Health insurance mistakes that raise your hospital bill

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Most individuals buy an insurance policy thinking it has everything covered — until the hospital bill indicates otherwise. Every policy includes exclusions — treatments, conditions, or procedures that are not covered. Dental procedures, cosmetic surgery, or specific pre-existing conditions, for instance, can be excluded for a couple of years. Failure to read this fine print will bring unpleasant surprises at the checkout counter. Always go through your policy document carefully or ask from your insurer a comprehensive list of exclusions before buying or renewing your policy.

Omission of the waiting period clause

Another expensive error is ignoring the waiting period. Most health insurance plans have a waiting period for pre-existing conditions, maternity care, or certain diseases. If you are hospitalized during this time, the insurer will not pay. This is particularly relevant for individuals purchasing health insurance when they are older. Being insured sooner means you get waiting periods over when you are healthy and get comprehensive coverage when you really need it.

If you actually find yourself getting treated at a non-network hospital, you'll need to pay out-of-pocket and get reimbursed later — time-consuming and not necessarily for the complete sum. To prevent this, always cross-check your insurer's network hospital list. Cashless treatment centres not only reduce stress but also save you from the shock of out-of-pocket payments. Prior to any planned admission, make sure both the hospital and insurer agree on your policy being Cashless-enabled.

Missing the deadline to inform your insurer

Delay in intimation to the insurer upon hospitalization may create hassles at the time of settling the claim. Even in emergency situations, a large majority of insurers insist on intimation within 24 hours. In the event of pre-planned surgeries, pre-authorisation is most likely. Any delay here can lead to rejection of the claim partially or even fully. Keeping your insurer's helpline and policy number handy may come in handy later.

Underinsuring yourself or going without add-ons

Selecting the most budget-friendly policy with lowest cover could be perceived as saving, but it can boomerang when there is a huge hospital expense. Owing to rising medical expenses, a ₹3–5 lakh sum insured might not prove to be much help for a family based in metro cities. Watch out for add-ons like room rent waiver, no-claim bonus, or critical illness riders to grow your cover and stay away from financial burden during hospitalization.