Why Health Insurance Claims Get Denied: Kotak General Insurance Unveils the Top 5 Reasons

Business Wire India

Kotak General Insurance, a leading contributor of insurance solutions in India aims to educate policyholders about the common reasons why health insurance claims may get denied. Kotak General Insurance believes that understanding these reasons can help individuals to decide and maximise the benefits of their health insurance coverage with a commitment to transparency and customer satisfaction.
 
Unveiling the top 5 reasons behind health insurance claims getting denied

Below are some of the primary reasons behind health insurance claims getting denied:
 

1. Non-disclosure of pre-existing conditions
   The non-disclosure of pre-existing conditions is one of the primary reasons for claim denials. It is essential to provide accurate and complete information about any pre-existing medical conditions while applying for health insurance. As Kotak General Insurance rely on this information to assess the risk and determine the appropriate coverage, failure to do so can result in claim denials. Policyholders should always disclose their pre-existing conditions truthfully during the application process to avoid claim denials.
    
2. Waiting periods and exclusions
   Waiting periods are certain durations during which certain treatments or conditions are not covered. Health insurance policies often come with waiting periods and exclusions. On the other hand, exclusions are specific medical treatments or conditions that are not covered under the policy. Policyholders need to be aware of these waiting periods and exclusions to avoid claim denials.
    
3. Inadequate documentation
   Policyholders must provide all the necessary documents, such as medical reports, bills, prescriptions and discharge summaries while filing a claim, as per the policy requirements. Insufficient or incorrect documentation is one of the common reasons for claim denials. Failure to submit the required documentation may lead to claim denials.
    
4. Policy lapses and non-payment of premiums
   It is important for policyholders to pay their premiums on time and keep their policies active. A lapsed policy or non-payment of premiums can result in claim denials. Failure to pay premiums within the specified time can lead to the policy lapsing, where coverage becomes invalid.
    
5. Claims for non-covered treatments or services
   If a policyholder files a claim for a medical treatment that is not covered under their policy, it is likely to be denied/rejected. Health insurance policies have specific coverage limits and exclusions. It is necessary to understand the coverage details and limitations of the policy to ensure that claims are filed for eligible medical treatments and services.

For more information on Kotak General Insurance's health insurance portfolio and coverage options, please visit Kotak Health Insurance.
About Kotak General Insurance

At Kotak General Insurance, we believe in being a partner in our customer's journeys, ensuring that they have the right coverage for their unique needs. We are committed to delivering innovative solutions that protect what matters most to them. Kotak General Insurance has streamlined its commitment to customer-oriented.

Kotak General Insurance was established to service the growing non-life insurance segment in India. The company aims to cater to a wide range of customer segments & geographies offering an array of non-life insurance products like Motor, Health, Home etc. As a practice, the company seeks to provide a differentiated value proposition through customised products and services leveraging state-of-the-art technology and digital infrastructure.