It is extremely important to purchase travel insurance when traveling overseas. If you have relatives or friends visiting the USA, you must purchase appropriate travel medical insurance, as the cost of healthcare is extremely high in the US.
Becoming sick or being injured while traveling could ruin your vacation, but having your claim denied can make matters worse. This article will help you understand the common reasons why claims are denied.
Claim Occurred Before the Effective Date
Of course, travel insurance or any insurance for that matter, would provide coverage for legitimate claims if it were effective at the time of the claim.
Many people mistakenly choose the coverage effective date as the date they will reach their destination. If you are traveling half way around the world, your international travel start date may be different. If you get sick or injured while traveling and your insurance is not yet effective, the insurance company would obviously not pay. The possibility of some things happening when traveling is greater, such as swollen legs, food poisoning or stomach upset, injuring your back or wrist while picking up heavy luggage, or a number of other issues that could occur.
In addition, some people wait until they are already sick or injured before buying the insurance. At this point, no insurance can afford to pay for such claims.
Not Sending a Claim Form
Even if the medical provider billed the insurance company directly, you must file a claim form as well because the claim form is used for more than just reimbursement purposes. The insurance company can't begin processing your claim until you file a claim form. To expedite matters, you should file a claim form immediately after seeking medical treatment.
Missing Medical Records
Insurance companies cannot determine the eligibility of a claim until they receive complete medical records from the treating providers. After the insurance company sends the request for medical records, some providers delay sending them or simply don't send them at all. If your claim is pending due to missing medical records, it is in your best interest to contact the provider(s) and coordinate with them to make sure that they send them at the earliest.
Timely Claim Filing Limit
Each insurance company has a deadline for filing a claim that you must follow. If you don't file a claim within the stated timeframe, your claim could be denied, even if it is a payable claim. This limit varies by plan but may be 60 days, 90 days, or a different duration. To be safe, you should file your claim as soon as possible, preferably right away after seeking treatment.
Routine or Preventive Care
Short term travel medical insurance is meant to generally cover unexpected and unforeseen sicknesses, and injuries or accidents that occur after the effective date of the policy.
If immediately after arriving in your destination country you visit a doctor for a thorough physical checkup, preventive blood work or diagnostic tests, buy expensive prescription glasses, or otherwise indulge in a medical shopping spree, travel medical insurance is not going to cover that.
Travel medical insurance plans are generally not designed to cover pre-existing conditions. Some plans cover acute onset of pre-existing conditions up to a certain amount for persons below the age of certain years.