Will filing a complaint with DOI help if a travel health insurance company has denied claims and appeals?
Question Details: A travel health insurance company has denied a claim for medical services received during the policy period stating "Pre-existing" as the reason for denial. The medical condition was discovered for the first time at the time of diagnosis during policy period and was never identified or even had a reasonable certainty of existence prior to this diagnosis. The company has denied the claims appeal twice - first by stating that the policy was purchased after the symptoms began and when proven otherwise with the help of doctors letter, they denied the appeal for the second time stating a different reason - the policy wording, which states the definition of pre-existing condition as any condition known or unknown which had "reasonable certainty of existence" is not covered. Will filing a complaint with the DOI help, as this condition came up as a surprise and there was no clue about this till the time it was diagnosed. Hence not sure as to how reasonable certainty of existence is applicable here.