Health Insurance Claim: Having a health insurance card often gives peace of mind. Many policyholders believe that once a health insurance policy is purchased, whenever they need treatment, the hospital bill will be paid automatically through the cashless facility. But it also needs to be kept in mind that approval does not always come automatically. Many factors determine whether a claim will be easily approved or will face hurdles.

But sometimes the situation can be very different from this. Every year, many policyholders face situations where their cashless claim gets rejected, partially approved or even rejected during hospitalization. In many cases, the policy is active and the premium has been paid on time. Yet, patients and their families suddenly find themselves scrambling to find money at a time when their entire focus should be on treatment and recovery. The reason for this is quite clear that merely having an active health insurance policy does not guarantee the success of a cashless claim.

Train News: Couple’s train got late, now Railways paid a fine of Rs 69000, you also know your rights

Why can there be problems in cashless claim?

The most interesting thing is that cashless health insurance is meant to make hospitalization operations better and less financially stressful, but there are certain situations where the operations do not go as expected.

According to Siddharth Singhal, Head, Health Insurance Business, Policybazaar.com, ‘Cashless health insurance aims to make hospitalization smarter and less financially stressful, but there are certain situations where even when the policy is active, cashless claims may get delayed, partially approved or rejected. In most cases, this decision is based on the policy terms and documentation requirements rather than the policy itself’. Also said that one of the main reasons for claim related problems is the stay restrictions.

The cost of every treatment is not covered by insurance.

According to the information received, many consumers assume that having health insurance will automatically cover every hospital expense. But it is not necessary.

Electricity Scheme: Electricity connection for ₹5! 83 thousand people benefited in MP, apply online like this

According to Singhal, ‘In some cases, the treatment or procedure may be outside the scope of insurance. Every policy has certain conditions and complaints. Some procedures, treatments or medical expenses are not covered under the policy. That’s why experts advise policyholders to read the policy wordings carefully instead of just focusing on the sum assured and premium.