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Claims Appeal for a UTI, Sepsis and Kidney Failure

Most people inviting their parents or other relatives to visit the United States already know how expensive healthcare is in the United States, so they purchase visitors insurance for their visitors. Obviously, most customers lack the medical knowledge, as well as the ins and outs and the complexities of the insurance policy they chose. In times of need, the expertise of a willing broker, such as Insubuy, is needed by customers to help get legitimate claims paid. Our claims resolution services provide you with valuable support and assistance at no cost.

Reason for Claim Appeal

One of our customers purchased a visitors insurance plan and less than two weeks later needed to seek medical treatment which lead to a diagnoses of a Urinary Tract Infection, Sepsis and Kidney Failure. These are medical conditions that normally take more than 2 weeks to develop and manifest in the body. Due to the severity of this condition there was a medical certainty that it developed before the effective date of the plan and are therefore pre-existing conditions. All the claims were denied due to pre-existing condition.

After Contacting Insubuy

The insured contacted Insubuy for help immediately after they received notice of the denied claim. Our Claims Resolution Specialist reviewed the medical records and found it odd that the history of present illness and what the insured told the doctors the day of service were missing from the medical records. These are some of the most important statements when it comes to filing an appeal. We also learned that the insured had a full physical with blood work the week before they flew to the United States which indicated that none of these conditions existed at that time. It was overlooked that the customer also had been infected with the flu. We coached our customer on how to write an appeal focusing on the fact that they got the flu after the effective date of the plan and simply had very severe reactions and complications as a result of the newly contracted influenza virus.

An appeal was submitted to the claims department by the insured requesting all claims be processed for payment. To support their appeal they included the medical records from India, evidence of how a severe case of the flu can cause all these symptoms and diagnoses, proof that the medical conditions diagnosed while visiting the United States did not exist prior to the effective date of the policy, and ended by requesting payment of the claims unless the claims department can prove within reasonable medical certainty that the medical conditions did exist prior to the effective date of the policy.

Two months later, the denial was overturned and the claim was paid to the policy maximum of $50,000. With the help from Insubuy, our customer got $50,000 of medical bills paid. The only unfortunate part of their experience is that the medical bills were greater than their selected policy maximum of $50,000, so the insured was still responsible for paying everything above $50,000.

Conclusion

As healthcare costs are very high in the U.S., a $50,000 policy maximum is not enough coverage for anything serious. To better protect yourself, we recommend purchasing at least $100,000 of coverage, preferably $500,000 if a higher policy maximum is available for a given age.

While it is easy to think that all insurance brokers are the same and it’s fine to purchase your insurance from any website that comes up in the internet search results first, it is very important to understand the types of after-sales services a given broker is willing to provide and the quality of the services they assure you. With around twenty years of relevant experience, Insubuy’s expertise in resolving legitimate claims issues is unmatched in the international visitors insurance industry. Contact us for any assistance you need.

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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