dslreports logo
site
 
    All Forums Hot Topics Gallery
spc

spacer




how-to block ads


Search Topic:
uniqs
1465
share rss forum feed

jaberi

join:2010-08-13

What happens when travel insurance rejects your claim

You buy travel insurance to ensure a health mishap outside Canada doesn't turn into a massive financial burden.

But it appears you need a lawyer beside you when you fill out the insurance application, judging by some cautionary tales reported by CBC News's Go Public reporter Kathy Tomlinson.

»ca.news.yahoo.com/blogs/dailybre···292.html

jaberi

join:2010-08-13
those who have had health problems do not have an easy time buying a policy that will cover them on everything...

PX Eliezer7
Premium
join:2008-08-09
Hutt River
kudos:13
Reviews:
·callwithus
·voip.ms
reply to jaberi
I [hate] insurance companies, yet I have to agree with the companies as to the facts of the matter. (Not the morals, but the facts).

The lady who answered NO as to being treated for heart problems in the last 12 months---SHE said she assumed it meant 12 months prior to the future upcoming trip date, NOT 12 months prior to the date she applied for the insurance.

HOW THE HELL would her view make any sense? She is saying that she is being asked about treatment in the FUTURE. No reasonable person would assume they were being asked about treatment in a future that has not existed yet except on some Einsteinean plane of quantum existence. That's such a ridiculous interpretation of the question, anyone with common sense would have realized that such an interpretation of the question was wrong.

As to the guy---Yes, he DID have bowel disease. While 1965 is a long time ago, Ulcerative Colitis is a big deal, and he was CURRENTLY taking medicine for it. So he can't claim he forgot about it, or that it was not an issue.

I fully agree that insurance slimeballs use any excuse to get out of paying.

Yet the two examples cited in the news story are rather weak.

Even though I hate insurance companies, if I were on a jury I would side with the companies in both of these cases.

LastDon

join:2002-08-13
I believe some companies cover pre - existing conditions if under control , meaning taking medication etc etc.

i know a few people that travel, and have anxiety, panic disorder, but because they have been taking medications with no changes in the last year, they are covered as it is under control.

Some though don't have this policy.


corster
Premium
join:2002-02-23
Gatineau, QC
said by LastDon:

I believe some companies cover pre - existing conditions if under control , meaning taking medication etc etc.

i know a few people that travel, and have anxiety, panic disorder, but because they have been taking medications with no changes in the last year, they are covered as it is under control.

Yes, but that doesn't mean you don't have to declare the condition when asked.


DKS
Damn Kidney Stones
Premium,ExMod 2002
join:2001-03-22
Owen Sound, ON
kudos:2
reply to jaberi
Denial ain't just a river in Egypt. People have "gone south in the winter" for so long, even owning property, that they can't understand why they aren't entitled to enjoy their vacations.

Guess what?

You can't. I see this all the time. Health changes as you get older mean you have to stay closer to home. Welcome to the world of aging, Baby Boomers. Expect insurance companies to get more strict and their applications to get more complex. This is profit-driven health care.
--
Need-based health care not greed-based health care.


Thane_Bitter
Inquire within
Premium
join:2005-01-20
reply to jaberi
Makes you wonder if anyone is capable of meeting the insurance requirements as such.

plumerya

join:2004-08-20
Montreal, QC
reply to jaberi
Hi Guys,

You can watch this video clip from CBC Market

»www.cbc.ca/marketplace/2012/trippedup/

quote:
Going on vacation? Think travel health insurance is going to protect you if something goes wrong?

Marketplace exposes an industry that's set up to fail -- convoluted medical questionnaires that can trip people up, travel agents on hidden camera giving dangerous advice, and travellers left on the hook for hundreds of thousands of dollars.

Watch what happens when Erica Johnson goes looking for answers from a multi-million dollar industry that "regrets your claim is denied."



elwoodblues
Elwood Blues
Premium
join:2006-08-30
Somewhere in
kudos:2
Reviews:
·VMedia
reply to DKS
Yep, for profit health care, just what some of you young and healthy are advocating.

