Denied Health Insurance? Here’s Why That Might Be | William Russell (2024)

Have you been denied health insurance? Here’s why that might be…

Whether you are trying to switch insurance providers or make a claim on an existing policy, there may come a time when you are denied health insurance.

Having an application or claim rejected can be distressing, but it is important to remember your health insurance provider should always do everything in their power to offer you cover and settle your claims. In situations where they can’t do this, there is usually a good reason.

Some of the reasons why you might be denied health insurance include:

1. You have pre-existing conditions that can’t be covered
2. You are too old or too young
3. Your employment status does not meet your insurer’s criteria
4. You’re in a country where your insurer cannot provide cover
5. Your lifestyle puts you into a high-risk category
6. You have a poor insurance history
7. You have been sanctioned
8. Your application was incomplete

Always speak to your international health insurance provider if you’re unsure about anything

Why was my health insurance application rejected?

While taking out a new health insurance policy, your insurer may tell you they are unable to take you on as a customer.Sometimes, you may be denied health insurance without being told why.

Here are some of the reasons a health insurer may turn down your application:

1/ You have a pre-existing condition

Perhaps the most common reason a health insurer may deny your application is because you have one or more pre-existing conditions.

A pre-existing condition is any health condition, diagnosed or undiagnosed, you have at the time of applying for an insurance policy.

Technically, any condition – whether a disease, an injury or a disability – could count as a pre-existing condition. Pre-existing conditions encompass a wide range of health issues that you have displayed symptoms of for a long period of time, that have been diagnosed by a medical professional, and/or for which you have received treatment in the past.

If you have, or have ever had:

These are likely to count as pre-existing conditions. A past suicide attempt may also affect your ability to take out health insurance.

Common ailments such as cold, flu and COVID-19 usually do not count as pre-existing conditions (although long-term complications resulting from a COVID-19 infection, AKA ‘Long COVID’, may count).

What does and does not count as a pre-existing condition is up to your health insurer. If you have what they would define as a pre-existing condition, this presents a risk for them, especially if you are likely to need treatment for it again in the future.

You are likely to end up paying more to cover a pre-existing condition or, if the condition is considered too risky, the insurer may reject your application altogether.

2/ You are too old or too young

Age is a significant factor when it comes to taking out a new health insurance policy.

Many insurers will set a minimum age of 18 for people taking out health insurance for themselves. Up to this age, you may need to register as a dependent on your parents’ or guardians’ health insurance. Alternatively, you may find health insurers who are willing to offer health insurance to people aged 16 or 17.

Older people, meanwhile, are considered to be more at-risk of needing expensive medical treatments than younger people, which means the older you are, the more likely you are to be denied health insurance. Some health insurance providers provide specific policies for older people.

While many countries have implemented legislation to protect older people from being denied health insurance, as an older person, you may still end up paying higher premiums for your health insurance, even if you are in good health with no pre-existing conditions.

3/ Your employment status does not meet your insurer’s criteria

In order to be approved for health insurance, your insurer will want to know two things:

1. Are you employed, and therefore able to meet the cost of your premiums?
2. Does your line of work come with any risks that make you more likely to succumb to injury or sickness?

If you are unemployed, in part-time work or retired, or if your income is low, you are more likely to be denied health insurance, as your insurer may consider you to be at risk of being unable to afford your premiums. On the other hand, if you work in a field that is considered dangerous, you may be denied health insurance as your insurer is unwilling to shoulder the risk of you being injured at work.

Some fields of work that may exclude you from taking out health insurance include:

• Armed forces
• Emergency services including police, fire and rescue, coast guard or security
• Working at heights
• Working at depths
• Working at sea
• Working with explosive materials
• Working with complex or dangerous machinery
• Working with animals

As part of your application, your health insurance provider will run a risk assessment based on your employment type. If your work is considered too risky, your insurer may turn you down for health insurance. In these cases, you may need to look for health insurance providers who specialise in providing cover for people in your line of work.

4/ You’re in a country where your insurer cannot provide cover

This one is especially true if you are taking out international health insurance while living abroad. If you live in a country where a health insurer is unable to issue new policies, you may be denied health insurance.

One of the most common countries in which international health insurance providers cannot issue policies is the USA. As the United States operates on a different healthcare model to other countries, expats living in the USA may need to seek out specialist expat health insurance that provides cover in America.

For many health insurance providers, the cost of insuring members in the USA would push up their overall costs, making health insurance more expensive for members in other countries. As an expat in the USA, it’s vital you take out a specialist health insurance policy – the cost of healthcare in the USA can be extremely expensive without insurance.

There may be other countries where your health insurer is unable to provide new policies. These may include countries actively at war, countries that are considered extremely dangerous, and countries with limited healthcare infrastructure.

