المملكة: Advisory: Hiding a hernia or gallstones voids insurance coverage for the surgery
Breast and general surgery consultant, Dr. Muhammad Al-Kilani, confirmed that failure to accurately disclose health status is the most common reason for rejection by insurance companies Covering the costs of surgical operations, even if the patient has a valid insurance policy.
Al-Kilani explained that doctors encounter these cases frequently, where patients who need essential surgeries are surprised by the refusal of The insurance company covers the costs.
Medical disclosure is necessary for insurance costs
He pointed out that the reason in many of these cases is that the patient neglected to mention his previous medical conditions when filling out the insurance form, such as a hernia, gallstones, or the presence of a tumor in the breast, pointing out that the patient is often unaware of the importance of this simple procedure that protects him from rejection of claims in the future.
The consultant explained that disclosure Medical is a mandatory and official procedure aimed at determining Insurance eligibility accurately and to avoid subsequent disputes between the patient and the company.
This is done through an official form approved by the Saudi Health Insurance Council, which the beneficiary is asked to fill out when applying or renewing the policy, including his medical history and current condition, he and his family members covered by the insurance.
Dr. Al-Kilani stressed that full and honest disclosure contributes to accelerating medical approvals and guarantees the patient his full right to coverage when needed.
Most prominent cases. Health
He pointed out that the unified form obliges beneficiaries to mention a specific group of cases, the most prominent of which are genetic diseases, congenital malformations, eye diseases such as cataracts and glaucoma, and bone and joint problems such as torn ligaments, in addition to chronic diseases such as tumors, heart and kidney diseases, pregnancy cases, and any hospitalization during the last 12 months.
Al-Kilani noted that disclosure of common diseases such as high blood pressure or diabetes is not usually required, unless it is stated. Mention it explicitly in the disclosure form.
The consultant warned that incomplete or misleading disclosure not only leads to the rejection of claims, but may lead to the cancellation of the insurance policy permanently.
He stressed that filling out the form is the personal responsibility of the insured, and the employer has no right to do it on behalf of the employee, reassuring at the same time that all disclosure data is treated with complete confidentiality and is only used for health insurance purposes.
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