In Group Health Insurance Hospitalization not justified is a condition under which a hospitalization claim can be rejected even after completing the 24 hours in the hospital.
Hospitalization, not justified means
A patient who is admitted to the hospital for more than 24 hours with no active line of treatment and as per medical terms patient was not required hospitalization or which treatment given to the patient during the hospitalization for that hospitalization was not required or patient can be taken that treatment in OPD basis.
Example: If a patient is admitted to the hospital due to fever and after being admitted during the hospitalization patient got treated with oral treatment or without IV and antibiotic, and only investigations have happened during the hospitalization and as per the vital chart patient’s vital was normal and as per the treatment chart no active treatment was given that means the patient was not required hospitalization patient can be treated on OPD basis. Hence hospitalization is not justified condition can be applied and the claim can be rejected.
