures list policy me verify karein.
Policy Lapse
Premium late payment se policy inactive ho jati hai.
Fix: Auto-debit enable karein aur due dates track karein.
Cosmetic / Elective Procedures
Medical necessity ke bina ki gayi surgery.
Fix: Doctor ka medical justification ensure karein.
Fraudulent or Inflated Bills
Fake ya overcharged bills serious issue hote hain.
Fix: Reputed hospital choose karein aur bill items verify karein.
Claim Rejection Se Bachne Ke Best Practices
Policy document achhe se padhein
Health card hamesha saath rakhein
Network hospitals prefer karein
Doctor ke advice ke bina extra services na lein
Har bill aur report safe rakhein
Claim Reject Ho Jaye To Kya Karein?
- Written rejection reason maangein
- Supporting documents ke saath re-appeal karein
- Insurer grievance cell me complaint file karein
- IRDAI grievance portal par escalate karein
Zyadatar genuine cases yahin resolve ho jate hain.
Real-Life Scenario
- Claim amount: ₹3,20,000
- Rejected amount: ₹70,000
- Reason: Room rent limit breach
Policy samajhne se yeh loss avoid ho sakta tha.
Final Thoughts
Health insurance claim rejection ka matlab yeh nahi ki policy bekaar hai. Aksar thodi si awareness aur planning se claim 100% smooth ho sakta hai.
Sahi knowledge aapko financial loss se bachati hai aur emergency ke time confidence deti hai.