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Claims Appeal for Flu Treatment with Pre-Existing Conditions in Visitors Insurance

Claims Appeal for Flu Treatment with Pre-Existing Conditions in Visitors Insurance

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Healthcare expenses in the U.S. are among the highest in the world. Therefore, it is always advisable to purchase comprehensive visitors insurance to protect yourself.

The subject of insurance is very complex in general, and just like any insurance, visitors insurance products have many terms and conditions in the certificate wording. It may be very difficult for a common person to understand the intricacies of the subject matter without ever having studied it before. When you’re dealing with a denial of your claim, that is when Insubuy’s Claims Resolution Specialists are ready to assist you to ensure that you get your eligible claim paid.

Even though visitors insurance is available from many websites and the prices are exactly the same for the same insurance plan, our expertise in helping the customer select the right product can be very valuable. Even more importantly, if the customer runs into any legitimate claim issues, our willingness to help goes a long way and it can make a big difference between the claim getting paid or not.

Reason for Claim Appeal

The insured had multiple, very severe pre-existing conditions. However, the hospital failed to give the insured a medical diagnosis. There was no doubt that the symptoms the insured had were the same symptoms of his multiple pre-existing conditions. Therefore, it was very easy for the insurance company to claim the symptoms and the reason they went to the Emergency Room were either from pre-existing conditions or the complications of pre-existing condition – both of which are not covered. This visit resulted in a $58,000 plus claim that was denied by the insurance company.

After Contacting Insubuy

As the customer was not able to deal with the claims appeal themselves to directly try getting it approved, they reached out to Insubuy for help. After the customer gave the necessary authorization and medical records, Insubuy’s Claims Resolution Specialist looked into the details of their medical records.

Upon reviewing the medical records, the claims department’s perspective was understood. However, the claims department missed the fact that they thought he had the flu and the doctor had tested him for it, the result of which came back positive. All the symptoms they had experienced were the same symptoms of the flu. The certificate wording of the policy states that there must be reasonable medical certainty that the insureds claim was the result of a pre-existing condition.

Insubuy’s Claims Resolution Specialist coached the client on what to focus on, the medical terminology to use, and how to write an appeal letter based on the fact that the flu symptoms did not exist prior to the effective date of the policy. In their letter they requested all claims be processed for payment unless the insurance company can prove within reasonable medical certainty that it did and that there was medical certainty that the claim was the result of the flu. By using the right words and narrowing the focus, the claims department overturned their decision and paid the claim up to the policy maximum.

Conclusion

Knowing the intricacies of the visitors insurance certificate wording and the experience of dealing with many customers on a daily basis for many years makes a significant difference in helping a customer handle their unique situation. Insubuy’s Claims Resolution Specialists do exactly that and their expert help is available to our customers for legitimate claims issues at no additional cost. Therefore, choosing the right broker is crucial while deciding to purchase visitors insurance for USA or travel medical insurance for traveling anywhere outside the home country.

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.

Learn More

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