travel insurance claim denied pre existing condition Denial?

The insurance company is betting on your silence. They hope you see their "No" as final. We know better. Follow this tactical guide to force a reversal.

53%
Reversal Rate
< 90d
Avg. Resolution
0€
Initial Cost
100%
Evidence Lock
Tactical Alert

The Insurer's Playbook

Context: Travel Insurance

READ THE FINE PRINT. "Cancel for Any Reason" is different from standard cancellation. Most denials come from not having a "covered reason" (e.g., fear of travel isn't usually covered, but a doctor's order not to travel is).

Their Strategy

Attrition. They expect you to give up after the first denial letter. 40% of people do.

Your Counter-Move

Persistence. A formal, evidence-backed appeal shifts your claim from the "auto-reject" pile to "needs legal review."

Strategic Analysis

Breaking Down Your Denial

The "Pre-Existing Condition" Clause

In modern health insurance (ACA compliant plans), denying for pre-existing conditions is largely illegal for essential services. However, short-term plans, travel insurance, and pet insurance can still use this.

The Strategy:

  • Prove the condition was stable.
  • Prove this is a *new* acute issue, not a continuation of the old one.
  • Check the "look-back period" in your policy. If you haven't seen a doctor for it in X months, it might considered "cured" for coverage purposes.

The Path to Victory

Execute these maneuvers precisely. Timing is everything.

Level 1 Protocol
01

"Obtain your complete medical records for the 12-24 months before your policy started."

02

"Identify the specific diagnosis codes (ICD-10) the insurer is flagging."

03

"Get a letter from your treating physician explaining this is a NEW acute condition."

04

"Research your policy's 'look-back period' and 'exclusion period' language."

05

"File an internal appeal with medical evidence that the condition was stable/cured."

06

"If denied again, request an external review (your state may mandate this)."

🔒

The Evidence Vault

Insurance companies use "insufficient documentation" as their #1 denial loophole. Don't give them the chance. Weaponize your appeal with these files:

Complete medical records from 12-24 months before policy start
Letter from your physician documenting current condition is NEW
Treatment records showing prior condition was stable/asymptomatic
Policy language on pre-existing condition exclusions
Any 'waiting period' or 'look-back period' disclosures
Execution Phase

Activate Your Professional Appeal

Our engine will synthesize everything into a formal legal challenge. No fluff. No begging. Just the facts they can't ignore.

Generate Your Appeal Letter

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Intel Recap: Common Queries

They are digging through my records from 5 years ago. Is that legal?
Check your policy for the 'Look-Back Period.' Most reputable policies only look back 6 to 24 months. If they are denying based on an injury from 5 years ago that hasn't been treated since, they might be violating their own contract. Point out the specific timeframe defined in your 'Definitions' section.
Can they deny if I didn't have a formal diagnosis?
This is where they get sneaky. They use 'symptom-based' exclusions. If you had an undiagnosed pain that later turned out to be cancer, they might claim it was pre-existing. To fight this, you need your doctor to state that the prior symptom was 'non-specific' and didn't warrant the current treatment at that time.
Does 'Pre-Existing' apply in emergencies?
Generally, yes, unless you have an ACA-compliant health plan. However, for travel and pet insurance, even an emergency related to a pre-existing condition is often excluded. Your only hope is proving a 'waiver of pre-existing conditions' was purchased or that a 'stability period' was met.
Sarah J.

Integrity Officer

Sarah Jenkins, CIC

"People ask why I do this for free. It's because I spent 15 years on the other side. I know how the machine works. I know how they calculate settlements. And I know that when a policyholder fights back with the right data, the machine breaks and the policyholder wins."

Read my full story

Intelligence Network