5 Reasons Why Your Health Insurance Claim May Get Delayed

With the recent ongoing pandemic issue having health insurance to cover medical needs for you and your loved ones is essential. No matter if you are planning to buy the best health insurance or have one already, it is important to remember some basic points that can help in a successful claim settlement.


At the time of hospitalization, your efforts should be to take of your loved ones but not worry about financial help. Whether you have a family health insurance plan or an individual health insurance plan, a minimum expectation would be a hassle-free claim settlement. Most times the health insurance claim gets cleared if all goes well, but rarely there can be some cases that get rejected or delayed. Let’s try to explore some possible reasons that can delay the health insurance claim process.

Late Submission of Claim Filing

One of the main reasons for the delay or rejection of the claim of health insurance can be not submitting your claim request on time. Guidelines and deadlines for claim form submission would be mentioned in the policy document. The deadline for claim application can vary from company to company.

Most people ignore reading the policy document properly which can lead to mistakes later at the time of the claim process. Hence you must apply the claim request within the stipulated time for quick and successful claim settlement. In case you forgot to submit it on time or got delayed for some reason then you can expect a delay in the process.     


Not Having the Insurance Papers

Your health insurance document is basic proof that you have the coverage from the insurer and have a certain amount of cover. You must preserve that safely and handy at the time of hospitalization. Saving a soft copy backup of the health insurance papers that can be accessed anytime is a good idea. If the health insurance papers are not readily available at the time of claim application and if you find them later then there will be a significant delay in the claim process too.


Not Following Pre-authorization Process

Pre-authorization is the declaration done by your insurer if you are going to have a planned hospitalization for pre-planned treatment. To get the cashless treatment you must inform your insurer about your planned hospitalization in advance at least before 48 hours. For most of the insurance companies, the pre-authorization process flow is generally as mentioned below.

  •  Get the pre-authorization form from the insurer or TPA desk at the hospital
  • Fill the form with accurate details such as patient details and insurance details
  • The treating doctor may need to fill in the details about the medical procedures conducted to treat the insured person
  • This form is then sent to the billing desk in the hospital for the estimation of the treatment cost and other costs that may be incurred in the treatment
  •  The pre-authorization form is then shared with the insurance company along with required documents   
  •  The final step is the insurance the company verifies the submitted pre-authorization form and attached documents and sanctions the claim
  • Any delay at any of these steps or errors can lead to a delay in the claim process. That is why you need to make sure there are no manual errors that are under your control at least.


Delay in Communication between the Hospital and the Insurance Company

Any delay in communication between the hospital and the insurance provider can lead to a delay in the claim settlement process. The hospital has to send your discharge summary report and all billing details. Claim settlement can delay if there is a delay in receiving the final document from the hospital. 


Mistakes in supportive information provided by the insured

Another issue behind the delay in the claim settlement process may be due to errors from the customer end. Errors in filling form such as entering the patient details or policy details wrongly can be one reason, in which the insurance company would ask for the correction. Another the reason may be the wrong entry of discharge date and time, not notifying the TPA to prepare the necessary documents and share the same with the insurer, not able to provide the required supporting document on time.


Conclusion

Most of the time the reason for the delay in the claim may due to errors in filling claim form. Such manual errors can be avoided if the insured person is aware of the policy wordings. Another type of error can be communication delays or errors in entering the billing details or wrong entry of treatment details. The insured person should take care to minimize the possible errors by spending time to understand the policy wordings, terms, and conditions. Once you know the in and out of your policy there is less chance of errors from your end.  

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