As the healthcare in the U.S. is the most expensive in the world, the importance of purchasing appropriate visitors insurance is well understood by the visitors to the U.S. or their host. Just like any type of insurance anywhere in the world, U.S. visitors insurance has terms and conditions, including exclusions; each insurance company’s claims department processes the claims based on that. While a vast major of the customers’ claims are processed without any issues, some claims may fall in grey area where the customer may need expert help.

Reason for Claim Appeal

One of our insureds went to an urgent care with back pain, due to the lab results they were told to go to the emergency room at a nearby hospital. They were admitted to the hospital and discharged after a few days. About 10 days later they went to the same urgent care for shivers and again were told to go to the hospital where they spent a few more days there. The urgent care and the hospital billed the insurance company directly for all visits. Our customer then spent two months attempting to get the claims paid only to receive a letter in the mail stating that all claims were being denied due to pre-existing condition. That is when they decided to contact Insubuy for help.

After Contacting Insubuy

Our Claims Resolution Specialist reviewed the medical records and discovered the insured has a pre-existing condition of Chronic Kidney Disease Stage III. They were diagnosed with Hyponatremia and a Kidney infection. The plan the insured bought does have an acute onset of a pre-existing condition benefit but this benefit does not cover chronic conditions. Therefore we could not attempt an appeal under that benefit of the plan.

Insubuy’s Claims Resolution Specialist then coached our customer on how to write an appeal based solely on the Kidney infection and Hyponatremia. They acknowledged that the insured does have a prior medical history of Chronic Kidney Disease but the recent diagnosis of Kidney infection/Hyponatremia are unrelated. Any otherwise healthy person can experience a kidney infection. It should not be assumed that the kidney infection is a direct result of the kidney disease when the kidney infection could be due to the development of a bacteria in other parts of the urinary tract. Unless the insurance company can prove with reasonable medical certainty that the kidney infection is a direct result of the kidney disease the insured asked that the insurance company reconsider and process all related claims in question.

We also added a supporting letter from the insureds Nephrology Specialist who has been treating the patient for over 3 years. The letter stated that the above conditions are unrelated to the patients Chronic Kidney Disease and that the patient did not suffer from these conditions in the past. Essentially, the patient only had one episode of Kidney infection/Hyponatremia since their Chronic Kidney Disease diagnosis and that occurred in United States while being covered under their insurance plan. They had no past history of these conditions and neither did they suffer from these conditions after their treatment. All in all, the Kidney infection and Hyponatremia are an isolated episode unrelated to the Chronic Kidney Disease. Two weeks later, all the claim denials were overturned and paid.

This was an extremely difficult claim to get overturned on an appeal due to the severity of their Chronic Kidney Disease. With the help from the insureds doctor and Insubuy’s expertise with claims, once again, Insubuy was able to get all legitimate claims of our customer paid!

Conclusion

Without Insubuy’s expert help and willingness to go the extra mile, it would have been almost impossible for this customer to get their legitimate claim paid. Insubuy is a well-wisher of their insureds and always works in their best interest. While the same visitors insurance plan is available anywhere at the same price, Insubuy’s additional assurance to help with legitimate claim issues goes a long way in customer satisfaction and lets our customers be worry-free.