A denied claim can be worrying, but if you find yourself with a denied travel insurance claim, you have several options for resolution at your disposal.
Following the proper steps to correctly file a claim and understanding the most common reasons claims are denied can also set you up for success before filing a claim to help ensure a positive outcome.
If your claim was denied and you feel the decision was unfair, you have a few courses of action you can take to reach a resolution you’re satisfied with.
If you receive a message stating that your claim was denied, don’t panic, as you typically have several options for recourse. It’s helpful to view a claim denial as the start of a negotiation process rather than a final event.
Generally speaking, around 20%-30% of claims are denied by travel insurance providers due to simple errors like missing paperwork or clerical errors. Plan on getting to the bottom of why your claim was denied and getting into the mindset of finding a solution to the issue.
Once you have received notice that your claim was denied, reach out to your provider for further clarification. Claims denials can typically be classified as either a hard denial or a soft denial.
A soft denial typically means that the provider needs more information in order to resolve the claim. These are easier to solve than a hard denial, which typically requires you to open an official request for review via an appeals process.
If you received a hard denial and plan to appeal, you may want to request a full copy of your case file along with a letter stating the reason for your denial.
Most travel insurance companies allow you to appeal a denied claim and stipulate a deadline of 30, 60, or 90 days for filing your appeal.
That said, the exact process differs by provider, so be sure to contact your provider directly to learn their specific appeal process, as well as understand the necessary deadlines and timelines for submitting paperwork.
Once you miss this deadline, your claim will be considered closed for good, so it’s important to work quickly to follow up with an appeal.
The appeals process typically involves submitting a new claims form with additional third-party documentation that supports your case.
For example, one of the most common scenarios we see with claims involves needing additional support from the treating physician. This may be to validate that your treatment was an emergency, considered medically necessary, or was unrelated to a pre-existing health condition. All of these are common reasons medical claims may be denied.
It's also helpful to draft a supporting cover letter detailing the additional documentation you are attaching and why you believe your claim is valid.
All travel insurance policies sold through Squaremouth come backed by our Zero Complaint Guarantee, which is our commitment to ensuring that your claims are treated with fairness and integrity.
If you have an issue with your claim or simply need help filing a claim, our Zero Complaints team is here to act as a claims advisor, advocate, and mediator.
With your permission, our direct connection between you and the provider can allow us to:
If your claim was unfairly denied, our team of licensed claims adjusters will examine your case and work with the provider to try to find a solution. Over the years, our team has successfully appealed claims on behalf of our customers and has occasionally been able to overturn decisions in favor of our customers.
Travel insurance, like other forms of insurance, is governed at the state level by each state’s Department of Insurance. If you believe that repeated attempts at a resolution have been unfairly denied by a provider, you can file an official complaint with your state’s Department of Insurance and request a review.
That said, once a claim has been escalated to the state’s Department of Insurance, Squaremouth can no longer intervene or assist.
Be prepared to provide documentation and a copy of communications with your travel insurance company in the event of an external review.
Travel insurance claims can be denied for a myriad of reasons. Understanding common reasons why people are unsuccessful in their request for reimbursement can help you avoid the same mistakes and get your claim approved.
Missing or insufficient documentation is the most common reason travel insurance claims are denied. Typically, the claims agent will go back and forth with you to request additional documentation before denying the claim outright. Diligently requesting, preparing, and sending follow-up documentation can help ensure you get your claim resolved quickly and efficiently.
Another common reason claims are denied comes down to the specific event or scenario falling outside of your travel insurance coverage. Reading, reviewing, and fully understanding your policy's coverage exclusions can help you avoid filing claims for scenarios not covered by your policy. Keep in mind that pre-existing conditions, high-risk activities, foreseen events, named storms, and alcohol-related incidents are all commonly excluded from travel insurance policies and could lead to denied claims.
Most travel insurance providers have strict deadlines on when a claim needs to be filed. Waiting too long to submit a claim could make you ineligible for reimbursement. Be sure to review your policy for information regarding claims deadlines. Sometimes these deadlines vary depending on the type of event and claim being made. When in doubt, contact your provider for clarity on claims deadlines and timelines.
Travel insurance is designed to cover unforeseen events, but many people unknowingly file claims related to foreseen or known events that cause the claim to be denied. Once again, understanding your policy's coverage and buying your policy early, before an event becomes known or foreseen, can help you avoid a denied claim. The most common type of foreseen events relates to severe weather events and named storms.
Visiting the hospital for routine care or checkups, elective treatments and surgeries, or medical tourism are all common reasons travel insurance claims are denied.
These items are not covered by most travel insurance policies, as travel insurance is designed to cover unforeseen medical emergencies. To avoid a denial, avoid filing a claim for elective treatments and routine care, and be sure to provide proper documentation that shows any emergency medical treatment was brought on by unforeseen circumstances.
Find your provider's contact information to file your claim.
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