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Claims Appeal for a Syncope and Collapse, Type 2 Diabetes Mellitus Hypertension

Claims Appeal for a Syncope and Collapse, Type 2 Diabetes Mellitus Hypertension

As healthcare expenses are among the highest in the United States, many people visiting the U.S., or their hosts, already consider the importance of purchasing visitors insurance. With the wide usage of technology, there are many brokers and insurance companies that make it very easy to purchase visitors insurance online. As the insurance prices are regulated by law, everyone pays the same price for the exact same insurance. However, it is very important to carefully consider which broker you choose to purchase the visitors insurance from as you won’t receive the same services from different brokers. It’s best to consider the ones that provide the best service before, during and after the sale. Insubuy’s experienced claims resolution specialists are always ready and willing to help customers with their legitimate claims issues.

Reason for Claim Appeal

One of our insureds was not feeling well and almost fainted. 911 (US medical emergency number) was called for them and they were taken by ambulance to the nearby hospital where they were diagnosed with a primary diagnosis of Syncope and Collapse and a secondary diagnosis of Type 2 Diabetes Mellitus and Hypertension. After 7 months of our customer attempting to get the claims paid, they finally received notice from the insurance company that all claims were being denied due to pre-existing conditions.

After Contacting Insubuy

Immediately after they received the denied claim notification, they contacted Insubuy for help. Once our Claims Resolution Specialist reviewed the medical records, it was clear that the hospital was unable to discover the cause of this medical incident. However, the way the Attending Physician wrote his notes in the medical records, there was medical certainty that pre-existing conditions were the cause of this medical incident and that is why the claims were denied. The claims department processes claims electronically based on the diagnosis codes submitted by the doctors; without this information the claims department would not have an idea of what occurred or what caused it.

We then coached our customer on how to file a legitimate appeal, focusing on the fact that there are other medical conditions that can cause a Syncope and Collapse. These symptoms are associated with various illnesses such as dehydration, hyperventilation, low sodium, and even the act of standing up too quickly. That Syncope and Collapse are symptoms associated with people who would otherwise be considered healthy. Just because the insured has a past medical history of Diabetes and Hypertension does not and should not imply that those conditions caused the symptoms mentioned. Unless the insurance company can prove that their symptoms were a direct result of their pre-existing conditions in such a way that an otherwise healthy person would not experience such symptoms, they request that all claims be reconsidered and paid. Two months later, all the claims were overturned and paid.

Conclusion

Had our customer contacted Insubuy sooner, we could have helped as a liaison between our customer and the insurance company’s claims department to smooth out and speed up the claims process. Often times delays are caused by an oversight or with an expert advice, they are simple to fix in order to get things moving along quicker. Help with legitimate claims issues comes at no additional cost to you. Insubuy is on your side and we are here to help you, our customer!

Did you know?

Prices are regulated by law.

You cannot find a lower price anywhere for the same product.

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Why purchase insurance from Insubuy®?

Same Price. Better Service.®

There are many advantages in purchasing from Insubuy® and no disadvantages.

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Visiting USA?

Healthcare costs are very high in the U.S.

Buy U.S. based visitors insurance and enjoy your trip.

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Traveling abroad?

Did you know that your insurance may not cover you abroad or that it may only provide limited coverage?

Purchase travel medical insurance that includes emergency medical evacuation.

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New immigrant to USA?

You are not eligible to enroll in Medicare for the first 5 years.

Purchase new immigrant medical insurance to bridge the gap.

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Going on a vacation?

You could lose your non-refundable trip costs if you had to cancel your trip.

Buy a trip cancellation insurance package plan and be worry-free.

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Are you an exchange visitor to USA?

The U.S. Department of State requires all J visa holders to purchase compliant insurance.

Buy J visa medical insurance to meet your requirements.

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Traveling to Europe?

Schengen countries require most non-US citizens to purchase Schengen visa insurance.

Make an instant purchase online and get instant visa letter.

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Traveling frequently throughout the year?

You don't need to purchase travel insurance for every trip.

Purchase annual multi trip travel insurance for your travels.

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International student in the U.S.?

Most schools require international students to purchase health insurance.

Purchase international student health insurance that meets most school requirements.

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