Travel Insurance Claims Problems

[Kabula]

Based on 40 years of worldwide travel and dealing with travel insurance I've learned the following:

Be sure to read all exclusions prior to your trip. If you are considering renting motorcycles, wave runners, any high risk sports, you will probably have to pay more for that coverage.

If you encounter any unusual expense, check your policy as it may be covered. Don't pay first as you need authorization in most cases.

Understand time limits.

Take the policy out in advance and not a day or two before the trip.

Be sure to report all claims immediately.

Get authorization for any procedures.

Save all receipts.

If you have a health problem, be sure to read the preexisting condition coverage. Some policies cover preexisting conditions, but generally there are time limits.

Expect all claims with high medical costs to be denied with boiler plate denials, with their own medical expert's, boiler plate medical opinions. Don't be discouraged, fight them with written emails, faxes or letters. Document everything and put all correspondence in a folder with receipts by date for future reference. Back up all digital copies, photos and emails.

Understand that most foreign major medical policies DO NOT EXTEND COVERAGE INTERNATIONALLY!

Without your own travel insurance policy, you could end up in a Public Hospital nightmare and standing in long reception lines. If you owe a hospital money, some countries will prevent you from leaving until they are paid.

Medical liens could bankrupt you.

In most cases you don't need a lawyer, just a good understanding of the written, insurance contract.

I would like to hear the claims problems you are having and see what to watch out for and prepare for in the future.

[gerry123]

thanks for all the info anything non obvious you would care to add to this list of very common knowledge

[JLCrab]

I can see a problem with travel insurance getting authorization for a procedure that just happened to occur during the short-term period of coverage but why would there necessarily be a problem with a claim when a travel insurer has pre-authorized a procedure at a specific hospital?

[Kabula]

Because in the preauthorization letter to the hospital, in fine print, states if their post op investigation reveals a preexisting condition, they reserve the right to deny the claim and they do it all the time after the operation, procedure, burning the hospital and creating a nightmare at times for the insured/patient. For this reason many hospitals have doubled their charges in the last two years to make up for insurance scam losses. Many private hospitals will not even admit a patient now unless they have $20,000 US $ credit card lines of credit!

[Kabula]

Regarding the non obvious; I believe my last post covered the biggest non obvious problem. To complicate the issue even more is different court decisions in different courts in different countries with regard to the definition of a pre-existing condition. Some courts have ruled that it is not fair to deny a claim on a medical problem that was not previously a problem nor Diagnosed. There are many strategies to over come these denials and wear the Insurance companies adjusters to cave in! Another problem is the policyholder seldom reads the contract and believes everything is covered and there are many risks that Are not that require a rider, endorsement extending additional coverage.

[JLCrab]

So the post-op investigation is to possibly deny a pre-authorized coverage when you have failed to contact the pre-screening service of the travel insurance company to let them know about any possible pre-exisiting condition conflicts OR that it reveals a pre-existing condition of which you were unaware but should have been aware with proper diligence?

[Kabula]

It generally takes up to 30 days for the Insurance company to check the application, underwriting, pull prior medical records, talk to prior doctors, consult in house medical experts and lawyers to make a final determination. In most cases insurers can't wait that long, nor does the insurance company have the current medical records, nor billing so they can't commit to paying without a preauthorization written understanding that the claim may be denied. Unfortunately, to satisfy the insured in my opinion they frequently allow the procedure knowing there may be a problem down the road. This also allows an opening to initially deny most anything knowing most will not fight the claim denial.

[Pralaad]

Can not speak for all countries but Australia has banking and insurance ombudsman.

When I had a problem with travel insurance, I lodged complaint through the ombudsman office.

It was resolved within 1 week and my claim was approved and paid .

This service was free.

Later I required physio but again a problem with insurance, again lodged complaint with ombudsman office and again resolved in something like 10 days .

I would strongly recommend going through the ombudsman office instead of lawyers

[JLCrab]

So either --

1. There are no pre-existing conditions but the insurance company after authorizing a procedure is sure trying to find one.

2. The insured knew there was a pre-existing condition and did not inform the insurer upon application, or, the doctor at the hospital who requested authorization for the procedure.

3. There was some condition that pre-existed but was unknown to the insured but either

a. could not have possibly been known to the insured

b. presented tangible symptoms such that the insured should have known with proper diligence