There can be various reasons why visitor insurance claims are denied, but if you feel like it was wrongly denied, you can file an appeal. An appeal is the process of explaining why a claim should be paid to your insurance company whether by more proof, a letter, or clarification. Frustration is understandable when a claim is first denied, but it’s better to be prepared for this possibility instead of reacting out of anger should it happen.
What is a Visitors Insurance Appeal?
An appeal can be done through a form, a letter, or a phone call by either the insured or the doctor. When submitting an appeal, you need to gather as much information as possible to show your case. If the denial was simply a clerical error then showing the mistake will be easy, but if there is more to the denial that needs to be proven, it’s up to you to bring it all to light. Insurance companies are used to the appeal process and will often grant an appeal if they were wrong. But any missing information will be grounds for yet another denial. Call the insurance company or your travel insurance agent to ask any questions you have about the denial and the appeal process. Also look at your policy documents for rules, exceptions, and the claim process.
How to File an Appeal?
After a claim is submitted, the first form you will receive is an Explanation of Benefits (EOB). The EOB lists your claims by date and indicates whether insurance will pay or not. In the case of a denial, an explanation is given for the reason of the denial. Usually a description for how to file an appeal is on the EOB as well. But you can always call the insurance company to get the most up to date process of appeals. The first thing you should always do is double check the reason for the denial of your claim.
- Do they think you have a pre-existing condition you never stated?
- Was the claim filed late?
- Was their insufficient information submitted?
Regardless of the reason, double check it with the policy documents and your original claim. If you feel you have a valid reason for the claim to be paid, that’s when you will start an appeal. Insurance companies will likely have you submit a form or call a direct number. You’ll answer questions, submit more proof, and resend all of your original claim material.
Keep in mind that an appeal process is a long one. Once an appeal is submitted, the insurance company then has to verify your information and decide whether or not to pay. They may tell you that the submission process can take a certain amount of time (likely 30-90 days), so mark the last day on your calendar to follow up with the company to make sure everything was processed.
If your claim is still denied after an appeal, there are more steps you can take that will eventually take you to small claims court. However, most claims are settled after an appeal.
Tips to File Visitors Insurance Appeal Accurately
- Always save your documentation.
- Read your policy documents thoroughly.
- Submit claims and appeals within the right time frame (don’t wait too long).
- Make sure your claim is covered before you submit.
- Always give more information than necessary.
- Get the denial in writing even if you speak on the phone.
- Don’t be afraid to ask questions. Speak with a representative, a manager, and even higher in the insurance company if necessary.
Remember that you have a right to file a claim and to file an appeal. If you believe you are entitled to the coverage you submitted for, then you should file an appeal regardless of the denial explanation.