Why was my claim denied although I paid full premium?
Insurance providers process many claims every year for a variety of different reasons. While some programs, such as INF Health Plans, pay ALL eligible claims, other insurance plans may deny your claim. This will definitely leave a bad taste in your mouth, and cause some resentfulness. After all, you paid the full premium but when it came time to use the insurance, your claim was denied. In many cases, claims can be denied for a few of these general reasons:
1) Your policy does not cover what you thought it did
Most insurance policies come with a large list of exclusions. The exception to this list would be the INF Plans- particularly the INF Premier & INF Elite Network Plan- which cover all pre-existing conditions. Other insurance plans lack adequate coverage and may not pay claims. This is why some plans will offer $1,000,000 + of insurance coverage for only $100. The reason is because these insurance plans never pay claims because they do not cover medical expenses when you need it.
3) Your plan was purchased after an incident occured
Many times, people will think they need insurance once it is too late. Often, people will purchase insurance after they or their family member has gotten sick in order to get coverage. This creates a "moral hazard", that is, only people who need insurance will take it. The insurance company will reject claims from people who are already sick.
2) Your claim is excluded by the plan
Some insurance plans typically only cover the "sudden reoccurrence" of a pre-existing condition. Although there are a few plans which full cover pre-existing conditions (such as INF Premier & INF Elite Network), most exclude any sickness which can be attributed to a pre-existing condition. In that sense, these plans become quite useless because at an old age most any doctors visit can be attributed to a pre-existing condition.
4) Your claim was not submitted properly
Sometimes claims are denied for either 1) being submitted too late, or 2) paperwork was not submitted properly. We suggest before you purchase any insurance policy to find out what the claims procedure will be and to submit a claim as soon as you use the insurance to ensure the insurance company has a record of your medical services rendered and reimburse you in a timely manner.