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You Can Expect To Be Denied If You Try Availing Any Of These Four Types of Claims!

Your health insurance policy may feel like a set of codes you need to crack, and deciphering it can be a difficult task to take on. There are complex conditions and terminology to wade through, and you have to be incredibly careful when going through clauses as they are finicky things. While there has been an increase in the general population’s understanding of policy documents related to healthcare — particularly regarding pre-existing conditions and sub-limits — there is still a lot of information that is relevant and important that needs to be understood.

When you submit a claim, and you face a denial from your health insurance provider, it can come as a shock – literally and financially. Reduced payouts are faced with the same situation. Here we detail some things that are not covered by policies, and so, you can expect no coverage when you submit claims for the following instances.

Advanced/New Treatments or Procedures

Technology is such that each and every day, there is something new entering the medical industry, and health care is taking on a different shape as we speak. Insurance companies, on the other hand, do not keep up the pace, and so, there is a lot that they do not cover yet. Experimental or unproven treatments are not covered by your insurance which means if a treatment procedure is not based on established medical practice, you will face a denial of your claim. Robot-assisted surgery, cyberknife procedures, and stem cell therapies are increasing in popularity but are not covered by insurance. Of course, you can still opt for these treatments out of your own pocket, if you so wish.

Resident Doctor’s Fees

There are some cases where the hospital happens to segregate the room rent and the resident doctor’s charges in the bill. If this happens to be the case, you can expect that your insurance provider will not foot the bill for those charges. This is because, technically speaking, the resident doctor’s fees are actually supposed to form part of the room rent costs. Of course, as an individual, you have no control over the manner in which the hospital conducts its bills and charges, but what you can do to avoid footing any fraction of your bill from your wallet is to select a hospital from your insurer’s network that will not result in this type of charge. Therefore, if you happen to have an emergency or accident, you know which hospital to go to for peace of mind and a happy wallet.

Illnesses Resulting From Substance or Alcohol Abuse

In the event that you suffer from a critical disease that has been medically discovered to have been caused by excessive smoking, drinking, or abuse of other substances, the expenses that arise from your treatment may not be covered by your insurance. This is a grey area, though, and it is not uncommon for people to dispute the denial of their claim. Of course, nobody wants to go through such tug of wars, but when you are facing a several-digit bill for maintaining your life, things get a little tricky!

Domiciliary Hospitalization

If, for whatever reason, you cannot be treated in a hospital and instead have to be treated at home for an ailment or injury or whatever the case, some insurers will not cover the cost of treatment or perhaps will only cover up to 10% of the cost involved in your recovery. For some diseases, there is no amount payable even if the patient is allowed to be treated at home — like in the case of bronchitis or asthma. Inspect your policy wording carefully to establish whether your insurer covers domiciliary hospitalization entirely under certain conditions, at a fraction, or perhaps not at all.

There are still more loopholes in your health insurance that you will find through careful reading that you are not covered for, and it is important to bear in mind that the wording of everything in your policy document is very specific. If you need clarification on anything, it is best to contact the insurer and preferably save a record of the call. Nobody wants to find out they aren’t covered for a procedure after it has already been done – especially if there are alternatives that your insurance actually does cover. Better safe than sorry!

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