Why do health insurance claims get partly paid or rejected

Dealing with out-of-pocket hospital bills is hard enough, and it seems all the more confounding when you have to do it despite having a health insurance policy in place. There are several grounds on the basis of which your claim can lead you straight to rejection or partial settlement.

Given the ascending pace of medical inflation, especially after the pandemic, even a small portion of the bill can translate to a huge financial burden. To spare yourself the distress, it’s essential to have a watertight approach towards the factors that can impact your coverage and the steps you might have to take to foolproof it.

For instance, one such lesser-known critical element added to hospital bills after the pandemic is consumable items. Consumables refer to single-use items including PPE Kits, syringes, and sanitization products among many others. Before the Covid-19 outbreak, these items would make up only 5-7% of the medical bill. However, the pandemic necessitated an extensive usage of these items which means now these constitute a whopping 15-20% of the bill and not knowing about it can cost you dearly at the time of claim settlement.

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

Opt for add-ons for more holistic coverage

The elongated span of the pandemic has triggered a spur of infection and hospitalisation. Going by the recurring waves caused by new variants, it seems like we’ll have to live with the virus in the near future too. To sail through these difficult times financially, one needs a robust coverage in their health insurance. Also, considering the rising medical inflation, health insurance plans now come with riders that provide enhanced protection over and above your base plan. You can opt for these riders along with your base plan to avail of its benefit.

For instance, Bajaj’s Health Prime rider is a great add-on to your policy. For a small additional premium, the policyholder gets many benefits to enhance their coverage. Teleconsultations, that have become the new way of healthcare during the pandemic, are also covered under this rider. Apart from this, you can also get coverage for doctor consultations that are not covered normally under any plan.

The rider also covers annual health check-ups thereby focusing on preventive healthcare as well. Additionally, pathology and radiology expenses are also covered under this benefit. The rider can be opted for in both individual and family floater health insurance plans. One can even avail of discounts on this rider if the family members are covered under individual plan or if one has a multi-year policy and also on the online purchase of the policy.

Comprehensive coverage leads to better payouts

If you opt for comprehensive coverage – including high sum assured, useful riders and features – you won’t have to repent at the time of claim settlement. In case your existing policy doesn’t offer riders of your choice or as per your needs, you can always port your policy. It is indicative that opting for extensive coverage leads to 10-20% better payouts. If we talk about consumables, they definitely impact the claim settlement ratio. The recent data trends suggest that policyholders who opt for consumables riders fall under the ambit of those who have at least 11% better payout ratio than those who don’t.

Keeping the new Covid variants in mind, these numbers could go up or stay this way for a long time. Thus, it becomes important to have maximum protection through your health insurance. For instance, Care Shield rider, which costs 5% of the base plan premium, provides coverage against non-payable items and has no impact on NCB if the claim amount is within a certain limit as per the policy. So, it’s certainly better to opt for such features and a sound financial plan in the long-run.