Who are the parties in visitors insurance?
There are various parties in visitors insurance transactions:
- You, the insured, or insured's authorized representative. Also, called the customer.
- Insurance broker such as Insubuy®
- Insurance administrator such as Tokio Marine HCC - MIS Group, International Medical Group (IMG), Seven Corners, Trawick International, Global Underwriters etc.
- Insurance carriers such as Lloyds of London, Sirius International, GBG, US Fire Insurance etc.
When do I contact administrator for claims related matters?
If you have a routine claims related query such as the status of the claim, routine questions about completing a claim form or submitting the documents, if the providers would like to verify the eligibility etc., you would contact the administrator's claims department. They deal with your claims on a routine basis. Insurance company simply carries the financial risk of insuring you and never deals with your claims. In fact, the insurance companies will not even have information about individual sales.
When do I contact Insubuy for claims help?
If your claim has been denied and if you feel that the denial was not fair and it should be covered, or it is stuck in the processing for a long time, in such circumstances, you can contact us and we would be glad to help you coordinate and/or expedite the claim processing for you.
What information do you need from me for you to help?
Please note that we don't have the access to your claims information. And the administrator is prohibited from sharing private health insurance (PHI) with anyone due to the federal law HIPAA unless they have a written authorization to release any information.
In order to help us help you, we need the following from you:
- Please describe in detail what exactly happened.
- If you are not the insured, please ask the insured to complete and sign the privacy release form and send it back to us. Please authorize 'All employees of Insubuy'.
- Please send us the copy of all correspondence with the administrator.
- Please send us the copy of all the medical records from all the providers that were sent to the administrator.
Why are you asking so much information from us? Why don't you get that from the administrator?
As explained above, administrators are prohibited from sharing such information. Therefore, you must provide that information to us, if you would like us to help you.
My parents have already left the U.S. They have given me the authorization. Can I authorize you for privacy release?
No. Authorizations are not transferrable. We need the privacy release authorization from the insured even if you initially purchased the insurance on their behalf. In some cases, parents may not be familiar with fax or scanning and may not know how to send the written authorization. However, we still need the written authorization from the insured only. They may seek help of someone else or they can send it by postal mail which will obviously cause further delays.
I have no idea what medical records the providers sent and I don't have them. How can I provide them to you?
Please get all the medical records from all the providers so that we can review them and guide you accordingly.
What kind of claims problem people usually get into?
Some people get the impression that the insurance companies make frivolous claims denials or drag the processing for too long for not justified reasons. However, that is really not the case. Please read the Claims Procedure FAQ for further details on how it works.
People usually run into the following types of issues:
- Claim is pending because the company didn't get the claim form from you which is required even if the provider billed directly. If you have not already done so, please do that at the earliest. It is the best to send it right away after visiting a provider, even before the company asks. You can download that from our Client Center.
- Provider has not sent the medical records that the company needs to evaluate the eligibility. In that case, please coordinate with the providers to make sure that they sent it.
- Even after provider has sent the medical records, company may say that they have not received them. That could be due to many reasons. In that case, get the records from the providers and send them by trackable method such as courier, certified mail or offer to pay the cost of doing so to the provider.
- Claim was denied due to pre-existing condition or other ineligible condition. Sometimes, it falls in a grey area and we can help you evaluate that neutrally.
- Charges were billed (coded) incorrectly by the provider and therefore, denied. e.g., the provider billed sick visit as wellness visit. The only option is to work with the provider to get them corrected and resubmitted for processing.
- You need help understanding the communication from the company including the explanation of benefits.
Can I just give you the authorization so that you can completely deal with my claims and I don't have to deal with at all?
Unfortunately, we are unable to do so for various reasons.
I understand that my claim is not an eligible claim. However, since I bought the insurance through you, can you somehow get that paid?
No. We can only help you with the legitimate claims. We can't do anything to get ineligible claims paid.
You have this claim problem help FAQ. Do lot of people face claims problem?
No. That is not true. Vast majority of the people face no problems. However, neither us nor you would hear about them or read about them. The only people you would hear from would be the ones that have faced some kind of problem. Based on the number of policies we sell, we see that number of people who run into any kind of claim problem is less than 0.01%.
I see a lot of negative reviews about a particular company or product. Is it that bad?
No. Unfortunately, reviews are very tricky.
- If people see a lot of negative reviews, they can say the company is bad.
- If people see a lot of positive reviews, they can say that those reviews must have been written by the company itself or their brokers and therefore, fake reviews.
- If people see no reviews, they can say that there are no reviews and therefore, no one must be buying that insurance.
Therefore, there is really no way to justify any reviews. In any case, the fact is that most people only write about negative experiences. Therefore, you may feel that way. However, in reality, compared to the number people who purchase the insurance, and looking at the volume of reviews, they are not even 0.001%. E.g., if 100,000 bought the insurance, and you see 5 reviews and 4 are negative, those are the only people who bothered to write anything. Vast majority chose not to write anything while the fact is out of them, several thousand people got their claims processed smoothly. But you only see those 4-5 reviews.
My friend told me that he bought a particular insurance and they denied his legitimate claim. Why should I buy that plan again?
Many times, what you hear from a "friend" is not accurate. We have seen over and over again, many of their "friends" do not tell the complete and accurate story. Without looking into the complete details of the particular case, it would be extremely difficult to make any comments. And without proper authorization for everyone involved, we or the company can't discuss any details of those claims.
I bought the fixed coverage plan and the insurance company paid only a small fraction of the actual expenses. Can you get them to pay more?
No, they are supposed to pay only according to the schedule of benefits in the fixed coverage plans. As long as they paid that, there is nothing more anyone can do. There is no way to get more payments. Therefore, we always advise everyone to buy comprehensive coverage plans only.
I have not purchased the insurance through you. Can you please help?
Unfortunately, we are not allowed to interfere if you have not purchased through us.
I promise to buy insurance through you the next time, if you help us with our current claim for the insurance that we purchased from somewhere else. Can you help us?
If you purchase through us the next time, we promise to help you the next time if you have problems with it.
I know that my claim is ineligible and the claim rejection was justified. However, as I bought insurance through Insubuy, can you use your influence to get the claim paid?
No, that is not possible.
You work with the insurance company every day and you are just going to stand by the insurance company's decision to maintain relationship with them. How are you going to really help me?
We don't work that way. As a broker, we work for you, not the insurance company. If you have a legitimate claim, we will try our best to help you with it so that it gets paid. However, if you don't have a legitimate claim, we will honestly advise you of the same.
We don't get paid by the insurance company based on whether certain claims are paid or not. Therefore, we have no such financial incentive either to favor them in an unfair manner. Morever, if you are happy with our service, you will refer more friends to us. Therefore, it is in our best interest to give you the accurate and honest advice, even if you are not going to be happy with it at this time.