Visitor medical insurance - The claims process; How travel insurance works
At American Visitor Insurance, we are often asked how the visitor medical insurance plans work. People are concerned that in the end, as maybe they have read or heard, the visitor travel insurance policy will not pay for medical expenses they are expected to be covered. Well, we would like to reassure you that all the companies we work with pay out hundreds of thousands of dollars in claims every year to their customers all around the world. So, to put your mind at ease, we thought we could give some details about how claims procedure work and what steps a client should take in using their travel insurance.
Important visitor insurance documents:
So, after you compare visitor medical insurance plans
, select one as per your requirements and buy it, you will promptly be emailed a receipt and confirmation email which will include many important documents for your policy. We recommend you keep this email available and not delete it until your trip is over and (hopefully uneventful in terms of medical issues) there are not claims pending on the policy. Among the documents, you
will find a link to an ID card. This card contains all the information needed for you or a provider to access your insurance should you need to use it. We recommend you either print this out or write out the information on the card and carry it with you while on your trip.
Relevant contact details while using healthcare services
If you are in the US, you have a high probability that the hospital or medical provider you visit will call the insurance company for you, confirm your benefits under the plan, and directly bill them for any services they provide for you. In order for that to proceed smoothly, you should provide them with the certificate number of the policy, the member number (if applicable), and the name of the insurance company whose policy you have purchased and the phone number for the insurance company, sometimes also the address for claims to be sent (all these details are provided in the documents that you receive on buying the policy). If you mistakenly give American Visitor Insurance's phone number or name, then this will delay your filing since we will have to contact you to change the place where the claim forms are sent and/or give the correct telephone number to the provider so they can contact the insurance company directly.
Sadly, we do get a number of claims coming into our mailing address. This is very frustrating for all involved since we at American Visitor Insurance find it hard to send it along to the insurance company (often there is not enough information on the form to figure out which company it is) and we cannot call the concernred insurance provider since they MUST hear from the patient directly. Please be aware that if you do not provide them with a phone number or email address, then we will NOT be able to contact you to make any correction and all will simply be left wondering what happened to their claim. So the initial filing of the claim is very important. Be sure you know the name of the insurance company (International Medical Group
, Seven Corners
, Global Underwriters
etc.), your certificate and ID number. The policies we sell generally do not have a group number, so this is one item you can leave blank or say “none” on any form from the provider. Again, we cannot stress enough the importance of having the ID card with all the relevant information on it; beware that American Visitor Insurance contact information can also be on it, but American Visitor Insurance cannot accept claims forms on the customer's behalf.
If a provider will not make the phone call for you, you can still use them if you choose, you will simply have to pay up front for your care and then submit a claim to be reimbursed. Note that if you have purchased a fixed benefit plan (as opposed to a comprehensive plan), you will need a detailed, itemized bill from your provider. If you have a comprehensive plan, a simple bill may be sufficient. Again, the claims form can be found in your initial confirmation documentation. If you do not have it or cannot find it, they are also all on our websites for each insurance company that we work with. You can download it there at your convenience. If you are not sure which company you purchased, you can give us a call, and, based on the certificate numbers and/or member numbers, we can direct you to the right form and even email it to you.
You fill out the claims form, keep all receipts and documents. Keep a copy for yourself then mail, fax or email (whatever is allowed by the company) the claim to the company. DO NOT WAIT too long. Many companies only give a limited time from the time of the claim to file it. If the company you chose has a client login (like IMG or TokioMarineHCC) you can use this to track the status of your claim. Give the company at least two weeks to deal with the claim before you call them or us about it since it does take time to process claims (and they have many clients to deal with).
Also, please remember that we will have very limited information on your claim due to confidentiality laws. However, we can answer questions about the process and use our contacts at the company to check on a claim and get back to the insured about it. The other important part of the claims process that may be forgotten is that if you purchased insurance for someone else, the company may not be able to talk with you about it either (due to confidentiality issues). Before your visitor leaves, you may want to set up permission to discuss and help your visitor with their claim; you will likely have to both sign a form and send it to the insurance company.
If you have a medical issue while abroad, please note that, although the phone numbers are all US-based, they will all accept collect calls from overseas to help you connect to providers and get the claims process going. If they cannot or will not call on your behalf, then, again, you can pay up front for your care and submit a claim to get reimbursed.
Contesting of a claims denial:
What if they don’t pay your claim? First, it is important to recognize that travel plans do not cover ALL medical expenses. They are not meant for wellness visits, check ups, immunizations (preventive care) , or over the counter medications. Those types of costs you will have to pay for yourself. They are meant to cover sudden illness or accident. The other main thing travel plans have very limited coverage if any for pre-existing medical conditions. So, if you take medication for some condition, the travel plan will not cover costs of that medication, even if you lost it or forgot it or it was stolen from you. In the US, you would probably have to make an appointment with a doctor in order to get a prescription written (even if it is for something you take regularly); the insurance would not cover that doctor visit either. The coverage you CAN get for pre-existing conditions is called “acute onset” of a pre-existing condition. That means, that if you have a condition (that is not excluded by the policy) that is stable and controlled, but something unexpected happens due to that condition, you can get coverage for that. This is a very specific situation. No other expenses due to pre-existing conditions will be covered, so first you want to be sure you understand the limitations of the policy you are purchasing.
Let’s say you had an expense that was not excluded by the policy and not due to a pre-existing condition but your claim was rejected. You still have recourse. You can file a appeal to the decision not to cover your claim. We would like to be clear that as far as we know, none of the companies we work with automatically reject claims. If that were the case, we would not sell the products anymore since this is a very old ploy to get out of paying legitimate claims and to do this with people that are foreigners and unfamiliar with our US system or with people traveling and not really given much choice (possibly) in their situation is abhorrent to us at American Visitor Insurance.
I can tell you that the appeals process can go either way. They do take these seriously and it does come into their rating as an insurance company. I can give you a few examples from our clients here. In one case, a claim was rejected because they determined the condition was pre-existing. In this case the person had a bladder infection that flared only a week after their arrival in the US. The doctor confirmed it had been a chronic condition that had started before the trip and therefore before the start of the policy, so they did not pay for it. In another situation, a client had to see a doctor about a pre-existing condition to check on it. The company did not pay for this visit. However, the client had a further issue due to new medication they were taking after this check up. At first, they rejected the claim saying it was still due to the pre-existing condition. Upon appeal, however, they changed the stance and said that it was, in fact, new since it was due to the new medication and they did pay it. So, while we cannot predict how things will work out, we believe that the policies will work they way you generally expect them to as long as you understand their limitations. Familiarize yourself with some factors on how visitors insurance claims could get rejected
Ultimately, it is up to you (and us to help you) to get all the forms submitted correctly and completely to facilitate the claims process. If you have specific claims like trip interruption or repatriation, these need to be dealt with directly with the insurance company (and you want their expertise there anyway). It can be a lengthy process, but use the resources you have (the client zone, our agents, the insurance company customer care) to best advantage and you can get through it positively.
As always, we wish you safe and healthy travels.