Travel insurance claim denied
We asked subscribers to each tell us about a time when they submitted a claim — medical or nonmedical — to a travel insurance company and expected reimbursement but had their claim denied. Our aim was to make travelers aware of what they might be surprised to find they are NOT covered for, in certain situations, under travel insurance policies.
Noting that we would not be printing the names of any travel insurance companies (we just wanted general accounts), we asked subscribers to each describe the situation or what occurred plus where and approximately when (year) the experience took place. We also asked what they thought they were covered for but were not, and we wanted to know the insurer’s reason(s) for rejecting the claim. Lastly, we asked travelers to tell us what they do or look for now to make sure they’re covered when purchasing travel insurance.
We printed a number of responses in last month’s issue and are presenting more now, some followed by notes from travel insurance broker Dan Drennen of the Travel Insurance Center (Omaha, NE; 402/343-3621, www.travelinsurancecenter.com).
In October 2015, traveling as a single, I left Los Angeles on a group tour to southern Peru and Bolivia. Through a website, I had purchased travel insurance that included coverage for trip interruption.
Because of the anticipated high altitudes, I was prepared with Diamox, which I had successfully used to prevent altitude sickness on prior trips (to Machu Picchu, Peru, and Lhasa, Tibet). This time, it failed me. In Arequipa, Peru, 7,600 feet above sea level, just a few days after the trip started, I became very sick from altitude sickness.
The next morning, our group headed for a resort at Colca Canyon, situated at 11,900 feet. I didn’t make it. I was vomiting and unable to sit up. At a lunch stop in Chivay, 100 miles from Arequipa, I was met by a doctor and an ambulance in the parking lot.
The physician diagnosed me as suffering from altitude sickness, tachycardia and high blood pressure, none of which I had ever had before, and after I agreed to pay up front, he gave me oxygen and an injection. I don’t speak Spanish, so the local guide accompanied me to the doctor’s clinic, where, again in cash, I paid for oxygen and pills and to be transported by ambulance back to Arequipa.
My tour group leader suggested that I stay at the hotel in Arequipa that we had left that morning and to see a physician at my own expense. Since I had extensively researched altitude sickness online the night before, I knew I had to descend and would not be able to rejoin the tour group, which was going to ever-increasing altitudes.
I had an ambulance take me to the airport to return home, where I paid for wheelchair assistance that the tour leader had arranged. By my second layover at sea level, I was out of a wheelchair and feeling fine.
Including my return air ticket, my additional out-of-pocket expenses for the trip were approximately $4,000.
My home hospital plan, or HMO, reimbursed me for the cost of the ambulance.
I asked my insurer to reimburse me the balance, nearly $3,850, but, after four months, they denied my claim “due to the lack of the physician statement at the time of loss.” The letter also stated, “The information required for reconsideration is: A letter or statement from the treating physician. A Physician must advise cancellation or interruption of the Covered Trip on or before the Schedule Departure Date.”
The claims adjuster admitted that I had needed to descend and could not have gone on with my trip, but the clinic did not respond to my emails or the email of my insurer, and my insurer apparently would not pay without a physician’s certification.
I was traveling alone when I was seen by the doctor, and I was in too extreme a condition to think about getting a certificate to submit to my insurance company later.
From now on, I will look for a policy that does not deny payment for trip interruption when there is no physician’s certificate.*
Some things are obvious and indisputable. In this case, it is indisputable that the remedy for altitude sickness is to descend. My travel medicine department says so, all the online information about altitude sickness says so and even my claims adjuster said so.
I have traveled to more than 60 countries, and the single time I tried to collect on a trip-interruption policy, I was stonewalled.
Linda Vogel, Pomona, CA
*Such policies do not exist. On any type of insurance claim, supporting documentation is required for the claims examiner to make a reasonable assumption that the insured’s claim is legitimate. If someone does have to go to a clinic for treatment, she or he should make sure to get the documentation before leaving the clinic.
As I was waiting in line to board a flight in South Africa in May 2012, I fainted because, evidently, a cold pill I had taken that morning made my blood pressure drop. When I hit the ground, I badly sprained my ankle, which became so swollen that I couldn’t walk.
