What To Do If Your Visitors Insurance Claim Is Denied? File An Appeal.
There can be several reasons why visitor insurance claims are denied, but you can file an appeal if you feel your claim was wrongly denied. Frustration is understandable when a claim is first denied, but it’s better to be prepared for this possibility instead of reacting out of anger in case your travel insurance claim is denied.
An appeal is a process of explaining why a claim should be paid by your insurance company: providing them with more proof, a letter, a doctor’s note or clarification, and additional copies of documents that help the insurance company re-assess the claim.
What is a Visitors Insurance Appeal?
An appeal can be made by submitting:
- appeal form
- a letter
- a phone call
by either the insured or the doctor/hospital from where the treatment was obtained.
When submitting an appeal, you need to gather as much information as possible to support your case. If the denial was simply a clerical error, then highlighting the errors could be easy, but if there is more to the denial that needs to be proven, it is up to you to bring it to light.
Insurance companies are used to the appeal process and will often grant an appeal if they were wrong. But any missing information could become grounds for yet another denial.
Call the insurance company or your travel insurance agent to ask any questions you may have about the denial and the appeal process.
Please Note: the agent won’t have any case-specific information from your insurance company, Your privacy is protected by regulations through the right to privacy on medical aspects. Your best resource in case of claims is the insurance company’s claims department, you can always seek help and general guidance from your agent if they are able to help.
Also look at your policy documents for rules, exceptions, and the claim process.
How to File an Appeal
After a claim is submitted, the first form you will receive is an Explanation of Benefits (EOB). The EOB lists your claims by date and indicates whether insurance will pay or not. In the case of a denial, an explanation is given for the reason for the denial. Usually, a description of how to file an appeal is on the EOB as well. But you can always call the insurance company to get the most up-to-date appeals process. The first thing you should always do is double-check the reason for the denial of your claim.
- Do they think you have a pre-existing condition you never stated?
- Was the claim filed late?
- Was insufficient information submitted?
Regardless of the reason, double-check it with the policy documents and your original claim. If you feel you have a valid reason for the claim to be paid, that’s when you will start an appeal.
Insurance companies will likely have you submit a form or call a direct number. You’ll answer questions, submit more proof, and resend all of your original claim material.
Keep in mind that an appeal process is a long one. Once an appeal is submitted, the insurance company then has to verify your information and decide whether or not to pay. They may tell you that the submission process can take a certain amount of time (likely 30-90 days), so mark the last day on your calendar to follow up with the company to make sure everything was processed.
If your claim is still denied after an appeal, there are more steps you can take that will eventually take you to small claims court. However, most claims are settled after an appeal.
Tips to File Visitors Insurance Appeal Accurately
- Always save your documentation, medical bills, payment receipts, etc.
- Read your policy documents thoroughly
- Submit claims and appeals within the right time frame (don’t wait too long)
- Make sure your claim is covered before you submit it
- Always give accurate information necessary to process the claim
- Get the denial in writing even if you speak on the phone
- Don’t be afraid to ask questions, speak with a representative, a manager, or the head of claims at the insurance company, if necessary
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Remember that you have a right to file a claim and to file an appeal. If you believe you are entitled to the coverage you submitted a claim for, you should file an appeal regardless of the denial explanation.
Understanding the insurance claims process of your insurance provider is extremely critical. Filing the claim and appeal within the defined time frame and following the stated process will ensure timely processing.
Do not hesitate to escalate your case to the insurance company if you feel you are wrongly denied reimbursement for the expenses you had to incur which were within the eligible and covered expenses as per the insurance policy document.