If you utilized your travel medical insurance plan and submitted a claim for expenses incurred during your policy period, there is always a chance that your claim may be denied. A claim can be denied for a multitude of reasons - you may have submitted a claim on services or treatment that are not eligible under your plan’s coverage or your claim is for an exclusion, such as care related to a pre-existing condition.
Regardless of why your claim is denied, don’t panic - you have the opportunity and right to appeal the denial and ask for another review of your claim. While a denied claim may be frustrating, understanding why your claim was denied and then writing an effective travel medical insurance appeal letter can help resolve your situation and give you a second chance at getting your coverage approved.
When to Appeal a Denied Travel Medical Insurance Claim
You filed your claim with your travel insurance company but received a denial of your claim back. Should you appeal? Typically, the insured will make an appeal for a denied claim when they disagree with the determination of the claim. The appeal should include supporting evidence as to your reasoning for believing that the claim should not have been denied.
If you truly believe that your claim should not have been denied, you may choose to go through the appeals process for a reevaluation of your claim. However, reviewing your plan’s policy documents and clearly understanding what is covered per the policy wording and what types of services or care are excluded can help guide you on whether or not an appeal is appropriate based on your original claim and whether or not it is eligible under your plan.
How to Start the Appeals Process
After receiving your claim denial, if you do not agree with the determination of your claim, you can submit an appeal. Typically, appeals are made for claims that are denied because of benefits which are not covered per the policy wording. If your claim was denied for an exclusion, such as a pre-existing condition, and you disagree with that determination, then you may include information and documentation to prove otherwise in your appeal.
After understanding your claim denial and reading your plan’s benefits and description of coverage, and you still believe you have a case for an appeal, it’s time to prepare your appeal for submission. The more documentation and information you provide in your appeal, the better!
What to Include in an Effective Travel Medical Insurance Appeal
In order to create an effective appeal, it is often recommended to prepare the following items.
A letter from your doctor(s) of further explanation of your diagnosis, if necessary. If you feel that your diagnosis may have been misunderstood during the claims process, you may request additional information from your doctor to further support your claim or better explain your diagnosis if you believe this will help clear up any confusion surrounding your treatment.
Additional medical records that will assist in explaining your diagnosis or treatment more in-depth. You may also gather and include additional medical documents or records from your history that you believe will assist you in better describing your diagnosis or treatment.
Medical journal articles about your diagnosis that may help support your claim, if applicable. You may also opt to conduct some research into medical journals that further explain your diagnosis in a way that helps to support your claim.
A written cover letter which explains why your claim should be paid. Your appeal cover letter is a great opportunity to explain your position on why you believe your claim should be paid. You may include references to the information included above, if applicable. A clear and concise cover letter with detailed points and supporting documentation can assist you in creating an effective appeal letter.
Submit Your Appeal and Sit Tight
Once you feel that your appeal is ready to submit, follow the appeals process as outlined by your insurance administrator and make sure that all information requested by the company is provided.
Additionally, be prepared to wait some time before your appeal is processed - this can often take up to 60 business days.
Travel Medical Insurance Claim Appeals Process FAQs
As the insured filing the claim appeal, can I travel back to my home country while waiting for my appeal to be processed?
Yes, you may travel back to your home country while waiting for the response of your appeal.
How long does a typical claim appeal take?
The claim appeals process can take up to 45-60 business days to complete.
When should I file a claim appeal?
You may decide to file a claim appeal if your initial claim was denied and you disagree with that determination and would like your claim to be reevaluated.
Do claim appeals have any benefit?
Filing a claim appeal can benefit you in the event that the insurance company agrees with your appeal and overturns your claim.
What is most important when filing an initial claim to avoid denial?
When filing a travel medical insurance claim, it is recommended to include as much information and documentation as possible to support your claim. This includes medical documentation, letters from your doctor, proof of payment and itemized receipts. Read more about how to file an effective claim with your insurance company.
While dealing with a travel medical insurance claim denial isn’t ideal, understand that you have the right to appeal that decision and having an effective and clear appeal letter can better assist you in supporting your disagreement with the insurance company’s decision.
Claims Assistance Through VisitorsCoverage
If you purchased your travel medical insurance plan through VisitorsCoverage, we offer Claims Assistance to help you through the claims and appeals process. Our friendly licensed insurance specialists can help you communicate with your insurance company, check for missing information, and assist you in better understanding why your claim was denied and what steps to take next. You can submit a direct request for Claims Assistance for your plan by logging into your VisitorsCoverage online Customer Portal.
