The medical expense benefit is designed to reimburse you for medical fees that result from a covered sickness or injury. If you get sick or injured on a trip make sure you keep all documentation concerning the medical treatment that you receive. It is best for the documentation to clearly show the medical condition that caused you to seek care, the exact treatment that you received, and that the invoice or bill is clearly itemized.
Travel medical expense is either "secondary" or "primary" coverage. If it is "primary" than you only have to deal with the travel insurance company, however, if it is "secondary" than you must first submit your claim to your primary medical company, if any, and then submit the balance to the travel insurance company along with the primary company's explanation of benefits which explains what was and what was not covered. It is important to note that you should not delay in filing your claim with the travel insurance company - do not wait for your own health insurance company to adjust your claim first. File the claim with the travel insurance company and complete the forms. You don't want to wait as most travel insurance policy's have a provision that requires you to notify them within a specific time period and if your don't it might invalidate your claim.
What to Expect When Filing A Claim
The insurance company or their third party administrator(TPA) will send you claim forms that you must complete. The claim forms will ask what happened and why treatment was sought.
There are three main things that you have to prove when submitting your claim to the travel insurance company:
- that the sickness or injury occurred while the policy was in force and that they are covered under the terms of the policy, and
- they were not due to a pre-existing condition unless your policy provides a "waiver of pre-existing conditions", and
- that the expenses are covered expenses. Covered expenses usually include treatment by a licensed Physician, nursing expense, hospital expenses, and prescription drugs.
As with all claims, the burden of proof is on you, the insured person so the more information you have and the closer you follow the insurance company's instructions the faster they will be able to handle you claim and the more accurate they will be able to pay you.