I watched the Marketplace episode last year.. they word things in such a way that are designed to take your money and deny you coverage.

I'm sure they'd find away to deny me coverage because I saw a doc about non specific aches and pains 2 months ago.

zod5000

join:2003-10-21
Victoria, BC
Reviews:
·Shaw
reply to Thane_Bitter
said by Thane_Bitter:

Makes you wonder if anyone is capable of meeting the insurance requirements as such.

It is possible they might of, but the insurance company never got the chance to assess the risk. At that point they may have charged higher premiums (because the people were at a higher risk) or declined coverage. Both would of prevent the problem these people found themselves in.

MaynardKrebs
Heave Steve, for the good of the country
Premium
join:2009-06-17
kudos:4
reply to jaberi
What about credit cards that offer built-in travel insurance?

I have not looked at the fine print in a while but since you aren't filling out an application each time you travel, you aren't intentionally or unintentionally not communicating about something trivial which they can deny you coverage for.


WhaleOilBee
What a long strange trip it's been

join:2011-08-02
Manotick, ON
Reviews:
·Acanac
reply to jaberi
It seems to me that the insurance companies have the right to reject fraudulent claims, BUT.. They appear to sometimes be over-zealous.

There was a story about someone ( I forget where I saw it ) that answered "no" to a question about being diagnosed for heart problems. While travelling, some other issue came up, but the claim was denied because he 'lied' on the application. He had received an EKG as a standard test while in the hospital; no heart issues were discovered at that time, but technically he had been 'diagnosed' for heart problems. Hospitals routinely give EKG to post-operative patients as a precaution. It's really nit-picking to say that a heart problem was diagnosed.

So, if a doctor says "how are you today", then I guess I've just been 'diagnosed' for every possible disease and condition known to mankind?


corster
Premium
join:2002-02-23
Gatineau, QC
reply to MaynardKrebs
said by MaynardKrebs:

What about credit cards that offer built-in travel insurance?

I have not looked at the fine print in a while but since you aren't filling out an application each time you travel, you aren't intentionally or unintentionally not communicating about something trivial which they can deny you coverage for.

Most of these umbrella policies usually have a clause saying they will not cover a "pre-existing condition that was not considered stable X days before travel" or something along those lines, but obviously each policy is different and you should read the fine print.


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
reply to jaberi
I have to wonder how any of this would apply when travel insurance is automatically included as part of group coverage, like the coverage my family has. I mean, it's not as if you filled out a questionnaire that they can wave in front of you and claim you lied on.


joeblow3

join:2000-12-27
London, ON
said by Gone:

I have to wonder how any of this would apply when travel insurance is automatically included as part of group coverage, like the coverage my family has. I mean, it's not as if you filled out a questionnaire that they can wave in front of you and claim you lied on.

It is post incident qualified. In other words when you need it or file a claim they will then ask you to fill out the questionnaire and then check to see if you qualify. If you do then then claim continue.

It is the same with mortgage insurance with your mortgage company. If you claim and don't qualify they will actually reimburse your premiums. This was also on Market Place.


joeblow3

join:2000-12-27
London, ON
For travel insurance only over 60 need to fill out a medical questionnaire when applying for the insurance. All others when claiming.


A Lurker
that's Ms Lurker btw
Premium
join:2007-10-27
Wellington N
reply to PX Eliezer7
said by PX Eliezer7:

As to the guy---Yes, he DID have bowel disease. While 1965 is a long time ago, Ulcerative Colitis is a big deal, and he was CURRENTLY taking medicine for it. So he can't claim he forgot about it, or that it was not an issue.

This one I disagree with. If his treatment out of the country was for the bowel disease I can see not covering it. However, he had pneumonia. They keep people on staff just to see if they can get out of paying claims.

