Top reasons international health insurance claims are refused

international health claims

Avoid having your claim rejected by double checking your policy and being honest.

We have warned expatriates many times to double check their insurance policies before they move abroad. Having full international health coverage will help give you peace of mind, but even with comprehensive coverage your insurer can still reject claims.

NowCompare, an international insurance comparison website, has looked at claims made by expatriates around the world to find the most common reasons for a claim being declined.

Policy limitations

The most common reason a claim is declined on expat health policies is not that the claim itself is excluded, but the amount on the claim isn’t covered.

International health insurance is designed to cover expats abroad when they require medical help. Depending on the country it can cover private hospitals or public ones. To avoid paying a lot for medical bills you need to check the policy deductible, this is the amount you should pay before the insurance kicks-in.

There may also be a lifetime maximum, a total amount the insurer will pay out over the duration of your policy. Co-insurance is the percentage of treatment costs you are required to pay. For example you may see dental: 20% co-insurance. This means you pay 20% of the costs and your insurer pays the remaining 80%.

Pre-existing conditions

A pre-existing condition, as the name suggests, is a condition you had before buying your insurance policy. The majority of insurers won’t cover you for an existing condition. Always be honest about your medical history when applying for an insurance policy, and if you aren’t sure whether you are covered for something, just ask!

Medical necessity

It is common for health insurance companies to question whether treatment is necessary or even beneficial for the patient. Many policies will have wording which excludes cosmetic surgery, holistic treatments or may blanket anything they deem necessary under the term “medical necessity”.

Medical necessity is debatable and if you feel a claim refusal on these grounds is unfair then don’t give up. Often the insurance company is unaware of how necessary the treatment actually was. Ask your doctor to explain the treatment and how it relates to your overall health and well-being, this will help support your claim.

Communication is key

Whether you have had a claim refused or not, the key is communication. Make sure you ask about pre-existing condition coverage and are honest about your health history, if you have concerns then check before you buy. If you require treatment, check you will be covered beforehand, you insurer can confirm coverage under your policy and even guarantee it directly with the medical facility.