In the travel insurance industry, claims are denied based on the terms of the agreement outlined in the insurance plan documents. A claim denial can be disappointing, even maddening, to a traveler counting on getting their money back, but here’s something you may not know – just because your claim was denied doesn’t mean that’s the final answer.
There are many simple reasons a claim may be initially denied: clerical mistakes, miscommunications, etc. A traveler who is holding a travel insurance claim denial has two options: take the denial passively and accept the loss, or file an appeal. The appeal process is a valid part of claims handling for any reputable travel insurance provider.
Start by Understanding Why the Claim was Denied
When an insurance claim is denied, you receive some formal communication explaining the denial. Often, when you read the reason, you understand what you need to do to fix the situation.
Sometimes, claims are denied for lack of documentation and in that case, you can obtain the appropriate documents and send them with the appeal. In some cases, the insurance company has trouble getting the documents they need from a foreign medical provider. This is why it’s important to obtain good quality copies of any documents you need to make a claim when you are in the hospital or doctor’s office.
If you submitted all the documentation requested and your claim was denied, you will need to review your travel insurance plan documents. These outline the contract between you and the insurance company. If the document says pre-existing conditions are not covered (and most do unless you buy additional coverage) and your claim was the result of an acute onset of a pre-existing medical condition, then the claim denial is correct according to the terms of your contract.
Additional Reading: Top 5 Reasons Why Travel Medical Insurance Claims are Denied
What is an Appeal in Terms of Travel Insurance?
An appeal is a formal request issued in writing to the travel insurance company asking for the claims to be re-considered. To successfully file an appeal, the traveler should re-submit copies of the supporting documents (invoices, receipts, doctor’s notes, etc.) with the appeal. The travelers should also carefully outline the reason they are making an appeal; point to specific sections of their travel insurance plan’s description of coverage and a specific request that the denial be reversed and the claim be paid.
What is the Appeal Process – How Do You File an Appeal?
The appeal process depends on the reason for the claim denial. If, for example, your claim was denied for lack of supporting documentation you can obtain that documentation yourself and submit the claim again for reevaluation. If you don’t understand the reason for denial, call the travel insurance company and ask for an explanation. In some cases, this can clear up the situation and help the insurance company process the claim.
The Appeal Process May Be Slow, So Be Patient
An appeal requires that someone higher in the insurance company will review your claim, so it may take awhile. An appeal may mean asking a foreign hospital for medical reports and those requests may not be answered as quickly as you’d like (another reason to get all documents while you are handling the emergency and keep copies).
It is utmost important to find the right visitors insurance or travel medical insurance for travelers visiting countries like USA since the medical cost in such countries can be financially devastating. In order to understand why it is important to file a claim and how to file a claim, refer to our article: Why file a travel insurance claim. Visit our Best Visitors Insurance for USA section to find the right fit travel insurance or contact us at firstname.lastname@example.org with any questions about our policies.