Visitors Insurance - Claims help FAQ

There are thousands of brokers that sell visitors insurance. What is the advantage of buying from Insubuy? If you have legitimate claims issues, we have a dedicated 'Claims Resolution Specialist' team that will help you resolve your claims. At no cost to you, they will work with you to coordinate your claim with the insurance company.

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 WorldTrips, International Medical Group (IMG), Trawick International, Global Underwriters, Azimuth Risk Solutions, Travel Insurance Services (TIS), Petersen International Underwriters (PIU), GeoBlue, etc.
• Insurance carriers such as Lloyd's of London, SiriusPoint Specialty Insurance Corporation, GBG, US Fire Insurance, Crum & Forster SPC, Allied World Assurance Company, Nationwide Mutual Insurance Company, Brit Syndicates Limited, 4 Ever Life International Limited, HDI Global Specialty SE, 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. The 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 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:

1. A completed and signed authorization form from the insured authorizing "All Employees of Insubuy" for the privacy release and discussion of the claim with the insurance company. Please note that it must be from the insured and not from a representative, such as a family member, friend, etc.
   
   In absence of that, due to a federal law called HIPAA, the insurance company is not allowed to talk to us.
2. Complete medical records from all the providers used. Please do not send the discharge summary or visit summary, as it does not the necessary information and is not useful.
3. Copy of the claim form that you submitted to the insurance company.
4. Copy of the explanation of benefits (EOBs) that you received from the insurance company, if any.
5. Complete description of what exactly happened. This can be either in written form, or you can describe over the phone.

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.

When I buy an item from Amazon or Costco, they take complete responsibility, and if I am not completely satisfied, they take the returns and refund me the money. Why don’t you take the responsibility for claims in the same way?

Retailers that offer tangible consumer goods have complete control of selling the goods that physically are in their warehouse or store, and they are free to make their own policies for returns or exchange.

Insurance is a completely different industry that is heavily government-regulated and cannot possibly operate in the same way. If you are facing claims issues with the insurance company, we need written authorization from the insured (not the buyer, if they are different) to discuss the matter with the insurance company.

Additionally, we need the documentation (medical records from providers and copies of correspondence with the insurance company) to assess your situation and advise you accordingly. Insubuy does not have access to any of the that information, and insurance companies as well as the providers (hospitals and doctors) are legally prohibited from sharing that with us.

Insubuy cannot control the actions or service provided by the insurance company, which is a third party, independent of Insubuy.

That does not mean Insubuy does not take any responsibility. However, we must follow the rules and regulations of the United States, including the federal law HIPAA. Therefore, your cooperation in providing necessary authorization and documentation is required. If you have an eligible claim, we will do everything to get it approved. If it is not, we will explain why. But we will not know that without your cooperation.

What is HIPAA?

HIPAA stands for Health Insurance Portability and Accountability Act and was enacted in 1996. According to HIPAA, the provider (doctor, hospital, lab, etc.) is legally prohibited from sharing any medical records with anyone other than the patient without written release.

To determine whether the insured has an eligible claim, the insurance company needs the medical records from the provider, which they can release only after the patient’s written authorization. The insurance company is not allowed to share that with anyone. If a representative (such as a family member or friend) wants to discuss claim with the insurance company, the insured (patient) must provide a written authorization of privacy release.

Similarly, if an insured wants an insurance broker to discuss the claim issue with the insurance company, the insured (patient) must provide a written authorization of privacy release.

In 2020, the HIPAA violation penalty is $59,522 per violation. Therefore, no doctor, hospital, or insurance company would knowingly violate that.

I don’t have time to follow all the rules in getting you the authorization and the documents. I bought the insurance from you, and I need you to take care of everything. Until then, I am just going to write negative reviews about Insubuy.

Writing a negative review about Insubuy does not compel the third-party insurance company to pay your claim by any means.

As a broker, Insubuy always works in the best interest of our customers, including you, and is more than happy to help with your eligible claims.

However, according to the reasons described above, we must receive the written authorization from the insured (patient) as well as the necessary documents for us to assess the situation and help you accordingly. In absence of that, we have no possible way to help you.

I don’t have time to talk to you about my mother’s claim problem. Why don’t you just take care of everything?

Unfortunately, if you are unable to spare time to talk to us, explain the problem, and provide us with the necessary authorization and documents, there is no way for us to help you with your problems with the third-party insurance company, independent of Insubuy.

My parents have already left the U.S. They have given me the necessary 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 from someone else or they can send it by postal mail, which will obviously cause further delays.

My parents don’t have access to the printer. Why don’t you have a mechanism to do electronic authorization?

Insubuy can only provide you with the privacy release authorization forms that are prepared and provided by various insurance companies. Insubuy cannot make its own forms, as they would not be accepted by the insurance company. Therefore, to enable us to help you, please get the signed authorization from the insured.

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 unjustifiable reasons. However, that is really not the case. Please read the Claims Procedure FAQ for further details on how it works.

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  Claims Procedure FAQ

  Read Article

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 as soon as you can. It is the best to send it right away after visiting a provider, even before the company asks. You can download that from our MyAccount.
• 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 again and send them by a 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 any of it 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.

There is really no way to justify reviews. In any case, the fact is that most people only write about negative experiences. However, in reality, if that one negative review is compared to the other people that purchase the insurance, the negative review is 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. The vast majority of those that purchased the insurance choose not to write anything at all. Thousands of people have their claims processed smoothly, but you will 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 tell you that you do not have a legitimate claim.

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.