Why It’s Hard to Claim Maternity Benefits in Health Insurance and What You Can Do

Why It’s Hard to Claim Maternity Benefits in Health Insurance and What You Can Do 

In case of any medical emergencies, health insurance acts like a sunbeam in a dark room.

But what happens if your health insurance claim gets rejected especially during the days of maternity?

Understanding the complexities of maternity benefits in health insurance can be challenging for

expecting parents.

Despite the importance of these benefits, many face difficulties when it comes to claiming

maternity-related expenses. Below is an explanation of why these challenges arise and what steps

can be taken to mitigate them.

Understanding Maternity Coverage in Health Insurance

Maternity coverage is designed to help with various expenses associated with pregnancy and

childbirth, including: 

● Hospitalization Costs: Covers expenses incurred during delivery, whether normal or C-section. 

● Prenatal and Postnatal Care: Includes consultations, diagnostic tests, and medications. 

● Newborn Care: Often extends to cover medical expenses for the newborn up to 90 days post-birth. 

However, many health insurance policies come with specific limitations and exclusions that can

complicate the claims process and raise claim rejection-related issues. 

Common Issues with Claiming Maternity Benefits

1. Waiting Periods: Most insurers impose a waiting period ranging from 9 months to several

years before maternity claims can be filed. This can lead to frustration if parents are

unaware of these expectations when purchasing their policy. 

2. Exclusions and Limitations: Policies may exclude certain expenses, such as

routine check-ups or complications arising from pre-existing conditions.

Understanding what is not covered is important to avoid unexpected out-of-pocket costs.

3. Claim Rejections: Many claims are rejected due to incomplete documentation or failure to meet policy criteria. This can include missing forms or not adhering to the notification timelines required by insurers.

4. Complex Claim Processes: The process for filing a claim can be complicated, often requiring multiple documents such as discharge summaries, medical bills, and consultation records. Failure to submit all necessary paperwork can result in delays or insurance claim-related issues. 

Steps to Improve Claim Settlement Success

To understand these challenges effectively, consider the following strategies: 

● Plan Ahead: Purchase maternity insurance well before conception to avoid waiting

periods and ensure comprehensive coverage. 

● Thorough Documentation: Keep records of all medical visits, bills, and communications with healthcare providers. This includes obtaining detailed invoices that break down costs. 

● Understand Policy Details: Familiarize yourself with your policy’s specifics—what is covered, what isn’t, and any limits on coverage amounts or types of services. 

● Utilize Expert Services: Experts like Bima Seva Kendra offer assistance in understanding policy

details and guiding the claims process. They can help clarify any insurance claim-related issues

you may encounter. 

● Seek Professional Help for Rejections: If a claim is rejected, consider

using claim rejection services that specialize in appealing denials and ensuring your case is

presented correctly. 

Claim Maternity Benefits like a Pro

Claiming maternity benefits in health insurance can be filled with challenges, but with careful

planning and an active approach, parents can let go of potential issues. Understanding your

policy thoroughly, maintaining organized documentation, and seeking expert assistance

when needed are crucial steps in ensuring a smooth claim settlement process. 

By addressing these aspects early on, expecting parents can focus more on welcoming

their new addition rather than worrying about the financial burdens associated with maternity care.