Advertorial Why might your health insurance claim be denied?

[ASEAN NOW Sales]

 

When you buy health insurance, the hope is that you never actually need to make a claim.

 

Having health insurance brings some peace of mind, leaving you safe in the knowledge that you are protected should you have an accident or become ill. 

 

But every once in a while a high profile case may hit the news about an expat in Thailand who has huge medical bills after their claim was denied.

 

This understandably leaves people with concerns about how much they can actually rely on their health insurance policy during those times when they need it the most.

 

As long as you fully understand the details of your policy and how it works for you, there is no reason why you should worry about the unexpected when trying to make a claim with your insurer.

 

Below are some of the reasons why your claim could be denied.

 

1. Your claim is related to a pre-existing condition

 

A pre-existing condition is a term that can cause confusion when it comes to health insurance. Simply put, “pre-existing condition” is a medical condition that you were already suffering from when you applied for your health insurance policy or that you have received treatment for in the past. 

 

Some health insurance policies will not offer coverage for pre-existing conditions, but there are other specialized plans that will offer coverage under certain circumstances.

 

If you are in need of this type of coverage, it is best to discuss what is available from your insurance provider. Don’t leave anything to chance to take an unnecessary risk. 

 

Your health insurance policy will only support you if you choose the plan that most suits your specific needs.

2. Because information was missing from your application

 

If you have a pre-existing condition and neglected to tell your insurer about it. Even if you consider your condition to be minor or unrelated to your claim, a lack of disclosure could mean that your claim is invalidated.

 

Therefore, it is absolutely essential that you be honest, accurate and thorough when providing information on your health insurance application. 

 

If you are unsure, ask your doctor for a copy of your medical records.

 

3. Your medical status changed

 

When you apply for health insurance, your application is based on the status of your health as described in your application.

 

Should there be any change in your health you are obligated to inform your insurer.

 

If you fail to do so, your claim could be rejected on the basis that your application was not accurate.

 

What people do not realize is that a minor change could result in a major issue.

 

For example, it could be something as simple as your doctor changing from one brand of prescription medicine to another. Alternatively, it could be that the dosage of your medication was changed, as your condition improves, however, this can still impact your insurance policy.

 

The bottom line is, always share new information with your insurer to make sure you have all bases covered.

 

4. You tried to claim for something not covered under your policy

 

There is no standard set coverage with regards to health insurance and every policy is different. That is why it is so important to do your research and speak to your health insurance provider so you understand exactly what is and is not covered in your policy.

 

Your policy will have a list of exclusions - things that are not covered.

 

For example, your policy may not cover you for injuries resulting from extreme sports or riding a motorcycle. Are you covered for dental work or treatment for a mental health condition?

 

Therefore, read the fine print.

 

For more information on health insurance, including a choice of coverage up to 30M baht and premiums starting from just 882 baht/month* contact Aetna now