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There may be situations when you choose to appeal how a claim was processed. You may appeal your claim decision using one of the following methods:

Submit the Claimant Appeal Request Form Via DocuSign within Member Portal:

1. Sign into Member Portal. You will be presented with your Member Portal home page.
2. Click “Claims and Appeals” in the main navigation menu at the top of the page. You will be presented with the Claims and Appeals page.
3. Switch the toggle at the top of the page under the “Claims and Appeals” header from “Claims” to “Appeals.”
4. To file an appeal via DocuSign, click the “Fill Out and Submit Via DocuSign” button under the “Claimant Appeal Request Form” subheader in the “File an Appeal” section.
5. Enter your name and email address on the PowerForm Signer Information page and click the “Begin Signing” button.
6. Click the yellow “Continue” button to the right.
7. Fill in all the required information on the form (as indicated by the red text boxes) and sign everywhere a signature is required (as indicated by the yellow “Sign” boxes).
8. Attach your supporting documents (medical records, receipts, itemized bills, etc.), if necessary, at the bottom righthand corner of the page via the yellow attachment boxes. If you have more than 3 attachments or exceed the 5MB attachment limit, see instructions for submitting additional documents here.
9. When you are done, click the yellow “Finish” button at the bottom of the page. Clicking “Finish” submits your documents and sends a PDF of your signed Claimant Appeal Request Form to your email.
10. Download or print a copy of your completed form for your records. If you do not receive a confirmation email with your completed form attached within 24 hours, please contact WorldTrips to make sure your form was properly submitted.

Want more detailed instructions including screenshots? See the “Claimant Appeal Request Form Submitted Via DocuSign within Member Portal (Most Efficient Approach)” section of our Claims Resource Center page.

1. Download the Claimant Appeal Request Form. (Click here to download the form in Spanish).
2. Fill out the form and email it, along with additional documentation that supports your reasoning and position (medical records, receipts, itemized bills, etc.), to appeals@worldtrips.com.
   
   OR
   
   Mail the form and supporting documents to:
   
   WorldTrips Appeals
   PO Box 240358
   Apple Valley, MN 55124
   U.S.A

Submit a Written Appeal Letter Via Email or Mail

1. Write a letter of appeal following the appeal procedure instructions outlined in your policy documents/certificate of coverage.
2. Email this written letter of appeal, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.), to appeals@worldtrips.com.
   
   OR
   
   Mail the form and supporting documents to:
   
   WorldTrips Appeals
   PO Box 240358
   Apple Valley, MN 55124
   U.S.A

IMPORTANT! In order for our claims department to review the appeal, you must provide additional documentation or information to support a reversal of the denial. Please note that submission of the appeal will lead to re-evaluation of your claim but does not guarantee that the initial benefit determination will be altered.

Many providers are willing to bill us directly, and we are happy to work directly with the provider. The provider should submit original itemized bills to WorldTrips. You, the patient, will still need to submit a completed Claimant's Statement and Authorization form to WorldTrips. If the provider requires you to pay for medical treatment at the time of service, you will need to file a claim for reimbursement. When seeking treatment, please ensure that you provide your name in the same format as provided for your insurance policy. You can check your name format on your fulfillment documents, ID card, or in Member Portal.

At the time of service, ask your medical provider for an itemized bill with the following information: 

• Provider name and address
• Provider tax ID (if U.S.-based)
• Your name, date of birth, and certificate ID number
• Itemized charges
• DX (diagnosis) code and CPT (Current Procedural Terminology) code
• Request your receipt for payment and complete medical records from the visit.

- The Claimant’s Statement and Authorization form.
- You can also fill out the form via DocuSign online in Member Portal. (See step-by-step instructions on how to file a claim via Member Portal.)
- You can also contact us at 800-605-2282 to request a form by mail or fax.

You can complete and submit the Claimant's Statement and Authorization form (along with supporting documents) in one of the following ways:
Via DocuSign within Member Portal (Most Efficient Approach)
1. Go to Member Portal.
2. Log in to your account. If this is your first time using Member Portal, view instructions for registering your new account here.

NOTE: If you already have a Client Zone / Student Zone account, you do not need to register for a Member Portal account. Simply log in to Member Portal using your Client Zone / Student Zone login details.

3. Click "Claims and Appeals" in the main navigation menu. 4. Click the “Submit New Claim Via DocuSign” button under the “Claimant’s Statement and Authorization Form” subheader in the “File a Claim” section and follow the instructions. For more extensive step-by-step instructions, including screenshots, please see our “How to File a Claim” guide.

