Visitors Insurance - Claims help FAQ

There are thousands of brokers that sell visitors insurance. What is the advantage of buying from Insubuy? If you have legitimate claims issues, we can assist you in getting in contact with the correct party and provide after-purchase support. 

Who are the parties in visitors insurance?

There are various parties in visitors insurance transactions:

• You, the insured, or the insured's authorized representative, AKA the customer.
• The insurance broker such as Insubuy®.
  
• The insurance administrator such as WorldTrips, International Medical Group (IMG), Trawick International, Global Underwriters, Azimuth Risk Solutions, Travel Insurance Services (TIS), Petersen International Underwriters (PIU), GeoBlue, etc.
• The insurance carrier such as Lloyd's of London, SiriusPoint Specialty Insurance Corporation, GBG, US Fire Insurance, Crum & Forster SPC, Allied World Assurance Company, Nationwide Mutual Insurance Company, Brit Syndicates Limited, 4 Ever Life International Limited, HDI Global Specialty SE, etc.

When do I contact the insurance administrator for claims-related matters?

If you have a routine claims-related query such as the status of the claim, questions about completing a claim form or submitting the documents, if the providers would like to verify the eligibility etc., you can contact the administrator's claims department. They deal with your claims on a routine basis. 

When do I contact the insurance carrier for claims-related matters?

Do not contact the insurance carrier for claims-related issues, as they simply carry the financial risk of insuring you and are not involved in the claims process. In fact, insurance carriers will not even have information about individual sales

When do I contact Insubuy for claims help?

Insubuy is not involved in claims resolution, as we are only the insurance broker for the transaction, not the administrator that handles claims. However, we can provide claims assistance by putting you in contact with the correct parties at the insurance administrator to answer your questions. 

Please note that Insubuy does not have access to your claims information. And the administrator is prohibited from sharing private health insurance (PHI) with anyone due to federal law HIPAA laws unless they have a written authorization to release that information.

What is HIPAA?

HIPAA stands for Health Insurance Portability and Accountability Act and was enacted in 1996. According to HIPAA, the provider (doctor, hospital, lab, etc.) is legally prohibited from sharing any medical records with anyone other than the patient without written release.

To determine whether the insured has an eligible claim, the insurance company needs the medical records from the provider, which they can release only after the patient’s written authorization. The insurance company is not allowed to share that with anyone. If a representative (such as a family member or friend) wants to discuss claim with the insurance company, the insured (patient) must provide a written authorization of privacy release.

What kind of claims problems do customers typically encounter?

Though uncommon customers can run into the following types of issues:

• The claim is pending because the administrator didn't get the claim form from you, which is required even if the provider billed them directly. If you have not already done so, please provide them with the claim form as soon as you can. It is the best to send it right away after visiting a provider, even before the company asks. You can download that from our MyAccount.
• The provider has not sent the medical records that the administrator needs to evaluate claim eligibility. In that case, please coordinate with the provider to make sure they have sent the records.
• Even after the provider has sent the medical records, the administrator may say they have not received them. That could be due to many reasons. In this case, obtains the records from the provider again and send them to the administrator via a trackable method such as courier, or certified mail.
• The claim was denied due to a pre-existing condition or other ineligible condition. Pre-existing conditions are not covered in most visitors insurance plans, and the denial may be accurate if the medical expense is not covered by the policy. When a claim is denied, you may submit an appeal to the insurance administrator by contacting them directly. You can also view the plan’s certificate wording which was sent to you upon purchase for further information on the appeal rules and timeframe. 
• The charges were billed (coded) incorrectly by the provider and therefore denied. For example, the provider billed a sick visit as a wellness visit. Your best option in this case is to work with the provider to get the issue corrected and resubmitted to the administrator for processing.

Can I just give Insubuy the authorization so that you can completely deal with my claims and I don't have to deal with any of it at all?

Unfortunately, we are unable to do so for various reasons.

I understand that my claim is not an eligible claim. However, since I bought the insurance through you, can you somehow get the claim paid?

No. The decision as to whether or not a claim is an eligible medical expense is solely up to the insurance administrator. They will make the decision based upon the medical records and the provider’s statement. 

I purchased a fixed coverage plan and the insurance company paid only a small fraction of the actual expenses. Can you get them to pay more?

The insurance administrator will only pay according to the published schedule of benefits for the fixed coverage plan. The administrator cannot and will not pay more than that amount. This is one of reasons we recommend all customers purchase comprehensive coverage plans.

I have not purchased the insurance through you. Can you please help?

Unfortunately, we are not allowed to interfere if you have not purchased through us.

I know that my claim is ineligible and the claim rejection was justified. However, as I bought insurance through Insubuy, can you use your influence to get the claim paid?

Unfortunately, that would not be possible. The claim decision is made solely by the insurance administrator. 

You work with insurance companies every day. How are you going to really help me resolve a claim?

As a broker, we work for you, not the insurance company. If you have a claim and need some help submitting it, we would be glad to assist. However, as we are the broker and not the insurance administrator, we can only provide guidance on processes to follow and who you can contact in accordance with HIPAA laws.