An "Unhappy insurance story" (Link to news story)

[A Sixth?]

Retired couple billed $50,000 despite travel insurance

 

 

http://ca.news.yahoo.com/retired-couple-billed-50-000-despite-travel-insurance-133857063.html

[Coral]

Truly sad.

 

I hope the couple win this as they should!

[MichCook]

What a horrible situation....I hope the insurance company reverses their decision.

[Kmkub]

She said: The fact I was being monitored, in my mind, wouldn't mean I was being treated."

 

I disagree with her, but that is unimportant. The important lesson is that the number one goal of any health insurance company is to deny the claim...

 

"Oh... you had a car accident? Well, I see you had a wart when you were 10... pre-existing condition... no can pay."

 

'Tis why I am so completely suspicious of travel insurance and have never purchased. (Probably never will.)

[4cats4me]

Horrible.

[A Sixth?]

I actually have travel health insurance 24/7 all year because most years I travel enough (not just cruise ships, but any time one leaves your home Province/State yo are at risk)

 

Never needed it, but since my doctor has me on basic blood pressure meds , Am I actually covered if I have a heart attack ?

 

:confused::mad:

 

 

(BTW I am healthy, thin and in my 50's, just slightly elevated BP brought to low/normal with a pill each morning)

[Kmkub]

(not just cruise ships, but any time one leaves your home Province/State yo are at risk)

 

I guess I'm lucky. The plan I have through work covers me while traveling anywhere on the planet. (Not sure if I'm covered for inter galactic excursions, though)

 

I'd definitely check with your insurer and make sure you didn't answer some question about your heart, wrong. Based on the story, even if you get a sliver you wouldn't be covered if that question was answered wrong.

[A Sixth?]

I guess I'm lucky. The plan I have through work covers me while traveling anywhere on the planet. (Not sure if I'm covered for inter galactic excursions, though)

 

I'd definitely check with your insurer and make sure you didn't answer some question about your heart, wrong. Based on the story, even if you get a sliver you wouldn't be covered if that question was answered wrong.

 

Okay :confused:

 

You said earlier that you never purchase insurance but are covered by your work place....

 

Are you saying you don't believe in it and it's a waste of money, or that why would you buy a duplicate policy?

 

Frankly, I can't believe I used to travel as much as I did with nothing other than a VISA card with a big limit and good luck :D

[Kmkub]

You said earlier that you never purchase insurance but are covered by your work place....

 

I never purchase travel insurance. Sorry for the confusion.

 

Until I started reading here, I've never heard anything nice about travel insurance from people I trust. I've heard mixed reviews here, but it mostly seems positive.

 

(As to my other comments... yes, my numerous dealings with numerous insurance companies (provided through work) for 3 decades have taught me that their primary goal is to deny and put the onus back on me to prove I have a right to a claim being paid.)

[Keith1010]

Hopefully she will be successful in her appeal and if not can take it to some other governing body, assuming the article is factually based and there is not another side of the story which has not been reported.

 

Keith

[6rugrats]

Hopefully she will be successful in her appeal and if not can take it to some other governing body, assuming the article is factually based and there is not another side of the story which has not been reported.

 

Keith

 

Yes, it's difficult to say exactly what happened in most of these stories. They never include all the information, and are usually just sob stories, not always factual. We can't read her policy, we don't know her medical background, and we weren't there to hear what was said. Obviously, the insurance company received her medical records, and based their denial on information we don't have.

 

I note that no mention in this article is made of coverage she had through her Canadian health insurance, which admittedly would pay very little on this claim, but would pay something:

http://www.health.gov.bc.ca/msp/infoben/leavingbc.html#outsidebc

[sirwired]

I can say that if this was a U.S. policy, she probably would have been covered if we assume the story is accurate. If she had no symptoms needing treatment, and no doctor visits or med changes for 3-6 months prior to policy purchase (depending on policy) the pre-ex exclusions do not apply.

 

I just thought I would point out to those here that complain about how complicated US trip insurance policies are... obviously compared to Canadian policies, they aren't complicated at all. Except for annual policies, US policies don't even HAVE medical underwriting...

[cruiseco]

She said: The fact I was being monitored, in my mind, wouldn't mean I was being treated."

 

I went to the insurer's web site and they're pretty clear that if you don't disclose EVERYTHING about your health situation during the application process the policy is void. They even state that if you file a claim for condition A and during the review of your health records they discover that you never disclosed that you were being treated for condition B your policy can be voided, even if the two conditions are unrelated. The reasoning appears to be that since each policy is individually priced according to the information received from the client, failure to disclose any relevant health information has deprived the insurer of their proper premium.

