What should you do if your insurance doesn't cover medical treatment?

When an insurer does not cover medical expenses, there are two key steps to take: gathering the necessary documents and verifying exactly which provision of the policy the decision was based on. The denial itself does not yet determine whether the costs should be reimbursed. The answer depends on the selected coverage, the circumstances of the incident, the coverage limits and sub-limits, and the obligations set forth in the General Terms and Conditions. It’s also not a good idea to rely on rules you remember from another policy—even similar insurance policies may require a different claims filing process. Below, you’ll find a practical step-by-step guide, examples of requirements from specific General Terms and Conditions, and a list of documents that will help you organize your case. Review the decision together with the policy and the applicable version of the General Terms and Conditions, rather than solely on the basis of a brief notice stating that coverage is unavailable.

What to Do Immediately After a Service Outage

First, determine exactly what the problem is. The situation is different when the insurer refuses from the outset to arrange assistance or cover its costs, and it is different when, after paying the cost, the insurer does not recognize the claim. Write down the date of the incident, the date you contacted the insurer, the claim number, and the content of the response you received.

If any documents are missing, make a list and note where you can obtain them. The policy, the General Terms and Conditions, and the insurer's response should all pertain to the same contract. Combining documents from different years or versions can lead to incorrect conclusions.

It's also a good idea to distinguish between an urgent matter related to an ongoing incident and a subsequent dispute over settlement. If you need more context, see, What type of insurance covers inpatient treatment?.

How to Check the Coverage of Your Policy

Start with the page or section of the policy that lists the selected plan, coverage provisions, and sum insured. Next, look up the definitions of an insured event, the scope of medical expenses, post-event obligations, and limitations of liability in the General Terms and Conditions. The scope of coverage is determined by the selected plan and riders, not by the product name itself.

A good example is the Compensa Cudzoziemiec policy under the 2026 General Terms and Conditions. Clause No. 1 regarding medical expenses in Poland, along with assistance services, is part of the contract if the policyholder has selected this coverage. According to this provision, it covers medically necessary costs of treatment for an illness or the consequences of an accident that the insured person must undergo immediately during their stay in Poland. This description applies to a specific Compensa clause, so it does not automatically prove that every bill is payable.

It is helpful to compare the following four elements:

In Uniqa’s 2020 General Terms and Conditions of Insurance, the sum insured, the maximum coverage amount, and the sublimits constitute the upper limit of liability for a single insured person. The document also specifies that claims reduce the applicable sum insured or sublimit, and their amounts are listed in the policy and the table of coverage options. Check the coverage amounts in your policy, because you should not transfer parameters from another document or variant.

You can read more about what protection might entail in the article on Regarding insurance of hospital treatment of foreigners.

How to Gather the Necessary Documents

The documents should provide a coherent account of what happened, when it happened, what assistance was needed, how much it cost, and how the claim was filed. The most important thing is a clear chronology. Organize the documents by date, and give the copies simple names, such as „insurance policy,” „incident report,” „medical records,” „invoice,” and „insurer’s response.”.

The 2026 Compensa Cudzoziemiec General Terms and Conditions provide for the submission of a claim form, other documents specified after the claim is filed, and the preservation of evidence related to the incident. Compensa may also require medical records and other evidence necessary to determine the circumstances and extent of the damage. Keep a copy of the receipt for each document you submit.

According to Uniqa’s 2020 General Terms and Conditions, a claim for medical expenses must include the policy number, a detailed description of the circumstances, a medical report with the diagnosis and recommended treatment, and the following supporting documents: invoices, receipts, hospital discharge summaries, and proof of payment. The policy number and the description of the incident must be unambiguous, so that the materials can be assigned to the correct case.

Do not add any diagnoses or circumstances that are not supported by documentation. If something is missing, state this clearly and ask the insurer for a detailed list of the required additional information. Medical records and expense documents serve different purposes: The first describes the assistance provided; the second confirms the costs incurred.

How do the procedures differ in the General Terms and Conditions?

There is no basis for applying a single deadline or a single list of documents to all policies. Always check the procedure specified in your contract. Be sure to check the deadline and the list of required documents in your General Terms and Conditions.

Compensa Cudzoziemiec — General Terms and Conditions 2026

In this version of the document, the incident must be reported within 14 days of the date of the accident. If, as a result of the accident, the insured was unable to do so, the deadline is calculated from the date the cause preventing the report is resolved. The General Terms and Conditions also specify the form to be used, the documents required to assess the claim, and the procedures for securing evidence. The 14-day period applies to this version of Compensa's General Terms and Conditions, rather than all products available on the market.

TUZ Insurance — General Insurance Terms and Conditions 2026

The General Terms and Conditions for Medical Expenses Coverage for Foreigners issued by TUZ Ubezpieczenia require immediate notification, no later than 14 days after the insured event or upon learning of the claim. The document includes a provision stating that additional clauses may contain separate provisions. It also lists the claim form, the documents required during the claims settlement process, and the steps to be taken to minimize the extent of the loss. Be sure to check the additional terms as well, instead of stopping after the general section.

Ergo Hestia — General Terms and Conditions of Insurance 2016

Under this version of the General Terms and Conditions, you are required to notify the Emergency Call Center immediately. The claim submission should include a properly completed form, originals of documents confirming the costs incurred, medical records with diagnoses, and other documents describing the scope of the assistance provided. The requirement for originals stems from a 2016 document; before taking any action, you should compare it with the General Terms and Conditions actually attached to your policy.

These examples do not constitute a ranking of insurers. They show that claims that appear similar may have different formal requirements. Don't assume that a previous application sets the procedure for a new policy.

How to Plan Next Steps

Once you have gathered the necessary materials, prepare a brief, factual explanation. In the first paragraph, include the policy number and case number. Next, describe the incident in chronological order, specify what the expense was for, and list the attachments. Finally, ask the insurer to reconsider its position based on the documents provided and to cite the specific provision of the General Terms and Conditions of Insurance if the insurer maintains that coverage is not provided. Each submission should correspond to a single chronological sequence.

Don't assume you'll get your money back before reviewing the contract. A claim may be denied due to the scope of coverage, a limit, a failure to meet an obligation, or missing documentation, but the reason should be evident from the documents related to the specific case. Ask about the basis for the decision, not just a general assurance.

If you're considering purchasing another policy for the future, be sure to close the file on your current claim first. Changing your policy does not alter the terms and conditions of an event that has already occurred. You may find the following guides helpful: a smooth transition to new insurance coverage during your stay and about Insurance options for a foreign national who is unemployed in Poland. A new policy does not automatically remedy a previous lack of coverage.

Before making your next purchase, compare the coverage, the total amount, the sublimits, the claims filing process, and the required documents. Before making a purchase, please carefully review the General Terms and Conditions for the applicable plan, not just a description of the offer.

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