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OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
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reply to A Lurker

Re: What happens when travel insurance rejects your claim

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.


jaberi

join:2010-08-13

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.



OverrRyde

join:2007-04-10
Waterdown, ON
Reviews:
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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.


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4

So let me ask you this...

I had Pancreatitis in September. I have been going for regular blood tests and the condition is improving at a rate that my doctor is very pleased about, but pancreatitis is a long drawn-out healing process, taking 6-12 months to fully recover prior to the condition first appearing. Is this considered "stable" ? If it flares up when I'm down in Vegas for whatever reason, am I SOL?

Just the same - I was told I had a kidney stone two years ago. To the best of my knowledge, it has not passed. Otherwise no changes. Is this considered stable if that little fucker decides to ruin a trip stateside, or will I be on the hook for whatever pain killers I need to have pumped into me?

What about my Crohn's Disease? It flared up in November 2011 and I was on medication until the Pancriatitis. I am under a doctors care, but otherwise there has been no change to my condition other than being taken off medication as per my doctor's orders.

Do you see how the whole idea of travel insurance can be outright intimidating for someone with health conditions?



OverrRyde

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

said by Gone:

So let me ask you this...

I had Pancreatitis in September. I have been going for regular blood tests and the condition is improving at a rate that my doctor is very pleased about, but pancreatitis is a long drawn-out healing process, taking 6-12 months to fully recover prior to the condition first appearing. Is this considered "stable" ? If it flares up when I'm down in Vegas for whatever reason, am I SOL?

Just the same - I was told I had a kidney stone two years ago. To the best of my knowledge, it has not passed. Otherwise no changes. Is this considered stable if that little fucker decides to ruin a trip stateside, or will I be on the hook for whatever pain killers I need to have pumped into me?

What about my Crohn's Disease? It flared up in November 2011 and I was on medication until the Pancriatitis. I am under a doctors care, but otherwise there has been no change to my condition other than being taken off medication as per my doctor's orders.

Do you see how the whole idea of travel insurance can be outright intimidating for someone with health conditions?

Absolutely it is intimidating, but you know what's worse? A 150k bill from a hospital in California plus the air ambulance bill 50k back home.

Simple rule of thumb is to follow the stable clause. In your case, as long as you are stable you are OK, and that is stable as per the policy. No new symptoms, recurring symptoms, new treatment, new meds, change in meds, new tests ordered, pending tests, specialist visits.

Say none of the above apply to you, you are considered stable. And again, this is only for the pre ex conditions. Anything new and unforeseen such as a cold, broken limb etc, is not subject to stable clause.

My best advice is first speak with your GP to discuss any peers conditions, then contact the insurance and ask specifically about your condition. Good travel insurance have nurses and medical case managers that can give you a clear answer to your question. Nurses and case managers don't get paid to sell you a policy so nothing to worry about wanting to make a sale. The nurses and case managers are there for people on trip requiring assistance for their condition.

MaynardKrebs
Heave Steve, for the good of the country
Premium
join:2009-06-17
kudos:4
reply to OverrRyde

said by OverrRyde:

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.

Just a question.....
Say you buggered your knee/ankle skiing years ago and had surgery to fix it. Your surgeon says it's fine post-surgery.

You go abroad years later and while walking down the street you step in a small pothole and your knee/ankle gets damaged as a result and you need hospital treatment abroad.

Is your knee/ankle surgery a deniable pre-existing condition or not?

What if you had a flu shot within 90 days of travel - is that disclosable or not? Will you be denied coverage if you don't disclose it and you have a heart attack?

What about women who are routinely placed on meds for hot flashes, or osteoarthritis as they get older? Are they forced to wait 90-180 days in order to become stable before they can travel with coverage? What if you're given antibiotics for an sinus/ear infection?


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
reply to OverrRyde

said by OverrRyde:

My best advice is first speak with your GP to discuss any peers conditions, then contact the insurance and ask specifically about your condition.

I spoke with my gastroenterologist/internist about travelling and he had no issues with it. I saw him yesterday and my ongoing regularly-scheduled tests showed continued improvement. I took that as a good sign.

Still, this is daunting. I sort of resigned myself to the fact that if I do get sick and insurance is denied for whatever reason they can come up with, I'll just go bankrupt and wash my hands of it.

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

said by Gone:

Still, this is daunting. I sort of resigned myself to the fact that if I do get sick and insurance is denied for whatever reason they can come up with, I'll just go bankrupt and wash my hands of it.

