Years of faithful premiums, then a denied hospital claim — most health-insurance disputes trace back to clauses the buyer never read at signing.
Why do insurers deny payment?
Under the Insurance Business Law 2022 (08/2022/QH15, in force since 1 January 2023) and the policy, insurers may deny claims under exclusion clauses: pre-existing conditions not honestly disclosed; treatment within the waiting period (typically 30 days for ordinary illness, 90–270 days for specified conditions and maternity); medically unnecessary treatment, cosmetic services, or unqualified facilities. The key: the buyer bears the duty of honest disclosure — hiding a pre-existing condition is lawful grounds for denial.
Are pre-existing conditions insurable?
Yes, conditionally: they must be honestly disclosed at enrolment; the insurer may impose longer waiting periods, higher premiums or specific exclusions. Fraudulent non-disclosure, once discovered, can trigger unilateral termination with total loss of benefits.
Where to complain?
The path: negotiate with the insurer (written complaint with medical records) → complain to the Insurance Supervisory Authority (Ministry of Finance) if unresolved → sue in court. Watch limitation periods and keep everything: policy, policy wordings, medical records, hospital invoices, the denial letter.
Frequently Asked Questions
The insurer cited a 'pre-existing condition' I didn't know I had?
Pre-existing clauses usually cover diagnosed conditions or clear prior symptoms. If you genuinely did not know and medical records prove it, you have grounds to challenge the denial.
How long are health-insurance waiting periods?
Per policy: typically 30 days for ordinary illness; 90–365 days for specified conditions and maternity. Treatment during waiting periods is not covered, except accidents.
I bought through a bank — who do I complain to?
The insurer that issued the policy — the bank is only a distribution channel. But if bank staff mis-sold the product, you may also complain about the bank's advisory duty.
This article has been quality-reviewed by the FLAW AI Legal Council