As a general rule, visitors health insurance for foreign nationals who are visiting the United Sates, pre-existing conditions are not covered. Though in theory its pretty straight forward, the implementation might get a little tricky depending on individual cases. Having said that, read through the following to clear up the hazy world of pre-existing conditions.
Who and how does one determine which condition is a pre-existing one or not?
There are 3 general ways a condition can be linked with a pre-existing condition:
1. Health History Form
This is the form all new patients fill out before seeing any doctor in the United States that asks for a general health history of the patient. This form helps the doctor to properly diagnose and treat the patent, as well as indicate which conditions the patient has been suffering from.
2. Attending Physician's Opinion
During the doctor consultation, the doctor or physician may ask the patient specific questions about their health history to help with diagnosis and treatment. The information given during the consultation is taken into account when the doctor will give his/her opinion about a pre-existing condition to the insurance company.
3. Diagnosis and Lab Results
Whatever diagnosis the doctor has come to from his/her own expertise will be communicated to the insurance company if it has anything to do with a pre-existing condition. The diagnosis including lab/test results are communicated to the insurance company in the form of Doctor Notes.
All of these ways to determine a pre-existing condition is based upon the information you have shared with your doctor and the doctors expert opinion there after.
Contesting a Denial of Claim Based on a Pre-existing Condition
Problem: The hazy part of pre-existing conditions can come in here when dealing with individual cases. Sometimes, a previous condition was there but was cured and was no longer a problem until now, so it would be considered a new condition. But you were denied the claim based on it was a it was a pre-existing condition.
Solution: You have the right to make an appeal on the matter by providing supporting evidence to contest the denial of claim based on a pre-existing condition. The evidence can include a recent physical (general health checkup) report or written statement from your family doctor stating this condition was under control or not existing before the start date of the current insurance.
The appeal will be reviewed and most likely the claim will be paid, depending on the genuinely of the evidence.
Claim Tips
Provide all the documents and/or information on time when requested by the insurance company to avoid any delay and frustration. Note: Some of the information and supporting documents might be requested from the doctor/hospital itself. The claiming process can be delayed if the hospital/doctor don't send the requested information on time.
It's a good idea to get a health check up done prior to traveling to United States. Those reports can be vital to support your claim.
This might take a little time and effort but if its a genuine case, rest assured your claims will be paid.
