Everything you need to know about a Claim and an EOB (Explanation of Benefits)  

Travel insurance can provide peace of mind when unexpected events or emergencies occur while travelling. When you experience an unexpected event or emergency while travelling, such as a medical issue or trip cancellation, you may need to file a claim with your travel insurance provider to receive reimbursement for expenses related to the covered event. Here is what you need to understand about claims, EOBs, and the claim procedure. 

What is a Claim? 

A claim is a request for reimbursement to your travel insurance company for expenses related to a covered event. Covered events can include trip cancellations, delays, interruptions, medical emergencies, evacuations, and more. When filing a claim, it is important to follow all instructions carefully and provide all necessary documentation to expedite the process. 

What is an Explanation of Benefits (EOB)? 

An Explanation of Benefits (EOB) is a document that provides details about how much was paid out for each benefit claimed under your policy and any remaining balances or denied claims. It explains what services were provided and billed by the healthcare provider or other service provider, how much the insurer will pay, and how much the policyholder needs to pay. 

In simple terms, the EOB is like an itemized receipt that shows what your travel insurance covered and what you may still owe. For example, if you had to visit a doctor while travelling and filed a claim with your travel insurance provider, the EOB would show how much of the medical bill was covered by your policy and how much you may still need to pay. 

How Does the Claims Process Work? 

The claims process generally involves submitting documentation of expenses incurred due to an unexpected event or emergency during travel, such as invoices or receipts from healthcare providers or airlines. Once your claim has been reviewed by the insurer and approved, payment will be made directly to you if you have paid or to the service provider. 

It is important to note that not all claims may be covered under your travel insurance policy. Certain exclusions and limitations may apply depending on your specific policy. 

How Do You Read Your Explanation of Benefits? 

To read your EOB properly: 

• Review each section thoroughly. 
• Check that all services listed were received. 
• Note any discrepancies between what was expected versus what was paid out in benefits. 
• Contact your insurer at once if there are any questions or concerns about the EOB. 
• Keep copies of all documents related to your claim for future reference. 

How do I review an EOB to ensure proper coverage? 

To review an EOB and ensure proper coverage, you should follow these steps: 

• Check the dates of service: Make sure that the dates of service listed on the EOB match the dates you received your healthcare services. 
• Look for errors or discrepancies: Check to see if there are any errors or differences in the EOB, such as incorrect billing codes, duplicate charges, or services that were not actually provided. 
• Verify benefits paid: Review the benefits paid by your insurer and compare them to the terms of your policy to ensure that they are accurate. 
• Look for remaining balances or denied claims: If there are any remaining balances or denied claims listed on the EOB, make sure that you understand why they were not covered by your insurance. 
• Contact your insurer if necessary: If you have any questions or concerns about the information listed on your EOB, contact your insurer for assistance. 

By reviewing your EOB carefully and verifying that all services were covered according to the terms of your policy, you can ensure that you receive proper coverage for your healthcare expenses and avoid any unnecessary out-of-pocket costs. 

Bottomline  

In conclusion, understanding claims procedures and EOBs is crucial when filing a claim under a travel insurance policy. By following these guidelines and contacting your insurer with any questions or concerns along the way, you can ensure that you receive the coverage you are entitled to under your policy.