The problem is that many of the forms are f-in confusing. I'll have to see if I can find the one that a relative filled out when travelling a number of years ago. They (and the doctor) read it one way, the travel agent wasn't sure, and together they ended up calling the insurance company to get a straight answer. When the travel agent made the call the insurance agent on the phone couldn't answer the question, which worked out well. Eventually they got a written response, which was nice. It was basically looking for information on if your medication had changed in the past 12 months. ie. it was okay if you had a previous condition, as long as it was under control. However, the question was so poorly written, it really was open to interpretation.

I applied for coverage on an extended trip I took for business years back (our company covered travel, but the number of days I was going was out of the max days). The HR person actually told me to hold off on filling it out as I was a week away from answering no vs. yes on one of the questions for myself. It was minor as I could apply as close as 48-hrs before the trip itself and this was months before hand.


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
reply to joeblow3
said by joeblow3:

said by Gone:

I have to wonder how any of this would apply when travel insurance is automatically included as part of group coverage, like the coverage my family has. I mean, it's not as if you filled out a questionnaire that they can wave in front of you and claim you lied on.

It is post incident qualified. In other words when you need it or file a claim they will then ask you to fill out the questionnaire and then check to see if you qualify. If you do then then claim continue.

It is the same with mortgage insurance with your mortgage company. If you claim and don't qualify they will actually reimburse your premiums. This was also on Market Place.

Maybe the company you work for, but i can tell you that there is no way a group policy is going to ask you to fill a ?aire post-incident. Usually group policy have a stable clause. be it 90 or 180 days prior to departure.

As far as travel insurance is concerned, you would all be surprised at the pay vs deny ratio. Travel division make the least amount of money in any financial institution. Premium are low and claim payouts are high.

Usually when a claim is denied its with good reason. And some of you are confused about the treatment received vs pre-ex conditions on ?aires. If you did not answer the ?aire correctly, you mis-represented yourself and bought a policy that was not for you, therefore your policy is not valid. It has nothing to do with wanting to deny a claim. It is up to you to properly answer the questions asked to you. Again, you would be surprised at how many claim also get paid EVEN if the client has mis-repped himself.

As far as credit card insurance is concerned, it's a stable clause on pre-ex conditions, and because these are usually for under 60 years old, its very likely a 90 day stable clause.

EDIT: for those of you who think that staff is on payroll looking to deny claims, you are wrong. i would kill myself if that was the case. plus again, financially not justifiable for any TRAVEL insurance company to do that. Usually, travel insurance companies are the less evil of the insurance branches!

peterboro
Avatars are for posers
Premium
join:2006-11-03
Peterborough, ON
reply to jaberi
I posted about the $80,000 bill for three days in the hospital for a relative last year who had private insurance.

Insurance denies as failure to disclose previous condition. Insured states no previous condition as x-ray at Ontario hospital says so.

X-ray technician misread x-ray. Insured hires lawyer who threatens to sue hospital (Ontario gov.) and insurance company.

Insured starts to challenge all the ridiculous charges from US hospital and gets bill down to $35,000.

Insurance company and OHIP eventually settle and pay the 35k.


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
said by peterboro:

I posted about the $80,000 bill for three days in the hospital for a relative last year who had private insurance.

Insurance denies as failure to disclose previous condition. Insured states no previous condition as x-ray at Ontario hospital says so.

X-ray technician misread x-ray. Insured hires lawyer who threatens to sue hospital (Ontario gov.) and insurance company.

Insured starts to challenge all the ridiculous charges from US hospital and gets bill down to $35,000.

Insurance company and OHIP eventually settle and pay the 35k.

That is an unusual situation and the insurance company probably went with what was provided to them. If you submit a report that says you have cancer to the insurance company and then you are denied cancer treatment because you didnt disclose, and then it turns out it was a misread blood test, then how is that the insurance fault? Blame the hospital and the Dr's who mis-diagnosed, the insurance had every right to deny coverage for misrepresentation.

