The company provided refused compensation and solution

Many cases of customers are denied health insurance compensation. Psychology of the majority will inhibit this and assume that insurance companies are trying to delay or “withdraw” their premiums. This article will help people take appropriate steps to receive compatible benefits and explain why you are denied coverage.

Step 1: Review the disclaimers of denial health insurance

Each insurance company will have its own exclusions in accordance with the views of each company. But in the future, there are common basic provisions. Here are those basic general exclusion terms. If you fall into any of the following categories, your health insurance claim process will be denied without any chance of successful appeal:

• Intentional actions of the insured or legal heirs.
• The insured who is at least 14 years old and seriously violates the law must have a criminal sentence and a traffic safety law violation.
• The consequences of drinking alcohol in excess of the prescribed concentration of 50 milligrams per 100 milliliters of blood or 0.25 milligrams per liter of breathing air. The insured is affected by other stimulants that are the direct cause of the accident.
• The insured violates laws, rules, regulations of local governments or social organizations.
• Medical treatment or over-the-counter medication and doctor’s instructions.
• Participate in aviation activities (except as a passenger), participate in military training drills, engage in combat of armed forces.
• War, civil war, strike, terrorism, violence, civilization, rebellion of civil activities or the actions of any leader of an organization to overthrow, threaten the government, control by violence.
• In addition, there are different exclusions for different insurance providers. You need to find out on the Insurance Rules for the exclusion clause on the website of your company participating in health insurance services. After you find yourself not in any exclusion point, skip to step 2.

Step 2: Check the wait for time to health insurance

If it is your first year in health insurance, there will be a waiting period applied. The waiting period is the period of time from the time the policy takes effect and the time you receive the insurance indemnity. In many cases, your illness is in the waiting period so it is not eligible for insurance compensation. Waiting time is basically regulated as follows:

Waiting time of health insurance

• 30 days in case of illness or disease (including the period of onset of illness until the end of treatment course / time of illness, not time of treatment).
• 1 year (365 days) for available and special diseases
• 635 days for maternity insurance.
  However, for each different insurance provider, there will be different waiting times. Therefore, do not apply the waiting time of another insurance company to the insurance provider you join. After you check and find yourself fully satisfied with all the conditions for waiting time. Move on to step 3.

Step 3: Contacting with your health insurance provider’s company or agent for advice.

You do not understand why you have met the exclusions and waiting period of the insurance policy and still denied the compensation. This is the time when you pay attention to the function of the insurance company. Contact your service provider to ask more questions about the issue.

Contact your health insurance provider
There will be 2 cases, but the probability of falling into the first case is the majority. First, you missed or didn’t really understand all the exclusions, so you missed the case, and you’re in it. Those with long knowledge and experience in the insurance industry will help you troubleshoot and answer questions. You understand the problem and the action ends here.

There will be very few cases where you still do not accept or the answer of the company staff is not satisfied with you. You still uphold your opinion. Consider going to step 4.

Step 4: Consult an expert of another insurance provider or bring a civil action

In case you do not trust the advice and explanation of the health insurance company you join, you can choose the form of reference. By asking experts or staff of other insurance providers for practical answers for yourself.

Or you may choose to file a civil action after you have shown yourself dissatisfied with the decision made by the health insurance company.

The above are 4 recommended steps when you are denied health insurance coverage. Hoping to bring you some help with your health insurance claims.

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PAA.VN is the agency that supports quick resolution of compensation by smaller scale, closely monitoring the problem and capturing the case of customers more clearly than the direct supply companies.