I was flying back home (Cape Town-Johannesburg-Washington, DC-Denver-Phoenix) after a 3-week trip. Not being able to walk, I was wheelchaired from flight to flight. I couldn’t see any doctor until the day after I got home, after about 36 hours in transit.
Although it happened in South Africa and I was with a group of people who witnessed it, because I couldn’t get treatment until I got home the insurance company would not pay for anything.
Including the cost of a boot I had to wear for several weeks, my total cost was nearly $500 (and I had to pay out of pocket because I had not yet met my yearly deductible of $2,500).
I now realize that, unless you get the medical care where it actually happens, and have it writing, insurers find a way to not pay for it.*
I have always purchased travel insurance from the companies that I tour with. In about 25 trips, this is the only time I have needed to file a claim, and it was denied.
Barbara Levy, Peoria, AZ
*If you expect to collect on a travel insurance claim regarding a situation like this, you must receive a medical diagnosis and treatment before you get home.
My mother and I took a river cruise from Amsterdam to Bucharest in September 2014. It was a wonderful cruise! However, many people on the ship became ill. Some were sick for a week to ten days, some even bedridden.
In Vienna, the cruise-tour company brought aboard a doctor, who diagnosed passengers with varying degrees of chest colds. For each visit the doctor made, he charged €50 cash. I paid €50, and my mother, who received several visits plus medications, paid €250.
We had purchased travel insurance through the cruise-tour company, so when we returned home we placed a claim with the insurance company. We were told that before they would consider our claim, we first had to apply to our health insurance providers in the US for reimbursement and receive denials.*
I spent months following up with mom’s Medicare and her supplemental insurance company as well as mine but did not get the required letter of denial. One problem was that the bill from the ship’s doctor did not have an address. I eventually ran out of time and patience. We never did get a refund.
We love the tour company and continue to cruise with them, but, when we purchase special insurance coverage, why is all of the burden on us?
Colette Frey
Key Largo, FL
*The cruise-tour company’s insurance was obviously secondary insurance, so, before they would pay the claim, they first would need to see that the traveler’s US insurance provider(s) covered no part of the claim. It is advisable to insist on “primary” medical coverage. If primary coverage is not available through the tour company’s insurer, visit a travel insurance broker in order to purchase it.
I had planned a trip to Panama from Los Angeles about two years ago. I ordered a taxi to the airport at 4:30 a.m. and waited with my luggage outside my house for the cab to arrive.
When the cab didn’t arrive on time (it would arrive 10 minutes late), I went inside to call the cab company. When I went back outside, all my luggage was gone. It had been stolen! This included my passport and about $1,000 in cash.* There was now no way I could make this trip.
I had a comprehensive travel policy that included a clause for lost passport. I wanted to recover the cost of my passport and air ticket. My claim was denied, and the reason stated was that I had abandoned my luggage and passport.
After multiple appeals, I gave up.
Robert Hersch
Huntington Beach, CA
*Note that some home owners’ insurance policies will cover losses from theft on the home owner’s property.
In 2014, I bought a $100,000 medical policy for the, then, fiancé of my daughter (and now my son-in-law) to cover emergencies in the US when he came from Canada to visit her. I bought the policy just before he left Canada, and on the website where I bought it I saw only a short description of the services. I did not get a copy of the actual policy until after he had arrived in the US.
As it turned out, he did have to go to the emergency room during his time here because of probable food poisoning. We all spent an exhausting 12 hours in the ER.
I was surprised to find out that, although charges for emergency treatment of illnesses were covered under the policy, all charges stemming from use of the emergency room, itself, were excluded. Moreover, there was a limit of $950 on diagnostic and x-ray tests plus a $475 limit on any one test.
Needless to say, almost all charges incurred were denied, to say nothing of unexplained limitations on the doctors’ charges. The insurance company paid approximately $2,200 out of a hospital bill of over $17,000. Although we filed a timely appeal, we never heard back from the company.
I now read the emergency medical section of travel insurance policies very carefully.
Lynda Millspaugh
Glen Ellen, CA
*If the premium for a policy seems really good compared to others you have researched, there is probably a good reason for that. In this case, it sounds like the medical coverage purchased was a “scheduled benefits” plan, which has specific limitations on specific medical services provided.