5/Your lifestyle puts you into a high-risk category

Your lifestyle is another area that could have an impact on your health insurance risk profile. If these factors push your risk profile too high, you may end up being denied health insurance.

Similar to your employment type, you may be denied health insurance if your hobbies and interests include dangerous activities. For instance, if you regularly take part in dangerous or extreme sports, such as motorcycle racing or mountaineering, your health insurer may consider you to be in a high-risk category and will therefore be more likely to decline you for health insurance.

You may also be denied health insurance if your lifestyle puts you at risk for various diseases. Smoking is one of the key reasons you may be denied health insurance, as this puts you at higher risk of various illnesses. Health insurers may also ask about the number of units of alcohol you drink each week and whether or not you regularly take drugs, as this can also have consequences on your health. And you may be asked about your weight – if you are underweight, overweight or obese, you will be considered at a higher risk of illness.

Another, less common question is around your driving record. If you have received multiple penalties for speeding and reckless driving, you will be entered into a higher risk category.

6/ You have a poor insurance history

While assessing your eligibility for health insurance, an insurer may call upon your records from previous insurers. This not only includes previous health insurers, but also your vehicle, life and home insurance providers. One thing we look for especially at William Russell is whether you have had a previous health insurance policy or claim denied. We’ll also ask if you have had special terms applied by a previous insurer.

Having a history of making multiple insurance claims, whether big or small, could signify that you are a high-risk client and therefore may make an insurer less likely to take you. If you are found to have committed insurance fraud in the past, you are highly likely to be denied health insurance.

7/ You have been sanctioned

While this is a rare occurrence, you may be denied health insurance if you appear on an international sanctions list. There are many reasons an individual may be subject to international sanctions, which typically relate to major political and economic relations between states concerning national security and international law.

In other words, if your country of residence, or the country in which your health insurer is based, considers you or members of your country to be a threat to their peace or security, they may embargo certain services – including your ability to take out health insurance.

You may also find yourself sanctioned as a result of previous or present political affiliations, your relation to certain businesses, your involvement in past military conflicts or your participation in national militaries or paramilitary organisations, your involvement as an athlete representing your nation, your career history (e.g. you were once a foreign ambassador or diplomat) or – most commonly – your criminal record.

If you are a Russian citizen, you may find that many countries around the world have imposed sanctions on Russians as a result of the war in Ukraine.

8/ Your application was incomplete

Of course, not all insurance denials come with a complex reason. Sometimes, you may find that you were denied health insurance simply because you did not complete the application form. This could mean anything from not completing your application form, to not submitting previous certificates of insurance or proof of residency in another country, to not signing your contract.

So, if you have been denied health insurance and aren’t sure why, be sure to go back through your health insurer’s application process and look for any steps you may have missed.

Why was my health insurance claim denied?

Even if you have taken out international health insurance, you may find when it comes time to make a claim that your application is rejected. While it is rare that a health insurance claim is denied, we understand that it can be very distressing, especially if you find yourself facing a large medical bill.

If this happens to you, it’s important to speak to your health insurer as soon as possible. There is usually a very good reason why your claim was denied, and you may even find that it is fixable.

1/ You are not covered at a certain hospital or for certain treatments

As well as understanding your coverage zone, it’s important to understand your insurer’s network within your country of residence. When receiving treatment, you must choose a medical facility that features within your insurer’s network, and the type of treatment you received must be covered by your plan. It is best to double check with your insurer the best place to receive treatment in advance, if you can.

Your plan is unlikely to include experimental, hom*oeopathic and alternative treatments, so be conscious that you may not be able to claim against these types of treatments. You may also be unable to claim against elective surgeries, especially if the treatment was deemed not medically essential. Your claim is also likely to be denied if your surgery or healthcare procedure was carried out by a member of your own family.

If you believe you may require treatment that is not included within your standard plan, you may be able to add these types of treatments as optional extras or upgrade your plan.

2/ You did not fill in your application accurately

This is a simple reason, but unfortunately one of the more common. If, at the time of applying for health insurance, you made a claim that was later found not to be truthful, your health insurer may reject any claim you make.

This is especially true if your insincerity is later found to be directly related to your health claim. For instance, if you claim not to smoke, and later develop a smoking-related illness, your insurer is within their rights to deny your health insurance claim. The premiums you have been paying up to that point were based on you being a non-smoker, so you were not technically insured for medical conditions resulting from smoking.

There are many other examples where your health insurer may refer back to your application when assessing whether or not you are eligible to make a claim. Any instance of falsehood – no matter whether or not it is directly related to your current claim – could be grounds for denial.

