Insurance Pre-Existing Condition

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Sep 26, 2017
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#1
Purchased travel insurance "cancel for any reason" and for pre-existing condition. Was only partially reimbursed but not for pre-existing condition even tho assured I met waiver clause prior to purchase. Advice on appealing? Submitted medical evidence. Even had surgery 2 weeks ago. Insurance won't provide rationale in writing.
 

jsn55

Verified Member
Dec 26, 2014
5,915
6,005
113
San Francisco
#4
This will take a little legwork on your part. First, review all the policy information to determine what amount you should have been reimbursed. Did you make notes while you were buying the policy? Specifically, the name of the agent who told you that your PEC was covered. Otherwise it becomes the dreaded "he said, she said" scenario.
 
Sep 26, 2017
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#5
This will take a little legwork on your part. First, review all the policy information to determine what amount you should have been reimbursed. Did you make notes while you were buying the policy? Specifically, the name of the agent who told you that your PEC was covered. Otherwise it becomes the dreaded "he said, she said" scenario.
 
Sep 26, 2017
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#6
Yes, I kept notes, names, dates and have an email trail. Unfortunately , they have only orally told me that the pre-existing condition clause was denied . They said since I received partial reimbursement they don't provide written explanation . I requested a written rationale .
 

Neil Maley

Moderator
Staff Member
Advocate
Dec 27, 2014
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11,277
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New York
www.promalvacations.com
#7
Without knowing about your medical condition; whether you booked the insurance within the correct time frame to have the pre-ex condition covered and the specifics of the policy- we can't comment. You are giving a generalized statement and not even telling us what company the policy is from.

Unless you want to give us all the details- we can't comment on why you were declined.
 
Sep 26, 2017
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#8
I emailed an appeal on Monday and spoke to someone at the insurance call center indicating that I was stunned that the pre-existing portion of the claim was denied since I had booked the insurance timely and met the clause. I told the call rep that I felt compelled to write a review describing my experience on their website and another recourse.

This morning I received a call from the insurance company that they had reconsidered my claim and were fully reimbursing. They sent it in writing too.

Thanks to all who responded.
 

Neil Maley

Moderator
Staff Member
Advocate
Dec 27, 2014
10,686
11,277
113
New York
www.promalvacations.com
#9
Sometimes they do make mistakes with claims. You have every right to appeal a denial but they have to send you the results in writing. If they don't you have an issue you can file a complaint with your state insurance dept.

Glad they relooked at it and you prevailed. Can I ask what insurance company it was?