Atlas Travel Medical Insurance is an insurance policy designed for international travelers from around the world. Atlas travel insurance includes comprehensive medical, emergency evacuation and essential travel benefits that provide financial protection to international travelers against different kinds of risks you can encounter while traveling outside of your home country.
If you have an Atlas Travel Medical Insurance policy from Tokio Marine HCC-MIS Group, you have submitted a claim and your claim is denied by the insurance company, you may file an appeal, ask HCC-MIS to re-evaluate your claim.
You can contact HCC-MIS Customer Service to find out why your claim was denied, so that you can better address the issues to make solid appeal. Ask the insurance company what additional information or documents may be needed to dispute the denial decision in your resubmitted claim.
Sometimes minor typo error(s) may result in your claim being denied, such as misspelled name, wrong birth date or insurance policy number etc. These are easy problems that can be corrected. Read through the reports that you receive from HCC-MIS or your medical provider(s) carefully to make sure that there are no processing errors made by the insurance company or your medical provider(s).
Your policy document provides details of the benefits and exclusions of your insurance coverage. Review your policy document carefully to understand what you are covered for. This may help you to determine if your claim is legitimately denied.
Sometimes your claim is denied because the insurer says that the medical treatment you received is not covered by your policy. Check your policy document to make sure the claimed services are covered by your insurance plan, so that you can dispute that decision.
If you believe that your claimed events should be covered by your insurance plan, you may provide additional information supporting your position for the insurance company to reverse the denial, e.g. receipts of your payment if you have billing disputes, or a letter from your doctor to explain why certain treatment is medically necessary and should be covered.
Some claims are denied because of pre-existing medical conditions. Atlas Travel Medical Insurance does not cover pre-existing conditions, except charges resulting directly from an Acute Onset of Pre-existing Condition subject to the limits set forth in the Schedule of Benefits and Limits.
For international visitors to the United States, visitor health insurance plans are not subject to the U.S. Patient Protection Affordable Care Act. They are not required to include a comprehensive pre-existing condition coverage.
Because medical conditions vary from person to person, in general it is difficult for the insurance company to provide you a definitive answer beforehand whether a particular medical condition will be covered as Acute Onset of Pre-existing conditions or not.
If your claim is denied by the insurance company citing it as a pre-existing condition, and you believe this should be considered a new condition or an acute onset of pre-existing condition, you should provide supporting evidence, e.g. your doctor’s written statement, recent physical check up results, past medical records etc. The insurance company will have a medical expert to review your appeal and make a final decision.
According to Atlas Travel Medical Insurance policy, an acute onset is rapidly progressive, serious or life-threatening, and requires urgent care. As a condition for acute onset coverage, you must obtain treatment within 24 hours of the sudden and unexpected outbreak or recurrence. Routine medical care for a pre-existing condition (e.g. check up, refill prescription medication etc) is not considered as an acute onset situation.
After receiving your claim, the insurance company will process your claim and send you an Explanation of Benefits (EOB) document that tells you how the billed charges are paid. You may view EOB online through ClientZone.
Your Explanation of Benefits document lists itemized medical services provided to you, billed charges for each service, how much are paid to the health care provider(s), how much you owe, etc. Each treatment or service has its unique service code. And there are reason codes that explain health insurer’s reason for the partial payment, delay or denial of the claim. See an example of EOB.
Carefully review the Explanation of Benefits to find out why the insurance company determined a charge for your submitted claim was denied. If you have any questions or concerns about the information on your EOB document, call HCC-MIS to ask for clarification.
Check the itemized charges to make sure you actually received the treatment and/or services being billed, the amount your doctor received, and the amount of deductible/ co-pay/ coinsurance as your share of the bill are correct.
Check the service code and reason code descriptions to make sure that your diagnosis and treatment are correctly listed and coded. You can find out why your claim for a certain service is denied, e.g. because the service is not covered by your insurance plan or it’s not medically necessary. If you don't think the denial is justified, you may provide additional information to dispute the decision.
In some cases, your doctor’s office or hospital may make billing or coding errors. For example, a wrong code for your diagnosis or treatment can result in you being charged for wrong health condition that you don’t have or services that you didn’t receive. You can ask your medical provider(s) to correct the code and/or provide accurate information, resubmit the claim so that HCC-MIS can reprocess it.
You can work with your medical provider(s) together through your appeal process. For example, if your claim is denied because certain medical procedure or service is not deemed medically necessary, your doctor may write a letter to provide supporting documentation that your treatment is medically necessary for your condition.