How to File an International Health Insurance Claim

Instructions for how to file a health insurance claim abroad

International health insurance claims are done very differently than what you may be used to in your home country. Whereas the provider in your home country worked directly with the insurer and handled everything internally, 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

All medical events, even if they are minor events and lower cost than your deductible, should be reported to the insurer immediately. If a surgery or accident that requires hospitalization isn't reported to the insurer within the required time period, not only do you face a monetary penalty, but it's more difficult to get the claims approved and reimbursed. We're happy to guide you through the claims process so it is done properly.

You can file claims for ambulatory visits, consultations with specialists, diagnostic testing (Pet Scan, MRI, etc.), lab studies, blood work, emergencies, programmed procedures, and a variety of medical events. There are some general exceptions depending on what policy you have. Read over your schedule of benefits carefully to find out what is and isn't covered by your policy.

What You Need to File Claims

Over the years we have put together a comprehensive list of documents required in order to file claims in a timely manner. Here is that list. Keep in mind that submitting all the documents on this list does not guarantee that additional information will not be requested or that claims will be approved. Claims are processed on a case-by-case basis, and each insurer has its own policies.

Important: The documents most crucial to request while still with the provider are the facturas and all medical records from the visit.

(If you are currently in an emergency, see this guide)

How to File Claims

Please remember that every insurer has their own policies on how claims are to be filed. These instructions are a general overview for all international insurance.

1. If you are planning for surgery, ongoing treatment, or diagnostic testing, you must 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 or claims support to help you through the claims process. We cannot help you if we do not know of your claim! You can email claims@expatinsurance.com or send a WhatsApp message to +52 415 167 0886 to notify us 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. (*Facturas are only available the month of the date of service and are then unavailable. Claims will not be approved without them.)

4. The first step is to collect all the necessary documents you need to file a claim. Here is a list of the most common documents we see insurers requesting from clients for all claim types. Print it out and share it with your provider. It is in English and Spanish.

5. Depending on your insurer you may need to fill out a claims form to submit for evaluation or upload your documents directly to a portal provided by the insurer. Please contact our claims team for any assistance needed in order to submit your claim: claims@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 who will relay the request to you via email.

7. Once all necessary documents have been submitted, the claim will be processed and the insurance provider will either approve, deny, or close the claim. You will receive an EOB (explanation of benefits) that shows how the claim was processed. It will be one of the following:

   • Approved and paid towards your deductible.

   • Financially reimbursed once deductible is met.

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

   • Denied due to general policy exclusions or non-disclosed preexisting conditions.

   • Closed due to missing information that was requested but not provided.

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

As always, reach out to claims@expatinsurance.com with any questions or concerns you have regarding claims.