In the real world, these do not happen that often, and when they do, they usually get settled after. Usually on misreps, if it quacks like a duck...

Was the 80K in a USA hospital? if so, seems about right.

peterboro
Avatars are for posers
Premium
join:2006-11-03
Peterborough, ON
said by OverrRyde:

That is an unusual situation and the insurance company probably went with what was provided to them. If you submit a report that says you have cancer to the insurance company and then you are denied cancer treatment because you didnt disclose, and then it turns out it was a misread blood test, then how is that the insurance fault? Blame the hospital and the Dr's who mis-diagnosed, the insurance had every right to deny coverage for misrepresentation.

In the real world, these do not happen that often, and when they do, they usually get settled after. Usually on misreps, if it quacks like a duck...

Was the 80K in a USA hospital? if so, seems about right.

Yes US hospital. I wasn't involved in the case but the impression I got was that the dollar amount was low enough for them to settle out of court.

The interesting part was how fast the price dropped when the hospital thought they were not insured. When they got the bill for 80k they went over it with a fine tooth comb and with the help from a consultant in Florida challenged every procedure and fee.


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
said by peterboro:

said by OverrRyde:

That is an unusual situation and the insurance company probably went with what was provided to them. If you submit a report that says you have cancer to the insurance company and then you are denied cancer treatment because you didnt disclose, and then it turns out it was a misread blood test, then how is that the insurance fault? Blame the hospital and the Dr's who mis-diagnosed, the insurance had every right to deny coverage for misrepresentation.

In the real world, these do not happen that often, and when they do, they usually get settled after. Usually on misreps, if it quacks like a duck...

Was the 80K in a USA hospital? if so, seems about right.

Yes US hospital. I wasn't involved in the case but the impression I got was that the dollar amount was low enough for them to settle out of court.

The interesting part was how fast the price dropped when the hospital thought they were not insured. When they got the bill for 80k they went over it with a fine tooth comb and with the help from a consultant in Florida challenged every procedure and fee.

Oh yeah, common practice! As soon as they see the patient has insurance, the bill is easily 2-3 times inflated.

What happens when they lower the cost after either a denial or a self-pay patient is that they rather get something than nothing at all.

This has started with other tourist area too, Dominican, Mexico and other are doing the same, i think it's worse there!


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
reply to jaberi
I guess it's safe to say if any of you have questions in regards to travel insurance, im your man!

Trust me, we don't bite!

We are the nice people from the insurance industry! lol


A Lurker
that's Ms Lurker btw
Premium
join:2007-10-27
Wellington N
reply to OverrRyde
said by OverrRyde:

EDIT: for those of you who think that staff is on payroll looking to deny claims, you are wrong. i would kill myself if that was the case. plus again, financially not justifiable for any TRAVEL insurance company to do that. Usually, travel insurance companies are the less evil of the insurance branches!

So, how was his claim denied? C'mon - he goes in for pneumonia treatment and someone denies it because he's being treated for more than 40 years for something completely unrelated? Call it what you will, but someone went back over his application, found a loophole, and denied the claim.

The company saved $112,000 - not worth to pay someone to look for mistakes? How much are they making?


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
There is no loophole, we don't need to search for anything. It usually pretty clear. No one is paid to search for errors.

Policy is sold on a specific category (say from A to E). If you are an A, you are usually healthy, no pre-ex conditions. If you are an E, you probably shouldnt be travelling.

Now, lets say you happen to be an D, we know from the get go you have a/some pre-ex condition and that you answered a questionnaire. We know what conditions fall under what category. Now, when we open a claim, we ask you upfront what pre-ex conditions you have and we compare that to the answers on the questionnaire. If you so happen to have had a heart attack in the last 12 months and didnt answer yes for that on questionnaire, you are a mis-rep. Simple as that, no loophole, no fine print.

Now weather or not you are being seen for a condition unrelated is irrelevant, you mis-represented yourself on a questionnaire to assess the risk which in turn determines the premium and category you fall under. Would you have answered yes, everything would be a-ok.

