How visitor medical insurance pays, key words, how to file a claim, why claims are denied, how to appeal and lower a bill.
Visitor medical insurance is private insurance for a trip. It is not like a US work plan. Each policy has its own rules, written in the policy document (the long contract). Read it before you need it.
Words to know
Deductible: what you pay yourself before insurance pays. With a $250 deductible and a $1,000 bill, you pay the first $250.
Coinsurance: a share you still pay after the deductible, for example 20%.
In-network: doctors and hospitals that work with your insurer. They often bill the insurer directly. Out-of-network: you may pay first and claim later.
Pre-existing condition: a health problem you had before the policy started, such as diabetes, high blood pressure or heart disease. Many plans do not pay for it.
Acute onset of a pre-existing condition: a sudden, unexpected flare-up of an old problem. Some plans pay for this, usually with a lower limit and strict rules (for example, care must start soon after it begins).
Explanation of Benefits (EOB): the insurer's letter saying what it paid and why.
How to file a claim
1
Call the insurer's assistance number as soon as you can, ideally before care if it is not an emergency.
2
Show the insurance card at the clinic or hospital.
3
Ask for an itemized bill: a list of every service with its code and price.
4
Get the medical records and the doctor's notes.
5
Fill in the claim form. Attach the itemized bill, receipts, records, passport copy and travel dates.
6
Send it before the deadline in the policy. Many policies have a time limit.
7
Keep copies of everything and write down every call: date, name and what they said.
Why claims are denied
The insurer says the problem is pre-existing.
Missing papers or a late claim.
The service is excluded, such as routine check-ups or regular medicines.
The plan limit is used up, or the policy dates do not match the care dates.
How to appeal
1
Ask for the denial reason in writing.
2
Read the appeal steps and deadline in the policy.
3
Write a short letter: the claim number, why you disagree, and the proof.
4
Ask the doctor for a letter, for example that this was a new problem or a sudden flare-up.
5
If the company is licensed in a US state, you can also complain to the state insurance department. This differs by state; see In your state below.
Lowering the bill
Check the itemized bill for mistakes or double charges.
Ask for the self-pay or cash price. It is often lower.
Ask for a payment plan with no interest.
Nonprofit hospitals must have a financial assistance policy. Ask for it and ask if visitors can apply.
Common mistakes
Telling the doctor "he has had this for years" without being exact. Give true, clear dates.