Receiving medical care is a stressful enough time in anybody’s life; but imagine needing treatment whilst living overseas but your health insurance company says that the claim is not covered and that they will not pay. Here are the most frequent reason for expat claims not to be paid.
Policy limitations: The top reason for a claim denial within the global community is not that the claim itself is excluded but the amount the claim is for is not covered by the expat health insurance policy.
Expatriates are often subject to higher medical costs when they are living outside of their country of citizenship and should make sure that they have an appropriate insurance plan in place to cater for these costs. Arranging a local plan may not be sufficient for an expat and they should look to invest in an international private medical insurance coverage for themselves.
Pre-existing Medical Conditions: A pre-existing medical condition is a condition that you had prior to buying your health insurance and more often than not, international health insurance companies from around the World will not cover these at all.
This can be a confusing exclusion on many insurance plans as the definition can change from company to company. Make sure you are open and honest about your previous medical history and if in doubt, ask! Whether it is covered or not, you need to know what risks you are exposed to whilst living overseas.
Medical Necessity: Health insurance companies will often question whether medical treatment is required or not or even if the care will have any bearing on the wellbeing of the patient. Many insurance policy wordings will have exclusion relating to cosmetic treatment, holistic treatment or may blanket exclude anything they deem unnecessary with the term “medical necessity”.
Medical necessity is debatable and if the insurance company declines your claim on this basis and you feel it is unfair, don’t give up; It is sometimes a case of the insurance company having not been informed of how necessary the treat actually was. Ask the treating doctor to explain it clearer in a way that relates to your overall wellbeing and the symptoms you were suffering from.
Health insurance companies often have a bad reputation for wanting to get out of paying a claim. On the whole, this is underserved and the companies can be reasonable and will authorize payment if there is cover in place.
One simple rule is communication; if you are concerned about anything discuss it with the company prior to buying the insurance. If you need treatment, advise them beforehand and they will be able to confirm the coverage under the policy or even guarantee it directly with the medical facility.
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