Health Insurance Claim Reject Kyun Hota Hai? Top 10 Reasons Aur Unko Kaise Avoid Kare

Health Insurance Claim Reject Kyun Hota Hai? Top 10 Reasons Aur Unko Kaise Avoid Kare

Bhai, health insurance ka sabse bada tension kya hota है? Policy lena mushkil nahi hota, par claim reject ho jaye to insaan ka dil toot jata है. Kai log sochte हैं ki premium time par bhara, policy li – ab claim to pakka milega. Lekin asli duniya me aisa hota nahi है.

Health Insurance Claim Reject Kyun Hota Hai?

Aaj main tumhe ekदम human-style, easy language me bata raha hoon ki health insurance claim reject actually kyun hota है, companies kya check karti हैं, aur tum kaise apna claim 100% safe rakh sakte हो.

Bhai sach me, agar tum ye 10 mistakes avoid कर लोगे to claim reject hone ke chances almost 90% kam ho jayenge.

1) Wrong or Incomplete Documents

Ye India me claim reject hone ka सबसे बड़ा कारण है. Hospital documents, bills, reports, doctor notes – agar inme se koi missing ho ya match na kare, insurer seedha rejection de deta है.

Kaise Avoid Kare:

• Admission slip, discharge summary, final bill properly check karo.
• Doctor ki handwriting unclear ho to typed statement lo.
• Hospital se sab receipts item-wise lo.

2) Waiting Period Complete Nahi Hua

Bhai insurance me हर cheez turant cover nahi milती. Pre-existing diseases ka waiting period 1–4 saal hota है. Specific surgeries ka 1–2 saal. Is period ke andar claim file kiya to reject hona guaranteed hai.

Kaise Avoid Kare: Policy kharidne se pehle waiting period clearly samjho. Details ke liye yeh guide padh sakte ho: Complete Health Insurance Guide

3) Wrong Information at Policy Purchase

Kai log sochte हैं ki BP, diabetes ya purani illness chhupa denge to premium kam aayega. Bhai, insurer sab verify karta है. Agar unhe pata chala ki information galat thi – claim 100% reject.

Kaise Avoid Kare: Honest medical details do. Kuch bhi mat chhupao.

4) Non-Network Hospital Me Treatment

Cashless claim tabhi milega jab hospital insurer ke network me ho. Agar nahi hoga to ya to reimbursement milega, ya kabhi-kabhi reject bhi ho sakta है.

Kaise Avoid Kare: Treatment se pehle hospital list check karo. Bike insurance me bhi rule same है — dekh lo yeh guide: Bike Insurance Renewal Guide

5) Treatment Policy Coverage Me Nahi Hota

Har policy sab kuch cover nahi karti. Cosmetic surgery, dental, infertility treatment, weight-loss surgery — ye sab mostly excluded होते हैं.

Kaise Avoid Kare: Exclusions list jarur padh lo.

Health Insurance Claim Reject Kyun Hota Hai? Top 10 Reasons Aur Unko Kaise Avoid Kare

6) Claim Amount Excessive or Fraud Suspicion

Agar hospital ka bill unusually high ho, unnecessary tests likhe ho, ya mismatch ho – insurer doubt karti है. Suspicious lagte hi rejection aa jata है.

Kaise Avoid Kare: Only required tests karaye. Har bill ka breakup lo.

7) Policy Lapse Ho Gayi Ho

Bhai simple logic hai — expired policy = no claim. Agar premium due date pass ho gayi aur grace period bhi chala gaya to claim reject.

Kaise Avoid Kare: Renewal reminder set karo. Car insurance me bhi same rule लागू होता है — Car Insurance Claim Process

8) Hospital Admission Not Justified

Insurer check karta है ki kya illness ke liye hospital admit hona medically necessary tha. Agar nahi – to rejection possible.

Kaise Avoid Kare: Doctor ka proper written admission advice rakho.

9) Policy Sub-Limits Cross Karna

Kai policies me room rent limit, ICU charges limit, doctor fee limit hoti है. Agar tum allowed limit se zyada services loge to insurer us amount ko deny kar dega.

Kaise Avoid Kare: Always choose “No Room Rent Limit” policy.

10) Claim Late File Karna

Emergency me 24 hours ke andar aur planned surgery me 48–72 hours pehle claim intimation dena hota है. Late file kiya — rejection ka risk high.

Kaise Avoid Kare: Hospital se admit hote hi insurer ko notify kar do.

Final Conclusion

Health insurance claim reject hona zyada tar cases me avoidable hota है. Bhai agar tum documents sahi rakho, exclusions samjho, waiting period ka dhyan rakho aur honest information do — to claim approve hona almost guaranteed hota है.

2025 me insurers fast settlement de rahe hain — bas policy rules ko thoda seriously follow karna hota है.