Don't Have Access to the Claims and Appeals Page? If you noted that you are not the insured or the insured’s legal guardian, you will see the Protected Health Information Authorization page in place of the Claims and Appeals page. Enter the insured’s email address and click “Send Request.” Once the insured has completed and submitted our HIPAA form, you will gain access to the Claims and Appeals page and have the ability to submit a claim within 3-5 days.

By Mail
1. Download the Claimant's Statement and Authorization form here.
2. Print, complete, and sign the form
3. Mail to: WorldTrips Claims Department PO Box 240358 Apple Valley, MN 55124 U.S.A. WorldTrips is also happy to fax, e-mail, or mail the form(s) to you upon request.

Important Note for Students:
For eligibility purposes, you must submit the following along with a Claimant's Statement and Authorization form:
- A copy of your education-related visa (F-1, J-1, OPT, etc.) or valid I-20/DS2019
- Proof of full-time student status (not necessary if submitting a valid F-1 visa including OPT, or J-1 visa)

You may complete and submit the form to us in one of the following ways:

- Electronically via Member Portal

1. Go to Member Portal.
2. Log in to your account. If this is your first time using Member Portal, please click here to view instructions for registering your new account. 
   
   If you already have a Client Zone / Student Zone account, you do not need to register for a Member Portal account. Simply log in to Member Portal using your Client Zone / Student Zone login details. 
   
   
3. Click "Claims and Appeals" in the main navigation menu.

If You See the Protected Health Information Authorization Page: - Because you selected that you are not the insured or the insured's legal guardian upon registering for Member Portal, you do not yet have access to the Claims and Appeals page. - Under the "Protected Health Information Authorization" header, enter the insured's email address and click the "Send Request" button. - The insured will receive an email with a link to complete, sign, and submit the HIPPA form via DocuSign. You will gain access to the Claims and Appeals page and will be able to see the status of any pending claims within 3-5 days of the date the policyholder completed and submitted the form.

If You See the Claims and Appeals Page: - Click the "Fill Out and Submit Via DocuSign" button under the "Authorization Form for Use and/or Disclosure of Protected Health Information (HIPPA)" subheader in the "File a Claim" section. - Enter the insured's name and an email address and click the "Begin Signing" button. - Click the yellow "Continue" button, fill out the form and the required information (as noted by the red boxes), have the policyholder sign the form, and click the yellow "Finish" button. - Clicking "Finish" submits the document and sends a PDF of your signed Authorization Form for Use and/or Disclosure of Protected Health Information to the email address entered. Download or print a copy of your completed form for your records. If you do not receive a confirmation email with your completed form attached within 24 hours, please contact WorldTrips to make sure your form was properly submitted.

- By Mail

1. Download the Authorization Form for Use and/or Disclosure of Protected Health Information.
2. Print, complete, and have the policyholder sign the form.
3. Mail to:
   WorldTrips Claims Department
   PO Box 240358
   Apple Valley, MN 55124
   U.S.A. 

In health insurance, subrogation is the process through which an insurance company seeks to recover medical costs from another party’s insurance. For WorldTrips, it refers to those times when you or your family may have submitted a claim for medical care for which a third party is responsible. These types of claims could be car accidents, slip and fall claims, negligence claims, or product liability claims. In cases where a claim for services in the United States is in question, WorldTrips is responsible for administering the claim.

We use Equian, an independent company, to assist us with the investigation and recovery process for these subrogated claims. [equian logo?] - What Equian Will Do? As part of the investigation process, you may receive a letter or email directly from WorldTrips and Equian asking you to provide details regarding an incident or paid medical claim. The date of your consultation or treatment and the name of the healthcare provider will be listed on the letter and the investigation will be allocated an event number.

-What You Need to Do If you have been contacted by WorldTrips and Equian, you can fill out the online subrogation questionnaire at the following link: https://selfservice.troversolutions.com You will be asked to provide your event number, which was provided in the correspondence, so please have it ready to reference. You can also call the toll-free customer service number at +1 (800) 395-5568 to provide the information to an Equian customer service representative.

Customer service hours in the U.S. are as follows:
- Monday through Thursday: 8:30 a.m. until 9:00 p.m., Eastern Standard Time
- Friday: 8:30 a.m. until 7:00 p.m., Eastern Standard Time
- How Helping Us Will Benefit You By providing WorldTrips and Equian with the requested accident-related information, you are able to take an active role in helping to control your healthcare costs. If Equian determines another party was responsible for your injuries, it may seek reimbursement from the responsible party or insurance.