Healthcare is very expensive and confusing in the United States. Without proper visitors insurance, it is not possible for most people to pay out of their pocket for moderate to severe healthcare needs. Even with visitors insurance, it may be difficult to understand the terms and conditions of an insurance policy to know exactly what is covered and what is not. Therefore, even though the same visitors insurance can be purchased at hundreds of places, the expertise and the willingness of the broker can make a big difference. Insubuy’s Claims Resolution Specialists are available to their customers at any time after the purchase to help with any legitimate claims issues.

Reason for Claim Appeal

One of our customers slipped and fell down stairs and injured themselves. Five days later, she experienced chest pains and sought medical treatment. After getting an EKG test at the doctor’s office, she was told to go to the Emergency Room immediately. She was admitted to the hospital, where she received cardiac tests. The customer was discharged the next day.

Eleven days later, the customer’s arm and shoulder were in a lot of pain, and she sought medical treatment again. An X-ray was done and she was diagnosed with a tendinitis injury as a result of the fall and referred to a chiropractor for treatment. The entire claim was denied due to a pre-existing condition of hypertension.

Attempts to Appeal Before Contacting Insubuy

Our customer appealed on her own, focusing on the chiropractic treatment for chest pain. That part of the claim was overturned and paid, but the insurance company upheld its decision to not pay the majority of the claims due to pre-existing condition of hypertension.

After Contacting Insubuy

Then, our customer contacted Insubuy for help with the claim. Our Claims Resolution Specialist, upon reviewing the medical records, quickly discovered the issue. The initial doctor she saw failed to mention anything about the fall. The medical records only stated that the purpose of the visit was chest heaviness and the diagnosis of hypertension.

We coached our customer on how to get the medical records corrected and to file another appeal. The doctor made a legitimate addendum to the medical record to state that the primary admitting diagnosis was chest pain/arm pain from a fall instead of hypertension and chest pain. The doctor made it clear the visit was due to an injury and removed hypertension from his diagnosis. The corrected medical record was sent to the claims department, and the entire denial was overturned.

The next issue was that one of the providers was out of network. It took 3 months of negotiations to get the bill lowered to an amount the insurance company was willing to pay. Once these negotiations were finished, the entire claim was paid thanks to the help that Insubuy provided.

Conclusion

Insubuy’s Claims Resolution Specialists are willing and eager to help customers pursue legitimate claims. They have both the knowledge of the complexities of visitors insurance and the experience to review a claim and pinpoint any problems or inconsistencies. Choosing the right broker is essential not only to purchasing the visitors insurance or travel medical insurance plan that best fits your needs, but also to being able to use that insurance for its intended purpose. This service comes at no additional cost to our customers.