Health insurance

Why are health insurance claims partially paid or rejected

Dealing with hospital bills is hard enough, and it seems all the more confusing when you have to do it despite having a health insurance policy. There are several grounds on which your complaint can lead you directly to a rejection or a partial settlement.

Given the increasing pace of medical inflation, especially post-pandemic, even a small portion of the bill can translate into a huge financial burden. To save yourself the distress, it’s essential to have a watertight approach to the factors that can impact your coverage and the steps you may need to take to make it foolproof.

For example, one of those lesser-known critical items added to hospital bills after the pandemic is consumable items. Consumables refer to single-use items, including PPE kits, syringes, and disinfection products, among others. Before the Covid-19 epidemic, these items represented only 5 to 7% of the medical bill. However, the pandemic has necessitated heavy use of these items which means they now account for 15-20% of the bill and not knowing this can cost you dearly when settling the claim.

Fortunately, there are now plans that adequately cover all of these costs and also offer smooth claims settlement. A claims settlement rate of at least 95-99% is of the utmost importance when choosing a policy. There are new products that have a better claims settlement rate and therefore better payouts. Here’s everything you need to know about them.

Opt for add-ons for more comprehensive coverage

The prolonged duration of the pandemic has triggered a surge in infection and hospitalization. From the recurring waves caused by new variants, it looks like we will also have to live with the virus for the foreseeable future. To get through these difficult times financially, you need solid coverage in your health insurance. Plus, with rising medical inflation, health insurance plans now come with riders that provide enhanced protection on top of your base plan. You can opt for these riders with your basic plan to enjoy its benefits.

For example, Bajaj’s Health Prime rider is a great addition to your policy. For a small additional premium, the policyholder benefits from numerous advantages to improve his coverage. Teleconsultations, which have become the new mode of care during the pandemic, are also covered by this endorsement. Apart from this, you can also get coverage for medical consultations which are not normally covered by any plan.

The endorsement also covers annual health checkups, thus also focusing on preventative health care. In addition, pathology and radiology costs are also covered by this guarantee. The rider can be opted for individual and family floating health insurance plans. One can even benefit from discounts on this endorsement if the family members are covered by an individual plan or if one has a multi-year policy and also on the online purchase of the policy.

Full coverage leads to better payouts

If you opt for comprehensive coverage – including a high face amount, endorsements and useful features – you won’t have to repent when the claim is settled. If your existing policy does not offer riders of your choice or as needed, you can always transfer your policy. It’s telling that opting for extended coverage results in 10-20% better payouts. If we talk about consumables, they definitely impact the claims settlement rate. Recent data trends suggest that policyholders opting for consumable riders fall under those with at least an 11% higher payout rate than those who do not.

Keeping in mind the new variants of Covid, these numbers could increase or stay that way for a long time. Thus, it becomes important to have maximum protection through your health insurance. For example, the Care Shield rider, which costs 5% of the basic plan premium, provides coverage against non-payable items and has no impact on NCB if the claim amount is within a certain limit. in accordance with the policy. So, it is definitely better to opt for such features and a solid long-term financial plan.

(By Amit Chhabra, Head of Health Insurance,