Same here.


OverrRyde

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

said by MaynardKrebs:

said by OverrRyde:

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.

Just a question.....
Say you buggered your knee/ankle skiing years ago and had surgery to fix it. Your surgeon says it's fine post-surgery.

You go abroad years later and while walking down the street you step in a small pothole and your knee/ankle gets damaged as a result and you need hospital treatment abroad.

Is your knee/ankle surgery a deniable pre-existing condition or not?

What if you had a flu shot within 90 days of travel - is that disclosable or not? Will you be denied coverage if you don't disclose it and you have a heart attack?

What about women who are routinely placed on meds for hot flashes, or osteoarthritis as they get older? Are they forced to wait 90-180 days in order to become stable before they can travel with coverage? What if you're given antibiotics for an sinus/ear infection?



Your knee will be considered pre-ex but not excluded as this is beyond the 90 days stable clause. Unless there was a change I'm the last 3 months before you leave, this applies for any condition

As for the flu shot, yes, you are still covered for the heart as the shot is unrelated to the heart. You don't need to disclose anything to the insurance unless you have a questionnaire, just remember the stable clause.


OverrRyde

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

said by Gone:

said by OverrRyde:

My best advice is first speak with your GP to discuss any peers conditions, then contact the insurance and ask specifically about your condition.

I spoke with my gastroenterologist/internist about travelling and he had no issues with it. I saw him yesterday and my ongoing regularly-scheduled tests showed continued improvement. I took that as a good sign.

Still, this is daunting. I sort of resigned myself to the fact that if I do get sick and insurance is denied for whatever reason they can come up with, I'll just go bankrupt and wash my hands of it.

Yeah don't get me wrong it is daunting. But honestly, we don't "come up" with a reason to deny. If I had your case, I would ask you about you history for said condition and depending if this was something in the last 3 months, I may ask for your last 3 months if you were stable or not, that is what determines payability.


dirtyjeffer
Anons on ignore, but not due to fear.
Premium
join:2002-02-21
London, ON
reply to OverrRyde

from what i gather from your statements (which makes sense), people fill out the form, leave things out, so they get the $300 insurance rate instead of the $1000 insurance rate...then if a problem happens, complain about the coverage being denied due to a pre-existing condition (or failure to disclose)...i realize that wasn't the case in peterboro's example, but i think in many others it could be.


MaynardKrebs
Heave Steve, for the good of the country
Premium
join:2009-06-17
kudos:4
reply to OverrRyde

said by OverrRyde:

said by Gone:

said by OverrRyde:

My best advice is first speak with your GP to discuss any peers conditions, then contact the insurance and ask specifically about your condition.

I spoke with my gastroenterologist/internist about travelling and he had no issues with it. I saw him yesterday and my ongoing regularly-scheduled tests showed continued improvement. I took that as a good sign.

Still, this is daunting. I sort of resigned myself to the fact that if I do get sick and insurance is denied for whatever reason they can come up with, I'll just go bankrupt and wash my hands of it.

Yeah don't get me wrong it is daunting. But honestly, we don't "come up" with a reason to deny. If I had your case, I would ask you about you history for said condition and depending if this was something in the last 3 months, I may ask for your last 3 months if you were stable or not, that is what determines payability.

So what about the questions specifically about women I asked before, only add in going on/off birth control pills? Those weren't answered.

What about a guy who gets/uses Viagra for the first time in the 90 days prior to a trip?

Are women systematically discriminated against because of issues like these? It just seems that they might be.


Gone
Premium
join:2011-01-24
Fort Erie, ON
kudos:4
reply to dirtyjeffer

said by dirtyjeffer:

from what i gather from your statements (which makes sense), people fill out the form, leave things out, so they get the $300 insurance rate instead of the $1000 insurance rate...then if a problem happens, complain about the coverage being denied due to a pre-existing condition (or failure to disclose)...i realize that wasn't the case in peterboro's example, but i think in many others it could be.

I think that's an overly simplistic view. I suspect in a lot of cases people either don't remember, or don't know how to accurately answer. One shouldn't confuse malice with ignorance.


dirtyjeffer
Anons on ignore, but not due to fear.
Premium
join:2002-02-21
London, ON

i think you would be surprised at what people will say to "get their way"...from my 20+ in retail, i've heard and seen it all.



