Common misconceptions with travel insurance lead people to think that the policy they buy will cover everything. This is simply not true. Before you buy a policy and especially after you buy a policy, you need to look at the fine print to understand what is and is not covered under the policy. This includes restrictions, maximums, and things not covered. When filing a travel insurance claim, make sure you understand your policy and how payments and reimbursements will work. You don’t want to find yourself sick on a trip and having to foot a large bill. It is important to understand what is covered and what is not. Here are some reasons why claims are denied & how to file claims properly.
1. The Benefits are Not Covered Under the Policy – Eg. Pre-Existing Medical Conditions
Unfortunately, travel insurance policies cannot cover every medical condition. Depending on the policy, heart disease, cancer, diabetes, and others may be on a pre-existing conditions list. This allows the carriers to deny a claim for treatment or maintenance of this condition, meaning you will pay for the expenses out of your pocket. It is extremely important to read what pre-existing conditions are listed for your policy. And if you have a pre-existing condition, look into plans that offer coverage for acute onset. It’s also important to take into account what you plan to do while on your trip. Let’s say you want to go to Utah for some skiing. It’s in your best interest to purchase a rider for sports and adventure coverage in order for any skiing accident to be covered. If you don’t have this rider and you have an accident, you will still be seen by a doctor but your insurance may not cover the claim.
2. Missing Proper Documentation
When you file a claim, you need to be able to show proof of your policy and proof of the medical treatments received. Always have your insurance card/policy number available to show proof of coverage. If you have to pay any money up front, keep your receipts. When a claim is filed, read over all of your claim documents and forms to make sure your information is correct. Either in the mail or online you will receive an Explanation of Benefits for every procedure you have. Double check that the information is correct on there as well. Because an EOB is not proof of payment, it’s easier to correct information at this stage. If anything is missing or incorrect, you run the risk of having your claim denied.
3. Claims Were Submitted Too Late
Travel insurance policies have deadlines. Read your policy documents to see how long you have to submit a claim. If the date you send a claim is past the deadline, even if you had the service in a timely manner, you could be denied. Most insurance carriers make it easy for you to submit claims wherever you are. Don’t wait until you get home and run the risk of losing documentation or time. File as quickly as you can.
4. Self-Inflicted Ailments
If you need to see a doctor after taking a risk like skiing or if you are hospitalized after too much alcohol consumption, this can be grounds for claim denial by some travel insurance carriers. While these policies are great for emergency health needs, they aren’t meant to be a fall back for risk junkies. This is another important reason to read the fine print of each policy you look at. These types of services will be listed as “excluded” in the policy.
5. Your Health Is Considered Too Unstable to Travel
Most travel policies require you show proof that you are well enough to travel. If you are thinking about trying to fool the system to fly anyway and you wind up needing healthcare, it could come up that you were too unstable to fly in the first place. This is again grounds to deny a claim. Then you will find yourself in a foreign country with no insurance to help you pay your bills.
Pre-Certification for Medical Treatments
If you are traveling and find out that you need a major surgery or other treatment, certain policies will require pre-certification in order to cover it. At least 48 hours before the treatment begins, you or your doctor will need to contact the travel insurance carrier to request coverage for that service. If it is approved, you can go ahead with the treatment. If it is not approved, any claims will be denied. If you can determine medical necessity for any of the above exclusions, you may be able to get pre-certified for treatment.
So, your claim has been denied. Now what? After you’ve read through your policy and all claim documents, you have to decide if this claim was rightfully or wrongfully denied. If you feel the claim should have been paid or is denied unreasonable justification, you can file for a visitors insurance appeal. Each insurance carrier has a different appeal process, but the basic principal is that you can refile a claim showing more proof that it should be paid. Usually you will need to write a letter or have a doctor write a letter explaining the need for a procedure or treatment. If the insurance carrier accepts your appeal the claims will then be paid.