Refusal of medical bills

BigBirdTina

Hi a friend said they were in the USA had to got to hospital had tests done on heart but insurance co wouldn't pay bill

What could be the reason for this?

One person told me it would be because they didn't disclose all medical history

Is this correct and woukd it be only reason?

Thanks

MeteredOut

What reason were they told? Insurers can't just say no without saying why.

Not declaring a relevant medical condition might be one such reason (and possibly the most likely), but that's conjecture. Another might be, for example, partaking in a high risk activity not specifically covered by the policy.

flaneurs_lobster

Could be any number of reasons including failure to disclose all pre-existing conditions and any medical history asked for.

Premium paid? Coverage included US? Exceeded time-limit on a single trip?

Not much point just listing possible reasons, did the insurer not give the reason(s) for non-reimbursement?

MyRealNameToo

https://forums.moneysavingexpert.com/discussion/6679110/refusal-of-medical-bills

No, non-disclosure is one of the more likely reasons but its not the only one. They could have declared their history of heart issues and their insurer gave them the option of paying another £400 premium or have anything heart related not covered.

Could be that the value of the claim is below the excess, which technically is treated as a decline. Some policies require prior authorisation for non-emergency treatment or it may generally be deemed that the tests werent necessary to be done then and there.

They could have lied about other aspects of their disclosures like their date of birth, residency etc, CIDRA allows the voiding of the policy for any intentional or reckless false disclosures not just those relevant to the claim.

Your friend will have been told the reason for the decline, ask them, you can judge if they are the type to be honest or make up a story. anyone else is just is purely speculating

user1977

Why are you asking? Does your friend want our advice?

Woodstok2000

It could be many things - the insurance company will tell your friend

Brie

Might be as simple as needing to ask permission for tests before getting them done? Which of course might be difficult/impossible in an emergency.

Slinky

How well do you know this person? Are they wanting you to send them money to help… if so it could be a scam.

Worried_fool

Many insurance policies are only valid for travel within Europe; others offer global cover, but exclude the USA.

Of course, the OP did not say there was any travel insurance at all: perhaps he had private medical cover that was only valid within the UK.

Or perhaps the insurance was only for his cat, and he never learned to Mew convincingly.

NoodleDoodleMan

Presumably the insurers gave the reason for refusing to cover the bills ?

That'll be the appropriate source to go ask - as above, there are a variety of possible reasons for the reimbursement claim being declined.

heatherw_01

They will know why as the insurer will tell them.

Most likely they didn't disclose something medical as this is the most common reason.

But they will know.