Styvas
Go Canucks Go
Premium
join:2004-09-15
Hamilton, ON
reply to Gone

Personally, I think that the insurance company should cover a claim but -- except in those cases where there is obvious fraud or attempt to misrepresent -- charge the difference between the premium they paid and the premium they should have paid.

In other words, if answering the questions accurately would have resulted in a $1,000 premium when they only paid $300, charge them $700. If accurate answers would have made them ineligible for coverage, then refund the premium and reject the claim.
--
"Moving your Tylenol to the low shelf in your medicine cabinet is not the way to prevent children from falling off a stool when reaching for the top shelf." (said by Savant, May 2008)



OverrRyde

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

said by MaynardKrebs:

So what about the questions specifically about women I asked before, only add in going on/off birth control pills? Those weren't answered.

What about a guy who gets/uses Viagra for the first time in the 90 days prior to a trip?

Are women systematically discriminated against because of issues like these? It just seems that they might be.

Actually no, viagra or the birth control wouldn't fall under stable. there is no way a dr can say that you had an upset stomach or gastro because of an adverse reaction to viagra or pill. we've had cases with older men using the pill and getting a stiffer longer than usual and he was covered. All that happens is that we chuckle about at work and wonder why he was the only one on the policy, travelling alone! hehe


OverrRyde

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

said by Gone:

said by dirtyjeffer:

from what i gather from your statements (which makes sense), people fill out the form, leave things out, so they get the $300 insurance rate instead of the $1000 insurance rate...then if a problem happens, complain about the coverage being denied due to a pre-existing condition (or failure to disclose)...i realize that wasn't the case in peterboro's example, but i think in many others it could be.

I think that's an overly simplistic view. I suspect in a lot of cases people either don't remember, or don't know how to accurately answer. One shouldn't confuse malice with ignorance.

This is true, most of the times people just forget what they take their meds for. alot of people dont even know why they take certain meds, thats scary.

But there are some that do refuse to answer honestly and then get dinged, but it's a small number, rarely even, we can tell when someone lied just by their tone of voice when we confront them about it.


OverrRyde

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

said by Styvas:

Personally, I think that the insurance company should cover a claim but -- except in those cases where there is obvious fraud or attempt to misrepresent -- charge the difference between the premium they paid and the premium they should have paid.

In other words, if answering the questions accurately would have resulted in a $1,000 premium when they only paid $300, charge them $700. If accurate answers would have made them ineligible for coverage, then refund the premium and reject the claim.

That is how it works actually. If you are a misrep, we do reimburse your premium. In some cases you are offered to buy the correct policy but the condition you had to be seen for is still denied.


Styvas
Go Canucks Go
Premium
join:2004-09-15
Hamilton, ON

said by OverrRyde:

said by Styvas:

Personally, I think that the insurance company should cover a claim but -- except in those cases where there is obvious fraud or attempt to misrepresent -- charge the difference between the premium they paid and the premium they should have paid.

In other words, if answering the questions accurately would have resulted in a $1,000 premium when they only paid $300, charge them $700. If accurate answers would have made them ineligible for coverage, then refund the premium and reject the claim.

That is how it works actually. If you are a misrep, we do reimburse your premium. In some cases you are offered to buy the correct policy but the condition you had to be seen for is still denied.

I understand that, as long as the denial is for something that never would have been covered, and not for an oversight on the application (again, I'm not excusing outright fraud here).

What I'm saying is that, other than cases of explicit fraud, the claim should be covered if it could have been covered, but at the correct premium. I realize that this is an unlikely business decision on the part of the insurance company. I'm saying that I think it SHOULD be that way, not that I expect it to be.
--
"Moving your Tylenol to the low shelf in your medicine cabinet is not the way to prevent children from falling off a stool when reaching for the top shelf." (said by Savant, May 2008)


elwoodblues
Elwood Blues
Premium
join:2006-08-30
Somewhere in
kudos:2
reply to Styvas

Why collect another $700 (your example) to pay out $1000's when they can just deny the claim? Not good business.



Styvas
Go Canucks Go
Premium
join:2004-09-15
Hamilton, ON

I made that point. Thanks for reading to the end of my post.



elwoodblues
Elwood Blues
Premium
join:2006-08-30
Somewhere in
kudos:2

My bad, I tend to skim over things...


jaberi

join:2010-08-13
reply to OverrRyde

thanks for answering my questions OverrRyde, sounds so simple yet it can get complicated... here is to living and learning every day!