How Does the Claims Process Work?
Not sure how to go about filing a claim? Maybe you’re wondering what happens to your claim after you submit it, or you’re interested in learning what you can do to expedite the process.
If you need a refresher on how to use your insurance, how billing and payments work, or how to find healthcare facilities abroad, check out How Does Travel Medical Insurance Work? Otherwise, read on!
Understanding the Claims Process
Travel medical insurance claims are processed in one of two ways: via reimbursement or direct billing.
The Reimbursement Process
If your insurance policy utilizes a reimbursement claims process, then you will be responsible for paying any medical costs up front and subsequently filing a claim for reimbursement with your insurance company. This is the process used by most travel medical insurance providers for claims incurred outside the United States.
These are the steps involved in filing a claim:
- You submit a claim form to your insurance company, including all documentation of the services you received as well as receipts for any bills you paid.
- The insurance company determines whether more information is needed, and notifies you or your provider if so.
- Your insurance company then determines whether the medical service or care you received is covered. The company sends you an Explanation of Benefits showing you the determination.
- If the service is covered, your insurance company sends you a check for the amount you paid up to the relevant benefit limit. If your plan has a deductible or coinsurance, your reimbursement is reduced by the amount of that deductible.
The Direct Billing Process
If your insurance policy utilizes a direct billing process, then your travel medical provider sends the initial bill for your medical treatment directly to your insurance company.
These are the steps involved in the direct billing process:
- Your medical provider sends a bill to your insurance company.
- You submit a Claimant’s Statement and Authorization form to your insurance company.
- Your insurance company determines if additional information is needed and whether the medical service is covered under your insurance plan.
- If it's covered, your insurance company pays the eligible claim according to the relevant benefit and deductible amounts. If it is not covered, your insurance company notifies you and your medical provider of the denial.
- Your insurance company sends you an Explanation of Benefits (EOB) showing whether or not the service is covered and how much the insurance will pay.
- Your doctor sends you a bill for any remaining amount not paid by your insurance company.
PRO TIP: Ask your medical provided to give you copies of all documents related to the services you received. Submit these with your claim.
The Claims Process Timeline
Unfortunately, there’s no exact timeline—the amount of time it takes to process a claim tends to vary from case to case and from company to company. In general, however, most claims should be processed within a few weeks (once the insurance company has all the documentation they need).
Keep in mind that one of the biggest factors in determining the speed of the claims process is how quickly you and/or your medical provider provide all necessary information.
PRO TIP: Expect that your insurer will ask for historical records of your medical treatment. Your insurance company will likely want to check for pre-existing conditions.
Speeding Up the Process
The best way to expedite the claims process is to provide your insurance company with all the information it needs to determine whether your claim is payable. This way, you can minimize additional requests for additional information.
Follow these tips to help move your claim along more quickly:
- Read your policy documents to make sure your plan covers the treatment you received.
- Review all claim submission instructions provided by your travel medical insurance company.
- Include all records your medical provider created when treating you.
- Use as much detail as possible when describing what led to your need for medical treatment. (Think about the circumstances that led to the illness or injury, who was involved, and background of the treated condition.)
- Provide itemized receipts for all payments you are claiming for reimbursement. Each receipt should show the patient's name and the purpose of the charge.
- Respond to all requests from your insurance company as promptly as possible.
- Be sure you submit a claimant’s statement and authorization form for each condition or episode of care for which you are seeking reimbursement.
If you’re an Atlas Travel insurance customer, visit the Claims Resource Center for FAQ’s, glossary terms, and more!