4 Commonly Denied Travel Insurance Claims (2024)

If you’re submitting a travel insurance claim, it’s because something went wrong during your trip. The last thing you want, to add salt to the wound, is a denied claim. The best way to avoid a denial is to understand what your insurance covers before you even start your trip. If there’s something you want covered but you don’t see it in your plan document, review plan options carefully before making a selection — Seven Corners plans often have a Basic as well as a Choice option, for example — that provide varying levels of protection for you and your trip.

What can cause a claim to be denied? Here are some of the most common reasons and how to avoid them.

Most Commonly Denied Travel Insurance Claims

1. Your claim occurs before your effective date.

There are two main types of travel insurance: trip protection and travel medical insurance. Trip protection, because it provides trip cancellation benefits to assist you before you leave on your trip, can start before your departure date. Travel medical insurance, because it’s focused primarily on medical benefits, covers illness and injury that occur during your trip, not before.

With this in mind, it’s important to know when your effective date is. You’ll find this information in your plan document. Claims for events that happen before your effective date will be denied because that event took place before your plan started.

How do you avoid this denied claim? One way is to purchase travel insurance as soon as possible. Seven Corners Trip Protection plan and the optional add-on Cancellation for Any Reason (CFAR) begin the day after we receive the required premium to cover your trip. Other benefits, such as Trip Delay or optional Rental Car Damage, can have different effective dates, so please review your plan document for a full explanation.

If you purchase travel medical insurance, make sure to buy it ahead of time. The earliest your coverage can begin is 12:01 a.m. the day after you buy it but not until you depart from your home country. While your travel medical coverage doesn’t begin until you have left your home country, starting coverage on your departure date means that if you get hurt or sick during a layover in a foreign country, for example, you’ll be protected.

For example, let’s say I leave the United States on August 1 for a vacation to South Africa. I have a connecting flight in Amsterdam and don’t arrive in Cape Town until August 2. I would want my coverage to begin August 1 even though I don’t reach my destination until the following day. This way, I’m protected in case I get sick or hurt during my layover in Amsterdam.

2. The care you received was routine or preventive.

This applies to Seven Corners Travel Medical Insurance plans.

Most travel medical insurance plans are meant for short-term coverage and cover sudden illnesses or injuries only during your travels. It’s expected that your domestic primary health insurance will cover routine checkups and preventive care you receive in your home country.

To avoid having this type of claim denied, check your plan document before you leave. If it says that routine or preventive care services are not covered, get your routine checkup before you leave (usually a good idea anyway, especially if you’ll be traveling for an extended period) or wait until you get home when you can use your primary health coverage.

3. It wasn’t a covered reason.

This reason applies to Seven Corners Trip Protection plans.

Trip protection plans can reimburse your prepaid, nonrefundable trip expenses if you need to cancel or interrupt your trip for covered reasons. If you decide to cancel or interrupt for a reason not listed, such as being nervous about the safety at your destination, your claim will be denied.

One way to avoid having this type of claim denied is to purchase Cancel for Any Reason coverage. This optional add-on benefit allows you to cancel your trip for any reason you wish, not just those reasons covered in your trip protection plan, and still be reimbursed for 75% of your prepaid nonrefundable trip costs.

Interruption for Any Reason (IFAR) coverage works the same way. If you decide to end your trip and come home early, the optional IFAR coverage that you added can reimburse you for 75% of those unused, prepaid, nonrefundable expenses, regardless of why you chose to interrupt your trip.

Another way to avoid this claim is, again, to read the plan document and understand the covered reasons. This way, you’ll know you’re covered before you decide to alter your trip plans. You might even be able to adjust your coverage or choose a different plan before you find out too late that the protection you wanted wasn’t provided.

4. The timely filing limit expired.

This is basically another way of saying you missed the deadline. Most insurance companies have a timely filing limit. If you don’t provide the required documents within the stated time frame, your claim could be denied.

The simple answer to avoiding this type of denied claim: file your claim as soon as possible after an incident. We also recommend you check your plan document, which will tell you how long the filing limit is. Most plans have a 90-day limit.

Support So You Can Travel Smarter

If you review your plan document and start to feel overwhelmed, never fear. Check out our blog with tips for how to read a travel insurance policy or contact our licensed travel insurance agents for more information and an explanation of our plans.

Email sales@sevencorners.com

Toll free 1-800-335-0611

Worldwide 1-317-575-2652

Collect 1-317-818-2809

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4 Commonly Denied Travel Insurance Claims (2024)

FAQs

How to fight travel insurance claim denial? ›

When you fight a claim denial, you must write an appeal letter to send alongside the documentation you collected. In the letter, explain why you're appealing the insurance company's denial.

