Determining travel insurance reimbursement

Some situations take longer to conclude than others, as in this next letter. — Editor

My wife, Judy, and I went on a tour of Viet Nam with Overseas Adventure Travel (OAT), March 4-28, 2006. About 60 days prior to the trip, Judy’s doctor changed one of her medicines, but follow-up visits prior to the trip indicated no potential problem. While in Hanoi she had a reaction from her medicine that required immediate care, hospitalization and then return to the U.S.

Inadvertently, we had duplicate medical evacuation insurance with both HTH Worldwide (purchased yearly) and Trip Mate (purchased through OAT along with trip-interruption coverage). I spoke with representatives of both companies at the time and followed their instructions.

Since I contacted HTH first, they became the “lead” provider, covering all of Judy’s medical expenses and transportation (but none for me).

Judy first became sick on March 8. HTH did a wonderful job of setting up an appointment with a British doctor in Hanoi (March 11 — it took several calls because of time differences), evacuating Judy to Bangkok, Thailand, for treatment (March 12) and then returning her to the U.S. (March 15), all at their expense. We cannot compliment the people at HTH enough!

While awaiting instructions from Trip Mate’s medical provider, On Call International, and from HTH, we continued to stay at the Guoman Hotel in Hanoi.

After Judy was evacuated to the Bumrungrad Hospital in Bangkok for treatment, I stayed in a hotel near the hospital. The Bumrungrad provided excellent care by English-speaking staff and U.S.-trained doctors. HTH made a fine choice on where to treat Judy.

Since HTH was caring for Judy, Kristen, a representative of On Call, told me to keep track of my expenses not covered by HTH and send them in for reimbursement, as the two companies would work together. I kept a journal of my expenses for meals, taxis, trips to the Viet Nam Embassy in Bangkok for a new visa and departure taxes plus whatever receipts I received and sent them to Trip Mate upon my return.

I had expected the full cost to be insured and repaid, but this was not the case. Our claim to Trip Mate was for $6,816. In May ’06 we received a check for only $3,815, or 56% of what we requested!

Over a 9-month period I made numerous calls to Trip Mate regarding this. I received a letter on June 21, 2006, outlining their position, and (delayed until we returned to the U.S.) I sent my rebuttal on Aug. 7. It crossed in the mail with another letter dated Aug. 3.

Trying to reach a conclusion, I called monthly to ask to speak with someone with authority and was always denied by the representative who took the call. My last conversation was on Nov. 16, 2006, with a Linda, who said that the matter was being detailed on a spreadsheet and someone would call after Nov. 28. Trip Mate never made the call they promised.

In frustration, we wrote to ITN on Feb. 12, 2007, and explained our problem.

The largest area of dispute was over our lost tour days. The 24-day trip cost $4,235 per person, equaling $176.46 per day, by my calculation. Robert Franco of Trip Mate told me that they calculated the per diem as “base amount divided by base tour,” and so the land cost of $2,204.35 divided by 16 equals $137.77 per day.

Although we accepted their per-diem rate, I felt Trip Mate shorted us on the number of days and expenses. Judy missed 20 days (March 8-28) and I missed seven days (March 9-16). Trip Mate reimbursed for 14 days for Judy, plus a refund of her 3-day post-trip extension ($695), and five days for me.

Their position was that we “were staying in the tour hotel” (the Guoman in Hanoi), therefore we were not delayed from the tour for the days in Hanoi.

Judy was bedridden in the Guoman while awaiting instructions on treatment. With the severity of her condition, I left the room only to transmit information required by HTH and On Call. Yes, we continued to stay at the “tour hotel,” but we did not participate in the activities or meals. Should we have moved to a different hotel to meet their requirement?

In my letter to Trip Mate, I mistakenly requested reimbursement for 24 days rather than 20 days for Judy (24 days @ $176.46 = $4,235.04). For myself I claimed seven days @ $176.46 = $1,235.22 plus $1,345.74 in extra expenses for a total of $2,580.96.

It was stated in handwriting on Trip Mate’s “Benefit Calculation” sheet, I later learned, that the “maximum benefit per person” was $3,931.35, which would have more than covered our claim.

Trip Mate stated in their June 21, 2006, letter, “If your Trip is delayed for 12 hours or more, we will reimburse you, up to the amount shown in the Schedule for reasonable additional expenses incurred by you for hotel accommodations, meals, telephone calls and local transportation while you are delayed.”

