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4 Steps To Take If Healthcare Travel Insurance Denies Coverage

You’re visiting the US from another country and unfortunately end up in the hospital. Thankfully, you bought travelers health insurance so you should be protected from outrageous costs. However, you’re shocked when your travel insurance denies coverage and you receive a hospital bill for tens or hundreds of thousands of dollars.

If this has happened to you, you’re not alone. At resolve we work everyday with visitors to the US who did everything they could to ensure they had healthcare coverage and were still stuck with enormous medical bills.

Fortunately, you don’t just have to pay the hospital. Here are the 4 steps to take to fight these bills and lower the amount you owe.

Step #1: Appeal the denial with your insurance company

Unfortunately, Healthcare Travel Insurance companies in the US are not regulated by the Affordable Care Act (ACA). Because of this, they are free to deny medical coverage for all kinds of things, including pre-existing conditions.

Like all other health insurance companies, there is an appeals process you can go through to try to get your medical care covered. However, travel insurance companies are heavily incented to continue to deny coverage – after all it means they have to pay less money. Because of this, appealing coverage denials with travel insurance does not work very often.

However, it’s still worth doing. There are 2 steps to appealing coverage denials:

  1. Understand the appeals process
  2. Prepare your appeal

Understanding the Process:

Most appeals processes allow for 2 internal appeals, and an external appeal. Note that the internal appeals are reviewed by employees of the insurance company – so they have an incentive to continue to deny coverage if they can. Even the external “neutral third party” appeal is usually done by a company that has a contract with the insurance company so it’s not entirely neutral.

To get the process started all you have to do is request an appeal (the Explanation of Benefits provided by your insurance company should give step by step instructions on how to make that request). If denied, you can request another appeal.

If still denied – you can write a request for a third party appeal. Remember, these “neutral” third parties are often in the pocket of the insurance company – which is intensely frustrating.

If your third party appeal is denied, you have the option of complaining to the State Insurance Commission or State’s Attorney General’s office. Unfortunately, it’s very unlikely that they will be able to do anything about it – but if enough consumers file these types of complaints, it may motivate lawmakers to create better protections for consumers on insurance coverage.

Prepare Your Appeal:

You want to write a clear and concise letter outlining your reasons for appealing the denial. Work through your logic step by step and make it as clear as possible. In addition, provide supporting documents for your claims (doctors notes, medical records, etc).

This step is tricky. It’s important to address very specifically the reason for denial and why that reason is incorrect. You can find the reason in your Explanation of Benefits that your insurance company should have sent you (if you don’t have one, call them up and request one – they have to give it to you).

Step #2 Hospital Financial Aid

All non-profit hospitals, and many for-profit hospitals, have mandates where they need to provide a certain amount of financial aid to the community per year. If you still have outstanding medical bills, it’s always worthwhile to see if you might qualify.

Most hospitals will post financial aid guidelines online. Read these guidelines carefully, as many times there are income guidelines AND exceptions for individuals who may be outside the income guidelines but have a very large bill.

You can also call the billing department on your hospital bill and ask to be transferred to the financial aid department. There you can walk through your individual situation with a financial aid representative to get a sense of whether you might qualify and how to go about the process of applying.

Step #3 Medical Bill Negotiation

The dirty little secret of hospital bills is that they’re entirely negotiable. The initial charge on the bill, called the chargemaster rate, is a sucker rate. The government, through medicare, doesn’t pay this rate, and insurance companies negotiate their own medical bill rates. This rate is so divorced from reality that insurance companies negotiate a multiple of the medicare rate rather than a discount off the chargemaster rate. That is, they ignore the chargemaster rate entirely when negotiating.

Unfortunately – it takes a lot of time and understanding to realize this, and hospitals far too often dupe uninformed people into paying the chargemaster rate. You can be better prepared and better armed when negotiating.

The trick is to calculate what a “fair rate” would be, and then send in written letters requesting that you be given that fair rate. You can calculate a fair rate by using Healthcare Bluebook and Fair Health to find what a “Usual and Customary Rate” and average insurance negotiated rates are. If you’re feeling ambitious, services like Find-A-Code will also allow you to look up the medicare rate.

For more information on how to negotiate these rates, check out our Guide To Negotiating Your Medical Bills. If you’d like to better understand how to calculate these rates, read  The Top 5 Ways To Find Out How Much You SHOULD Pay For Your Medical Bills. For more tips on negotiating, read 7 Tips to Negotiating To Help Lower Your Medical Bills.

Step # 4 Hire a Medical Billing Advocate

At the end of the day, the above can become an enormous time suck. If you don’t have the time to research and understand every nuance of the process, it may be worthwhile to hire a Medical Billing Advocate. While they cost money, good medical billing advocates understand the process in-depth and will more than make up for their cost in additional savings they may find.

Our experienced medical billing advocates have saved hundreds of patients millions of dollars. If you’d like a free consultation to see how much we might be able to save you, call us toll free at 877-245-4244 or Click Here to schedule a Free Consult.

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