The company didnt save or lose any money, you were not qualified for coverage to start with.

peterboro
Avatars are for posers
Premium
join:2006-11-03
Peterborough, ON
reply to OverrRyde
said by OverrRyde:

We are the nice people from the insurance industry! lol

Don't take this personally but there are few if any nice people in the insurance industry just degrees of weaselness.

I'm sure at conventions and office pep talks they tell you that you are the nice guys to help you sleep better at night.

jaberi

join:2010-08-13
reply to OverrRyde
OverrRyde......................what exactly does a credit card cover health wise, and or requiring medical attention when out of the country?

most travel insurance does not cover air-ambulance.....some foreign countries will not look at a patient unless they pay up front....they can then put in a claim to their insurance once they are back home...
people travel for reasons other than vacation, and might not think anything will happen.........one can slip and fall anywhere at anytime and break a leg and require medical attention....... what does that have to do with some questionnaire that is asking about ailments?....a pregnant woman, can require hospitalization, accidents can happen home or abroad.


capdjq
Premium
join:2000-11-01
Vancouver
reply to jaberi
One should come completely clean on "current medical" problems and "previous conditions" when filling out travel insurance. Most people, I know, don't and the complain when they are rejected.
My next door neighbour has had diabetes for years, yet never states that, when traveling. Anything, from strokes, heart attacks, could be traced to his diabetes and he would have a problem in his claim.

Even a change of prescription, prior to the travel (or filling out the form), could invalidate the claim for that condition.

Its better to pay the extra insurance than face the "exorbitant" charges.

I even take out medical insurance for a days travel to the US in case of an accident.
--
Liberalism is a mental disorder



elwoodblues
Elwood Blues
Premium
join:2006-08-30
Somewhere in
kudos:2
Reviews:
·VMedia
Private insurance companies are weasels.
Last job I got a substantial raise, and as a consequence, wanted to up the life insurance.

Denied.. why? Arthritic foot! WTF does a an arthritic foot have to do with life insurance, let alone for an IT person who sits on his ass half the day?
--
No, I didn't. Honest... I ran out of gas. I... I had a flat tire. I didn't have enough money for cab fare. My tux didn't come back from the cleaners. An old friend came in from out of town. Someone stole my car. There was an earthquake.......


OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
·Start Communicat..
reply to jaberi
said by jaberi:

OverrRyde......................what exactly does a credit card cover health wise, and or requiring medical attention when out of the country?

most travel insurance does not cover air-ambulance.....some foreign countries will not look at a patient unless they pay up front....they can then put in a claim to their insurance once they are back home...
people travel for reasons other than vacation, and might not think anything will happen.........one can slip and fall anywhere at anytime and break a leg and require medical attention....... what does that have to do with some questionnaire that is asking about ailments?....a pregnant woman, can require hospitalization, accidents can happen home or abroad.

Credit card usually cover emergency medical treatment and are automatic when you travel for a certain amount of days. They are usually annual policies that start on the first day you leave for a certain amount of days, 3-9-15 or 30 days depending on the card. They also are usually for clients up to a certain age, usually 65.

For air ambulances, good travel insurance has airam service and is usually arranged by the insurance company air paid by the insurance company upfront as long as the claim is payable.

The questionnaire is for people over 60 or 65. It is used to assess the risk and establish the premium the client is going to pay for what category. Having a pre ex condition does not exclude you from coverage so long as you have been stable for a certain amount of time, 90 or 180 days before departure depending on the coverage. If you are seen for any condition you are covered as long as the questionnaire was answered correctly and that you are stable.

Keep in mind people under 60 don't answer a questionnaire so they are only subject to the stable clause. Like I said, say you have a pre ex heart condition and you break your leg, you are 110% covered as this has nothing to do with your heart. Now if you are seen for a pre ex condition we may have to look at your past health history to determine if you were stable. If you were, covered.