Once insurance refuses to pay compensation, it is easy for people to think that insurance is deceptive, but in fact, every refusal is not without reason.
Not long ago, Zhongan Insurance announced? Some of the six reasons for refusing to pay for medical insurance are incredible.
Let's take a look at the reasons why you may not guess.
1. Reasons for refusing compensation Top 1: Not covered. In fact, I didn't expect this reason to rank first. This also fully shows that most people buy insurance in a hurry when they don't understand the protection at all, and they don't find anything wrong until they settle their claims.
I remember last year, another user asked me if I could use annuity insurance to reimburse medical expenses …
Each kind of insurance has its own coverage. What is the main guarantee for millions of medical insurance? Hospitalization and outpatient service.
General hospitalization expenses above 1 000 yuan can be fully reimbursed. Outpatient service is relatively complicated, which mainly guarantees the following three situations:
Image source: Deep Blue Treasure
For example:
Because of the upper respiratory tract infection, Mr. A went to the general clinic of the hospital several times, but was refused compensation by the insurance company on the grounds that it was not within the scope of millions of medical clinics.
On the other hand, if Mr. A has had a special outpatient service such as renal dialysis, he can apply for compensation.
I have made a detailed analysis of the coverage of different types of insurance before. Interested parties can go to official website Deep Blue Insurance to check related articles.
Second, the reason for refusing compensation Top 2: I have mentioned this reason to you many times. Medical insurance generally means that the previous illness before insurance is not covered.
So what was the disease in the past? Generally speaking, it contains three points:
I was sick, but I was not cured: thyroid nodules, breast nodules, for example, were not surgically removed.
Untreated diseases often recur: hypertension, hyperglycemia, etc. Need long-term medication control.
Symptoms have already appeared and may need treatment at any time: for example, kidney calculi has caused abdominal pain.
In fact, it is normal not to pay for the past illness. If you know that you are sick and want to be reimbursed through insurance, the insurance company will naturally not do it.
However, it needs to be reminded that if your illness before insurance has been completely cured, it will have no effect. For example, if you had pneumonia before, but it has been cured, then you can claim compensation for pneumonia after insurance.
Third, the reason for refusing compensation Top 3: Waiting period Millions of medical insurance will generally have a waiting period of 30 days after being insured. If you get sick and get out of danger within these 30 days, you can't pay.
For example, Mr. B bought a million-dollar medical insurance on June 30th this year, and was diagnosed with cancer in situ on July 10. He spent more than 20 thousand in hospital, because the waiting period has not passed and he can't settle the claim.
However, during the waiting period, not all cases will not be compensated. If it is an accident, such as accidentally falling and breaking a bone, compensation can be made normally during the waiting period.
In addition, it should be noted that millions of medical insurance only has a waiting period when it is first insured, and there is no follow-up period.
In addition to medical insurance, there is also a waiting period for serious illness and fixed life, which is generally 90- 180 days. Accident insurance is not available.
Fourth, the reason for refusing compensation Top 4: I didn't tell the truth for this reason. I thought I would be ranked first, but I ended up in fourth place, which was a bit unexpected.
When buying insurance, health notification is always an insurmountable hurdle. Before buying insurance, the insurance company will ask them about their past health.
Among the four insurance policies necessary for life, medical insurance is the most stringent health notification. I take the example of enjoying E-students:
It can be seen that there are many diseases to ask, except common hypertension and nodules, even the recent abnormal examination will ask. If you don't tell them the truth, you will risk refusing to pay compensation in the future.
For example, Xiao C had diabetes before he was insured, and he bought medical insurance directly without telling the truth. After hospitalization, he will be refused compensation by the insurance company.
However, there are certain skills in telling the truth and telling the whole story. My article in official website, "Buying insurance online, how to insure against diseases? Teach you all the skills of health notification! There is a detailed analysis in.
Verb (abbreviation of verb) Reasons for refusing compensation Top 5: Medical insurance that is not covered by the contract has its own guarantee period, which is generally 1 year and 1 year. If it is not within the warranty period, it cannot be compensated.
There are two specific types:
Before insurance: insurance has not yet started, and the medical expenses incurred cannot be compensated. For example, Mr. A bought a medical insurance in May this year, but the medical invoice was last month, and he will definitely refuse to pay.
After insurance: If the insurance period exceeds 1 year, if the insurance is not renewed in time, there is no way to compensate after the expiration. If Mr. A doesn't pay the claim until June next year, of course not, because the insurance has expired.
However, there is one exception. Those who have been hospitalized before the expiration of the insurance and have not been discharged after the expiration can get some claims. Take the exclusive E-student as an example, the fee can be delayed for 30 days. Of course, timely renewal is the best way.
Reasons for refusing compensation with intransitive verbs Top 6: The liability-free medical insurance will stipulate that some cases will not be compensated, which can be found in the exemption clause of the product. I will list some of them:
If it is for these reasons, it is impossible to pay the hospitalization fee. For example, if you have children, you want to reimburse maternity expenses; Plastic surgery expenses such as orthodontics and hair transplantation.
I have also sorted out the exemptions of other insurance types. You can go to Deep Blue Insurance official website to check the in-depth analysis of insurance refusal. What do you think of the exemption clause? What should I do after refusing to pay? 》
Seven, written at the end of the above is only the main reason for refusing to pay medical insurance premiums. In fact, there are many reasons for refusing to pay, such as failing to reach the deductible and the hospital's non-compliance.
Some friends may think that buying insurance really means: you don't have to pay for this or that. Actually, you don't have to worry too much.
I wrote an article in official website of Deep Blue Insurance entitled "19 Detailed explanation of real claims data of insurance companies! Which company is easy to be refused compensation? It is mentioned that the claims rate of major companies exceeds 97%, and only a few of them are rejected for the above reasons. In short, know more beforehand and misunderstand less afterwards!