International health insurance claims are done very differently than what you were used to in your home country. Whereas the doctor’s office and medical facility handled it themselves and you received a bill, it is now your responsibility to gather and submit all information. In an effort to make the process less daunting, please read our relevant guide below to help you navigate the process.

When to File Claims

If you do not file claims from the moment you have a medical event, and let us know about it, it will be 100 times harder to get your claim approved. Let us guide you through the claims process so it is done properly. All medical records, even if they are minor events under your deductible, should be reported to the insurer immediately. Insurers sometimes request in depth medical records of these minor events, if you dont have the appropriate medical records, later the claims can be denied.

You can file claims for ambulatory visits, consultations with specialists, diagnostic testing (PetScan, MRI,etc.), lab studies, blood work, emergencies, and programmed procedures. There are some general exclusions but those are a policy-by-policy basis, as well as an individual’s coverage plan which may include specific exclusions.

What You Need to File Claims

Over the years we have put together a list of documents commonly needed in order to file claims in a timely manner. Here is that list. *Submitting all the documents on this list does not guarantee that additional information will not be requested. Claims are processed on a case-by-case basis, and each insurer has their own policies.

Emergencies:

If you are currently in an emergency, see this guide

How to File Claims

General claim procedure

  1. If you are planning for surgery, ongoing treatment, or diagnostic testing, you have to precertify with your insurer (please see our precertification guide). If it is an emergency, notify the insurer or your broker within 48 hours of the emergency and/or hospitalization to avoid a penalty.

  2. Whether you decide to file your claims on your own, or need our assistance, contact your broker to help you through the claims process. We cannot help you if we do not know of your claim! You can email support@expatinsurance.com or send a WhatsApp to +52 415 167 0886 to notify you'll be filing a claim.

  3. You have 180 days (approximately 6 months) from the date of service to file claims. We strongly recommend filing the claims as soon as possible to avoid any delays, or running the risk of not being able to collect all necessary documentation. The longer you wait, the more difficult it is to collect medical records, facturas, lab results, and other important, required information.

  4. The first step is to collect all the necessary documents you need to file a claim. Here is a list you can print off of the most common documents we see insurers asking from clients for any type of claim. It is in English and Spanish so you can give it to your provider.

  5. If there is a form required to be filled out, be sure to complete it and submit it to the correct email address(es). Another option is to submit your documents via an online portal. It depends on your insurer. Please contact our claims team for any assistance needed in order to submit your claim: support@expatinsurance.com

  6. The insurance provider will then review the claim with their in-house medical committee. If any additional information is required, they will contact your broker, and we will relay the request to you via email.

  7. If all the documents are in order, the claim will be processed and the insurance provider will either approve or deny the claim. You will receive an EOB (explanation of benefits) that shows how the claim was processed. It will be one of the following:

    1. Approved and paid towards your deductible

    2. Financially reimbursed once deductible is met

    3. Paid directly to the provider if a GOP (guarantee of payment) was negotiated

    4. Or denied. Policies are most commonly denied for missing medical records, or a non disclosed preexisting condition.

  8. If you feel a denied claim was done so in error, you can file for an appeal, or later for third party arbitration to resolve the dispute.

As always, reach out to your broker with any questions or concerns you have regarding claims.

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