Other instances in which you may be denied include:

• You neglected to mention a pre-existing condition that you were aware of at the time of applying for health insurance
• You neglected to mention any prescribed drugs, ongoing treatments or other medical exclusions
• You denied consuming alcohol or recreational drugs
• You provided incorrect personal details, such as age, weight, height or occupation

3/ You neglected to tell your insurer about changes to your personal circ*mstances

Your health insurance policy is connected to your personal circ*mstances. Your marital status, the place you live and your occupation all affect your risk profile. If your circ*mstances change, you should let your insurer know right away, as you may be left under or over-insured. This could affect your eligibility to make a claim.

Examples of changes in personal circ*mstances you must tell your insurer about include:

• You have moved house, or moved to a new country
• You have changed occupation
• You have broken up with or divorced from a named partner on your health insurance policy

4/ You did not take reasonable or adequate care of yourself

When taking out health insurance, your provider may stipulate as part of their terms and conditions that you have a responsibility to take adequate care of yourself for the term of your contract.

Your health insurance premiums are decided on the basis that you will actively avoid life and health-threatening situations, so if you later require treatment for an injury or illness resulting from undertaking risky, reckless or dangerous activities, your insurance provider may refuse your claim.

Examples of injuries that your insurer may reject on the grounds you were not taking reasonable or adequate care of yourself may include:

• Taking part in extreme sports without first notifying your health insurer, without having undergone training or preparation, and without the instruction of a qualified professional
• Doing something unnecessarily that carries an immense risk to your physical wellbeing, such as entering a contaminated space
• Sustaining an injury while you were under the influence of alcohol or drugs
• Sustaining an injury while committing a felony offence

This does not mean you have to avoid all activities. Accidents that occur while you are driving, playing sports or performing DIY at home, for instance, will typically be covered, so long as these are not related to your occupation, and if you were taking reasonable care at the time.

Crashing while driving over the speed limit, attempting a backflip while celebrating a goal during a game of football, or working at height to fix your own roof without safety equipment, for instance, may be examples of claims that your health insurer rejects on the grounds you were not taking reasonable or adequate care at the time.

This goes for your general lifestyle, too. Putting on or losing an extreme amount of weight, especially in a way that is unnecessary or reckless, may count as not taking adequate care of yourself.

Sign up to our 5-part email guide to choosing expat health insurance
No spam, just helpful content for you!

5/ You exceeded your benefit limit

Your health insurer is likely to limit the amount you are able to claim for, either at one time or within the term of your policy. If your insurance claim exceeds your benefit limit, your insurer will be unable to pay out anything more than the maximum.

This is a rare circ*mstance, especially if you have filled in your health application truthfully, as your insurer will take into account the likely cost of major treatment in your country of residence and balance their claim limits accordingly. Your total benefit limit will usually be at least US$1 million.

However, benefit limits for individual treatments may be much lower. For instance, if you have a benefit limit of US$500 for health checks, and you have already used your US$500 benefit in a year, you will be denied if you try to claim again in the same year.

Furthermore, your insurer may stipulate that you need to choose a specific (usually cheaper) option when deciding between types of insurance – if you do not accept their recommendation, you may have your claim denied.

6/ You are outside of your policy’s coverage zone

If you fall sick or become injured while travelling to a country outside of your coverage zone, or to a country that is excluded in your health insurer’s terms and conditions, you will not be able to claim for your medical expenses, nor will you be entitled to additional benefits such as a medical evacuation.

It is vital you understand your coverage zone and any countries excluded by your health insurer, and that you either:

1. take out short-term travel insurance if travelling for a short visit, or
2. Extend your coverage zone before travelling, if permitted

In instances where you become sick or injured inside your coverage zone, but far away from adequate medical facilities, you may be entitled to a medical evacuation (medevac). This will transport you to a nearby facility where you can receive high-quality treatment.

What should I do next if I’ve been denied health insurance?

If you have had a health insurance application or claim denied, the most important thing is not to panic. The best thing to do in any situation is to speak directly to your insurer – they may be able to offer you alternative options and help you access the services you need.

If your application is denied by one insurer, this does not necessarily mean you are uninsurable. You may have better luck by speaking to a different insurer. Another option is to speak to a broker, who can offer you advice and refer you to specialist insurers who may be better suited to offer you insurance.

If your claim is denied, and you think it was denied unfairly, you should make a complaint directly to your insurer. If your complaint is not upheld, you can then escalate the case to an independent ombudsman or regulator.

Is there anything else I need to know?

We want to provide you with an insurance policy you can rely on, so it is important that you fully understand the scope of the cover we provide. Answers to the most common questions on our international health insurance plans are here, but feel free to get in touch and speak to our team. We’d be glad to help.