Those who purchase cruises need to decline the insurance offered, it is always offered. After final payment, no refunds, period. She might be lucky, God forbid she cruised and needed medical attention, most health insurance doesn’t work outside the US! Blame the trip organizer, blame the travel agent, but folks cancel cruises last minute due to illness, job loss, natural disasters, death of loved ones or themselves, injury, poor travel planning, flight cancellations, etc., every day. Not knowing any better doesn’t change the fact that insurance is offered (inexpensive), and gets declined. Although, if any other travelers knew about her medical issues and didn’t mention travel insurance and pre-existing conditions, that’s is unfortunate.