Reasons Why Health Insurance Claims are Denied!

Health insurance claim rejection can put you in a difficult situation. You buy health insurance to get financial protection in a health emergency. You may not afford the treatment without receiving compensation from your insurance company. So you must know the reasons why health insurance claims are denied.

Below are the causes of health insurance claim rejection:

Incorrect information

Providing wrong information gets health insurance claims rejected. Deceiving the insurance company is not beneficial. Upon discovering the truth, the company denies your claim and terminates your policy. 

The amount of insurance you get depends on your yearly income. Lying about your annual income may help you secure a higher sum for the time being. But you won’t realize it. You need to produce correct information about your age, habits, lifestyle, and annual income. 


“78% of American citizens worry about insurance fraud”


Preexisting illness

If you had an illness before purchasing health insurance, it does not get coverage. So, you may try to hide it from the insurance company. It will lead to health insurance claim rejection.

The purpose of buying insurance is to get protection against uncertain future events. It is beyond the scope of insurance to rectify the past damages. So, the claims made for preexisting illnesses do not receive compensation.

Policy lapse

A health insurance policy has a validity of one year. At the end of the year, it immediately needs renewal. Not renewing the insurance policy in time is also a reason for health insurance claim rejection.

You get no coverage if you fail to renew the policy in time and fall sick during that period.

Not notifying the insurer 

The failure to notify the insurer within 24 hours of an incident may render the claim useless. An insurance company may require you to inform it within 24 hours of an incident to make a valid claim. It becomes challenging if you meet a fatal accident.

Your loved ones can forget to file the claim. So, nominate someone who can do it on your behalf and take care of the paperwork. 

Faulty claim process

Filing a health insurance claim can be complicated. You need to fill out multiple forms and submit documents supporting your claim. Any mistake or omission can result in health insurance claim rejection.


Life Insurance Estimator



Spending beyond limit

Your health insurance policy only compensates you to a specified limit. When your expenditure exceeds that limit, the insurance company does not entertain them. You must know the sum insured to prevent any subsequent inconvenience.

Claim based on exclusions

You carefully need to read the terms and conditions of your health insurance policy. Not all health-related expenses get coverage. You may get injured while driving drunk or indulging in a dangerous hobby. Your policy terms may categorically state that such claims will get an outright rejection. 

These exclusions are different with different insurance companies.

Qualifying period

You get no coverage within the first 30 days of an insurance policy. If you fall ill during this period and file an insurance claim, it gets denied. This period is also known as the waiting period. 

Different companies can have different waiting periods in place.



What to do when health insurance claims are denied?

If your health insurance claim is denied, you have the right to appeal. You can file the appeal with your insurance company or an external reviewer. 

To successfully file an appeal, you need to know the appeal process of your insurance plan. Get all the information regarding this procedure through the insurance company’s website or customer service. Make sure that you file the appeal before the lapse of the deadline.

If the appeal process is underway, inform your doctor about it. Ask him not to send you the medical bill until your appeal gets decided. Also, ensure that a collection agency does not get access to your account.

How to avoid health insurance claim rejection?

The best way to avoid the rejection of an insurance claim is to be truthful and produce the correct information. Below are the tips that can save you the inconvenience of denial of a health insurance claim:

  • Provide accurate information when applying for health insurance.
  • Ensure that there is no mistake or omission in your application form.
  • Thoroughly understand the terms and conditions of your plan.
  • Collect information about the insurance provider to establish its credibility.

More blogs:

Share our Blog

Reasons Why Health Insurance Claims are Denied!

Follow us

Recent Posts