Claims Submission Process in International Medical Insurance

By following the below claims submission process in international medical insurance you can get your claim processed efficiently and quickly.

International Medical Insurance works differently from a traditional domestic health insurance that many people get through their employer. It is required that you file a claim form, even if the provider billed the insurance company directly. However, that does not mean that you have to first pay and file for reimbursement.

Process

• Download the claims form from MyAccount.
• Fill the form completely. The claim form may be completed by you or your representative.
• Follow the instructions given in the claim form.
• Complete the form in its entirety. Be descriptive in regards to services the doctor performed, past medical history, date the condition and/or symptoms were first experienced and addresses of prior physicians. Remember, if a question applies to your particular situation, please answer it. Make sure to include your email address.
• Mail the claim form and the accompanying documents to the address mentioned in the form. You can also submit the claim form via fax or email (provided in the claim form) as long as they are clear, legible and do not appear to be altered.
• When submitting prescription drug charges for reimbursement, you are required to send more than a cash register receipt. Please forward information which lists your name, date of service, quantity dispensed, price, prescribing physician and name of pharmacy.
• In case you made the payment up front,
  • Attach all original itemized bills, statements and invoices for services and supplies.
  • Please make sure that all documents indicate claimant's name, date of service, diagnosis and the itemized charges.

  If you are requesting the payment on behalf of someone else such as for your parents or a minor child, you can write that the payment should be made out to you. You can either write that in the claim form itself (wherever you find space) or you can enclose a separate cover letter explaining it.

• Enclose the travel documents:
  • Copy of your passport that includes the demographic page, visa page (if required) and entry stamp.
  • Copy of I-94 or any other proof of legal status in the U.S. (if the claim is incurred in the U.S.)

  All the companies do not always require these items. However, it is best to send them up front to expedite the process, just in case they need to determine the eligibility of your insurance coverage.

Tips

• Keep copies of all the documents submitted. There is no guarantee that your submission will always make it to their offices via the postal service.
• If requesting a wire transfer, the claims administrator must have complete banking information on file before they can honor that request. Please note that not all companies provide such service.
• You need to submit a new claim form for each family member AND for each new medical condition being treated.
• You need to file the claim form within a specific duration, usually within 60 to 90 days from the date of service. However, you are recommended to file as soon as you avail the medical service.
• After you submit the claim, you should follow up with the insurance company periodically to make sure that everything is going smooth.
• If you have any questions regarding completing the claim form or you want to check the claim status, you should contact the phone number listed in the claim form itself.

Processing

The insurance company will process the claim usually within 2 to 4 weeks after receiving the complete information about the claims, including medical records from the treating providers. If additional information is required, you will be informed with the explanation of benefits. You should follow the instructions carefully and arrange the documents submitted to the insurance company as soon as possible. Many claims are pending for a long time solely because the insurance company is waiting for the provider to send the medical records. If that is the case, please follow up with your provider to make sure that they send the required information as soon as possible.

Once the claim is processed, for all eligible claims, the insurance company will make the payment. If you paid up front, the insurance company will reimburse you. If the provider billed the insurance company directly, they will be paid directly. In other cases, the payment made out is the same and the possibility of the particular expense being covered is the same. In other words, whether you mail the documents or the provider mails the documents to the insurance company, the rest of the procedure is the same. It is not true that if you had to pay up front, the insurance company will find one or another excuse not to pay you.

In either case, you will get the explanation of benefits that would describe the services rendered and filed for claim, what charges were covered, what charges were not covered and why. It may also list your due amount that you should pay to the provider, if you have not already paid.