What are 5 reasons why a claim may be denied or rejected? ›

Six common reasons for denied claims
  • Timely filing. Each payer defines its own time frame during which a claim must be submitted to be considered for payment. ...
  • Invalid subscriber identification. ...
  • Noncovered services. ...
  • Bundled services. ...
  • Incorrect use of modifiers. ...
  • Data discrepancies.

What are the possible solutions to a denied insurance claim? ›

You can ask your doctor to resubmit the claim and correct the error. If your claim was denied for another reason, let your doctor know that you're appealing a claim. You can ask your doctor to write a letter explaining that the service was medically necessary, or provide other supporting documents.

What percentage of travel insurance claims are denied? ›

Legitimate claims

According to the United States Travel Insurance Association, one out of every six insureds ends up filing a claim, and less than 10 percent of those claims are denied. If your travel insurance claim is denied, you may be upset,. However, getting upset is not going to help you.

Do travel insurance companies actually pay out? ›

Without travel insurance, you'd lose the money you spent on your vacation. Fortunately, a serious, disabling illness can be considered a covered reason for trip cancellation, which means you can be reimbursed for your prepaid, nonrefundable trip costs.

How to prove illness for travel insurance? ›

Regardless, if you feel too sick to travel it's important to have your opinion confirmed and your diagnosis documented by a doctor. Medical documentation will be required if you're looking to be reimbursed for your non-refundable trip costs if you have to cancel your trip.

What are the 3 most common mistakes on a claim that will cause denials? ›

Here, we discuss the first five most common medical coding and billing mistakes that cause claim denials so you can avoid them in your business:
  • Claim is not specific enough. ...
  • Claim is missing information. ...
  • Claim not filed on time (aka: Timely Filing)

What are the most common claims rejections? ›

Most common rejections

Eligibility. Payer ID missing or invalid. Billing provider NPI missing or invalid. Diagnosis code invalid or not effective on service date.

What are three possible reasons for preauthorization review denial? ›

3 common reasons for medical claim denials
  • Reason 1: Missing or incomplete prior authorizations. ...
  • Reason 2: Failure to verify provider eligibility. ...
  • Reason 3: Code inaccuracies. ...
  • Leveraging AI Advantage to reduce medical claim denials.
Apr 6, 2023

What is the most common source of insurance denials? ›

Process Errors
  • The claim has missing or incorrect information. Whether by accident or intentionally, medical billing and coding errors are common reasons that claims are rejected or denied. ...
  • The claim was not filed in a timely manner. ...
  • Failure to respond to communication. ...
  • Policy cancelled for lack of premium payment.

What is a frequent reason for an insurance claim to be rejected? ›

Incorrect or Missing Patient Information

Many claim denials start at the front desk. Manual errors and patient data oversights such as missing or incorrect patient subscriber number, missing date of birth and insurance ineligibility can cause a claim to be denied.

Why do I keep getting denied for insurance? ›

They can include engaging in risky hobbies and behaviors like skydiving; having a history of DUIs or speeding tickets; having a dangerous job like roofing; having a criminal record or a less than ideal financial history; being a smoker; and failing a drug test.

What is the most common travel insurance claim? ›

By far, the most common and often most significant travel insurance claim is for medical emergencies. A sudden illness or injury during your trip can not only ruin your plans but also cause a severe financial strain.

What do I do if my travel insurance claim is denied? ›

While dealing with a travel medical insurance claim denial isn't ideal, understand that you have the right to appeal that decision and having an effective and clear appeal letter can better assist you in supporting your disagreement with the insurance company's decision.

What conditions are not covered by travel insurance? ›

Conditions which may not be covered

Conditions like terminal illness, the need for oxygen, pending surgery, chronic lung disease, cardiovascular disease, specific types of cancer, congestive heart failure, and recurring pain are generally excluded from coverage.

How can I stop my insurance claim being rejected? ›

Ask to expedite the appeal if you or your doctor feels that the denial of your claim could be life-threatening. Keep copies of everything you send to the insurance company for your records. Contact your state Department of Insurance if you feel your insurer is not cooperating with the appeals process.

How do you prevent a denied claim? ›

By addressing issues such as inaccurate documentation, coding errors, lack of medical necessity, timely filing limits and insurance coverage problems, providers can significantly reduce claim denials and improve overall financial performance.

How long does it take to settle a travel insurance claim? ›

This can depend on your insurer but, typically, once they've received your claim it'll take less than two weeks for them to assess it. Sometimes your insurer may ask you to provide more information to support your claim. This will usually add extra time onto how long it takes to process your claim.

How do insurance companies reject claims? ›

Typical reasons include: The policy was not in force when what you are claiming for happened. The policy is invalid because you provided incorrect information or disclosed relevant information when you applied for, or renewed, the policy. The item is not covered by your policy.

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