Health Care insurance rejections SOLVED!

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In the last 5 years that I have worked with expat and national clients, I have never had major issues in processing clients’ claims. As long as the broker and the agent have a high level of knowledge regarding the insurance contracts, it is not a complicated process. I have more than 100 clients and have never had to submit a case or appeal to the Superintendence of Companies.

The following is a situation that occurred recently.
My 68-year-old client was admitted to the Santa Ines Hospital due to an emergency. After being evaluated, he had Cardiac Arrhythmia. At the time of requesting the Hospital Credit (which allows you to not have to pay out of pocket. You pay only the copayment and the deductible) it was DENIED since the diagnosis was related to a pre-existence condition: Hypertension.

I immediately contacted the treating physician who confirmed that my client’s arrhythmia was not caused by hypertension; but by an alteration of the thyroid gland. I sent an email to the insurance company where the treating doctor explained that the diagnosis had no relationship with the pre-existence condition and attached my client’s medical history.

His short stay at the hospital totaled $3200. In the end, the insurance company covered 80% as they were obligated to according to the contracted plan.
The first response from the insurance company was to not cover my client. The key here was us, the broker. Our job is to fight for our clients and make the situation clear to the insurance company in order to show or prove that the company should cover the costs.

I am your service anytime. It is important that you understand your benefits and what is and is not covered by your health insurance. Knowledge is power!

For more information contact us!

Contact information:

Daniela Cordero

info@cuencaexpatinsurance.com




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