 

However brutal this is, apparently it's OK with the various provincial departments of insurance (or their version up there).

[Gail & Marty sailing away]

I hope they win.....

[CruisinGerman]

Yes I hope they win. Also, nobody is addressing the downright nerve of the hospital to charge $10,000 per day to a foreigner when the hospital would probably have to accept $1,000 per day from all of the PPO and HMO plans issued right in the United States.

 

When this comes down to a trial or settlement, any court is going to hold that customary and reasonable also applies to private billing and not just to insurance companies.

 

In any case, there is really no reason for the Original Poster to hide from the United States -- debtor's prison is illegal even there .......

 

Kind regards,

 

Gunther and Uta

[6rugrats]

Yes I hope they win. Also, nobody is addressing the downright nerve of the hospital to charge $10,000 per day to a foreigner when the hospital would probably have to accept $1,000 per day from all of the PPO and HMO plans issued right in the United States.

 

When this comes down to a trial or settlement, any court is going to hold that customary and reasonable also applies to private billing and not just to insurance companies.

 

In any case, there is really no reason for the Original Poster to hide from the United States -- debtor's prison is illegal even there .......

 

Kind regards,

 

Gunther and Uta

This makes no sense. You have no idea what the hospital's contracts are with any PPO or HMO plans. And of course, if this was a network hospital, and the patient was covered under one of these plans, the hospital would have to adjust off the difference between their charge and the allowed amount.

 

But this is not the case here. Patient came in as a private pay. Hospitals or other medical providers cannot change the amount they charge patients for services; they must charge the same amount for the same procedure no matter who pays. The article does not state that this woman was charged more than another patient receiving the same treatment, because she was a "foreigner".

 

If the terms of this person's travel insurance stated she must disclose EVERY medical condition she had, and she did not, they were correct in their denial. However, I don't know what her policy says. She does admit she had a kidney condition she was being "monitored" for.

 

As for the hospital calling her insurance company to see if she was covered; any time you call an insurance company to verify coverage, you are told, "authorization of care is based on eligibility and benefits at the time services are rendered. Claims are verified to ensure all benefits requirements have been satisfied including limits, such as pre-existing conditions" or "verification of benefits is not a guarantee of payment", or other similar verbiage.

[CruisinGerman]

In no country in the world does this happen except the United States. In every country of the world you are supposed to be given emergency care and treatment regardless of your ability to pay.

 

The United States is such a fantastic country in 99.9% of all aspects, and a model for the world to follow. So why can't it get the health insurance thing right once and for all. This has been going on since after World War II and the end is nowhere in sight.

 

Why are hospital, doctors and medicines so darn expensive in the United States. Why when I walked into a Rite Aid to buy Omeprazol in the United States, do twenty tablets cost something like $20, when in South America forty tablets cost $2 and in Europe forty tablets cost 1 euro?

 

I'm just a visitor, so I do make sure I never step foot in your country without my international health insurance (which is what the original poster thought she was doing in the first place), but how on earth do you Americans put up with that?

 

Kind regards,

 

Gunther and Uta

[sirwired]

In no country in the world does this happen except the United States. In every country of the world you are supposed to be given emergency care and treatment regardless of your ability to pay.

 

This is also the case in the U.S. Every medical facility that accepts federal money (and they nearly all do) and provides emergency care is required, under law, to provide acute care without regard to ability to pay up until the patient is stable enough to be transported to another facility.

 

The treatment is not free, but it will be provided regardless of the patient's financial circumstances.

[CruisinGerman]

they are treated and then given a bill for $50,000 to stay in a hospital for a few days with a blood clot.

 

Makes a lot of sense.

 

Kind regards,

 

Gunther and Uta

[LiftLockCouple]

Another interesting horror story of seniors being denied coverage by a canadian Insurance company. a couple of comments.

 

1) This is reallity for Canadians travelling to the US for vacations or as in this case to winter in warmer climes. It is particularly difficult for those who are older, have been "going south for 20 years ", and whose health is slowly failing. They are slow to admit to the insurance company that they are now a higher risk. This is a big deal given the highest PP medical costs in the world are in the USA, and arguably the best care goes along with the cost. That is certainly a debatable point as a Canadian and I'm sure from any European as well.

2) The provinical Ministry's of health have no stake in this. Their mandate is to provide care at home to thier own citizens from tax revenues. They will pay a very small pitance for out of country bills but it is insignificant.

