Travel Insurance Claims
Whether
we are talking about travel insurance for traveling Canadians or Visitors to
Canada, the most questions I get are about the claim process. Sometimes we want
to know more about the coverage we purchase but the policy is very long and
sometimes the terms are not so clear to understand. Today I want to touch up on
some main aspects of any travel insurance claim.
What should I do in the event of an emergency?
You MUST call your insurance company as soon as possible so as not to negate or reduce any allowable coverage defined in your policy. Some companies will reduce the amount of coverage you are eligible for (up to 20%) if you do not call them within a specified time period. Often it is 24 hours* window to inform the company about your medical emergency. Regardless, the reason they need to be called is, so they have a chance to become involved at an early stage in the claim.
*This period is determined by each company, make sure to ask about it when you purchase the coverage
What questions I will be asked when I call the company?
At the time of the call to the insurance company, they will ask you for:
- full name of the insured
- policy number,
- address on the file
- the reason for seeing the doctor.
How can your agent help?
Many people think that the agent who they purchased the insurance with, can do everything from claim submission to talking to the doctors in the hospital. In fact, that is not the case. In the case of Claim, your agent is limited in certain areas, agents cannot actively participate in the process of providing information between the client and medical professionals. For example: any doctors, clinics or hospitals are not allowed to give your personal information to anyone other than you or the insurance company (you will need to sign non-disclosure forms for this information before the insurance company can contact the hospital or clinic for your information). Therefore, the agents do not have the legal right to contact your doctor, clinic, or hospital even if the insured gives the permission. I understand how hard It can be to quickly navigate during a very stressful situation, so I am always happy to help with filling out paperwork to file a claim with the company.
Who makes the decision to approve or decline the claim?
It is important to remember that the decision regarding the payment of insurance claims is made only by the insurance company and no one else. We, as agents, cannot influence the decision of the company in any way. The decision is made only after collecting all the necessary papers providing all the necessary information about the health of the client and the reasons for going to the doctor or getting to the hospital. Unfortunately, no one can say in advance whether a certain case will be paid or not, before the file is processed by insurance company itself.
What else should I know?
It is important to understand that insurance companies cannot go against certain rules in a hospital or clinic, in terms of payments, conditions and policies. Each hospital or clinic might have their own regulations, even if they might be in the same city or province. It is entirely possible for the doctor to ask you for part of the payment in advance before the insurance company settles payment with them for the services provided. In such situations, you should immediately notify the insurance company so that they can sort out the situation by contacting the hospital or clinic providing the service.
If you have more questions, you want me to cover in my next travel insurance article, feel free to leave a comment below.
For more information, travel insurance quotes or advise, feel free to contact me at 204-807-1705 or by email: [email protected]