What if Your Insurance Refuses to Cover You?

Posted by on Dec 13, 2016 in Insurance | Comments Off on What if Your Insurance Refuses to Cover You?

With the promise of being covered from any health emergencies, health insurance service has been successful in encouraging clients to invest.

From corporations, private entrepreneurs and families, various insurance in the Philippines just seemed to have a unique policy fit for anyone’s lifestyle. It’s also why clients pay high regards in making sure they choose the right plan for their needs.

But just like any ventures, insurance companies is ultimately a business. And same with any businesses, it’s also not perfect. There are pros and cons in the industry and issues that remain to be an open book for resolution. Still, these did not stop the businesses from striving and getting clients who want to avail of the health care support.

But what if your current insurance service fails you? What if despite your diligent payment and adherence to its basic rules you end up not getting the service you hope for? Is it possible to get a refund and perhaps cancel your entire enrollment?

Before we arrive at answers for these issues, it’s important to understand specific matters about insurance services.

Terms and conditions for each company vary

Initially, you might find this section for different companies as synonymous. They state similar things, reminders, conditions and general rules that clients must follow for their plan to be valid. However, not all companies are the same and they have standard operating procedures that make them unique compared to the rest.

One common mistake by a lot of insurance holder is ignoring this part without understanding the conditions it states. If you wish to know what things invalidate your plan, you must take some time to understand the details written on this part.

Specific exceptions for the insurance coverage are stated on the policy details

This includes the activities and destinations that are not covered by their service. Of course, this may be different from one company to another. If an insurance service sees some activities that are highly risky, they have the right to include it in the coverage. For adventurous people whose main reason for getting an insurance is to protect them from the daredevil activities they embark, then asking the company if these activities are covered is important.

Claims, refunds and the like have predetermined time validity

You might think that insurances offer you lifetime hospitalization support, and true enough, as long as you are enrolled, you can avail of it anytime. However, you must keep in mind that claims for accident payments need to be accompanied by the necessary documents – some of which must be provided immediately after treatment.

Submitting these papers to the insurance service on time as soon as possible is vital as some companies may not honor it when too much time has passed.

The issue of whether or not an insurance company would cover you is ultimately a matter of how well you agree to their terms. This is exactly why understanding their policy content is important, to begin with.

A company’s refusal to refund or support you financially in any medical needs must have some basis on it according to the policy you’ve signed. If you reached a point when the company indeed refuses to release the money, do not hesitate to ask them for the reason. In most cases, their decision is final but it’s always good to know that there could be alternatives they could offer you instead.

In some cases when it’s the company fault and they can’t really give you a valid reason for the refusal, a legal counsel may be needed. As we have mentioned, no company is perfect. They have their own lapses in some way. If you think you deserve a refund or support which is not given by your insurance provider, then there’s a good reason to fight for it in legal terms.

This may take time and money, though. The safest way to prevent any of these issues from happening is to have a full understanding of your chosen policy and to constantly be in touched with the company the moment you need the service. This way, they could walk you through the necessary steps needed to make your claim valid.