3) The only protection we have are the laws governing insurance retailers and the local appeal process. The various Ministries of Health will never get involved.

4) The fact that this couple bought a policy from priimeLink tells me that they knew they were a higher risk and may have gone to this company because others were more expensive.

5) If they have been going to California for 20 years and buying a policy each year there is no way they are as innocent as they are being portayed. However as in many cases they are probably most guilty of wishful thinking regarding their coverage.

6) the Travel medical insurance industry is terrible on the issue of clarity. RBC insurance has been raked over the coals in the Toronto media this year for similar slippery behaviour. In one case a denial was made over the definition of high blood pressure. The individual had normal BP but it was medicated. RBC called that high blood pressure. go figure.

7) I don't think our policies are more complicated than US policies but the medical limits necessary on our policies expose the companies to significantly more risk. Their tactics to limit that risk is the issue.

8) I have antidotal evidence from an aquaintenance that winters every year in Arizona that there is "a insurance paid cost of care" and "a self pay cost of care". There is a significant difference in costs between the two. Even cheaper if it is self pay and the patient pays in cash upon leaving the hospital. This could easily be contested by the experts on this thread but that is my understanding.

9) I have read more policies than I can remember and I assure you it is a mind numbing experience. Almost stroke inducing trying to understand the implications of the weasel words often employed.

 

Bottom line ... read every word and do not buy unless you clearly understand. Tell them everything in writing and either pay the price or stay home.

 

Finally the last two paragraphs of this article say the following.

 

However, after CBC's Go Public got involved, Manulife, the underwriter, said another decision is forthcoming on the Friesen's claim.

"I understand a decision on the appeal of this case will be made shortly and should be communicated to the individual in the next couple of days," wrote Manulife spokesperson Michael May.

 

Funny how cooperative they become when the media starts broadcasting their slippery ways. As in the RBC cases in Toronto earlier this year the backtracking really starts then. I wonder what happened.

 

Cheers

[cruiseco]

8) I have antidotal evidence from an aquaintenance that winters every year in Arizona that there is "a insurance paid cost of care" and "a self pay cost of care". There is a significant difference in costs between the two. Even cheaper if it is self pay and the patient pays in cash upon leaving the hospital. This could easily be contested by the experts on this thread but that is my understanding.

 

No question about it. Some years ago when I was "self-insured" I saw an orthopedist for a knee problem (good doctor -- at the time he was the orthopedist for the US national soccer team). Full X-rays and other tests, consultation, etc and he charged me $100. Not only that, he told me that he would normally refer me to a physical therapist for twice-weekly sessions for eight to ten weeks but instead just showed me one exercise I could do ay home. Problem solved. $100 for all that compared to what he would have billed the insurance plus what the therapist would have billed them.

[mizdiz]

I think insurance should have paid, but I don't think she helps her case by stating she wouldn't have gone into the hospital if she would have known she wasn't covered by insurance. Did she think she didn't need immediate care?

 

"I never would have gone into the hospital if I knew that would happen. Never. I would have went home," she says.

[Pushka]

In no country in the world does this happen except the United States. In every country of the world you are supposed to be given emergency care and treatment regardless of your ability to pay.

In Australia you will be asked for your (Australian) Medicare card. If you don't have a card then you will be required to pay by credit card on the spot. If you don't have a means of paying, then I am not sure what would happen.

 

Unfortunately the lady should have disclosed her kidney condition. It is a pre existing condition even if she isn't seeking treatment at the moment. Any illness that could be attributed to poorly functioning kidneys would be refused.

 

We know of a young man who attended for an arm injury. He was given a cat scan and some treatment but did not stay the night. His parents got the bill a few weeks later as he was still traveling. It came to $10,000. Absolutely wicked overcharging by the US medical facility. They knew the insurance company would have to pay.

[CruisinGerman]

There is no way that by international standards a CAT scan and some care in an ER should cost $10,000. That is shameful.

 

 

Kind regards,

 

Gunther and Uta

[6rugrats]

We know of a young man who attended for an arm injury. He was given a cat scan and some treatment but did not stay the night. His parents got the bill a few weeks later as he was still traveling. It came to $10,000. Absolutely wicked overcharging by the US medical facility. They knew the insurance company would have to pay.

The average cost of a CT scan for an arm injury in the US is $2775. According to the New England Journal of Medicine average cost for an ER visit in 2011 was $400. Going to an urgent care center is usually cheaper. This bill seems a bit high, but if it was really $10,000, I guarantee the insurance company did not pay this entire bill.