And, yet, originally, they wouldn’t even pay for the fax that their own company On Call requested.

After Judy was hospitalized, I received an e-mail from the OAT tour leader Vu Nguyen inquiring about Judy’s condition. Since Judy was recovering nicely and I had a way to reach Vu, we decided that I should return to the tour since I might not have the opportunity to visit Nam again.

I had to make several trips to the Viet Nam embassy in Bangkok to obtain a new visa and make all of my own travel arrangements to rejoin the tour. These expenses plus my train and taxi travel were disallowed by Trip Mate because I had now “rejoined the tour.” No matter that OAT had canceled my airline ticket (thinking that I was gone), which necessitated my paying for the train.

After ITN’s involvement, Trip Mate paid us an additional $738.

What have we learned from all of this?

When purchasing travel insurance, ask specifically how much of your trip expense will be repaid. Will repayment be the full price that you paid for the trip or some calculated amount. At least you will know.

Keep a journal recording names, dates and what was said. Even though the On Call rep said we would be repaid, we weren’t fully repaid.

Keep hounding them!

Finally, if you need serious medical attention in that part of the word, consider going to the Bumrungrad in Bangkok. It’s truly a world-class hospital.

TOM MAISH

Bonita Spring, FL

ITN sent a copy of the above letter to Trip Mate on Dec. 13, 2007, receiving no further reply after having received from Trip Mate the following May 16, 2007, reply to a shorter version of Mr. Maish’s letter mailed to them on April 16.

We appreciate the opportunity to address Mr. Maish’s concerns regarding the processing of his claims.

Mr. and Mrs. Maish purchased a short-term travel protection plan in connection with their March 4-28, 2006, trip with Overseas Adventure Travel. The travel protection plan consists of two parts: Part A provides travel arrangement protection benefits which provides for reimbursement of expenses incurred for trip cancellation, trip interruption and travel delay, and Part B is an insurance contract which includes coverage for covered medical expenses, medical evacuation, baggage loss, baggage delay and accidental death.

During their trip, the Maishes contacted the assistance company On Call International to advise that Mrs. Maish had become ill. The assistance company was later advised that Mrs. Maish’s care and evacuation was being handled by HTH Worldwide.

On May 3, 2006, benefits were issued under the trip interruption and travel delay coverages, based on the information on file. These payments included reimbursement for unused tour services for both Mr. and Mrs. Maish; additional transportation for Mr. Maish, both to join his wife where she was hospitalized and to rejoin the tour, and reimbursement for additional hotel, meal, local transportation and telephone calls for Mr. Maish while his trip was delayed.

We are responsible for adjudicating claims according to the plan provisions. Some of the items for which Mr. Maish requested reimbursement do not include sufficient documentation (i.e., “cash advance” receipt) for us to determine coverage (i.e., what was purchased and when), and other items are not covered (i.e., expenses incurred after the trip was no longer delayed). Many of the items listed in Mr. Maish’s correspondence were reimbursed in May 2006.

For clarification, we are sending Mr. Maish a letter detailing each of the items he has questioned. We are committed to treating all of our customers fairly.

Thanks again for the opportunity to respond.

JENNIFER M. CRIST, Claims Manager, Trip Mate, 9225 Ward Parkway, Ste. 200, Kansas City, MO 64114

ITN also wrote to Overseas Adventure Travel (347 Congress St., Boston, MA 02210), receiving this reply on Jan. 21, 2008.

Unfortunately, Mrs. Maish became ill during the trip and, at her doctor’s advice, needed to return home. According to our office in Ho Chi Minh City (HCMC), Mr. and Mrs. Maish departed Viet Nam for Bangkok in order to get a return flight to the U.S.

We thought that Mr. Maish was going to accompany his wife back to the U.S. as, according to our area manager in HCMC, he had not informed us that he had planned to rejoin the group. Once the Maishes departed Viet Nam, our office in HCMC canceled their remaining hotel and flight reservations.

Had we known that Mr. Maish had wanted to rejoin the group, we would not have canceled his reservations and would have been glad to help him in any way we could.

PRISCILLA O’REILLY, Director, Public Relations, Overseas Adventure Travel