Why EOB from primary insurance carrier?

[M&M cruiseaholics]

I am filing a travel insurance medical clam for $156 to the Travel Insurance carrier that I purchased trip insurance from. The claim is for Medical Center billings from the cruise ship. Why would the travel insurance carrier require that I submit an EOB (Explanation of Benefits) from my primary health insurance carrier when the main reason we all buy travel insurance is because none of our primary health insurance carriers cover any international medical expenses?

 

Is this just an insurance company ploy to make it difficult to file a claim?

 

Why should I file my claim with my primary health insurance carrier when they expressly state they do not cover international medical expenses (and the travel insurance policies know this)?

[Clarea]

Probably just standard operating procedure. You must have purchased travel insurance that has secondary medical coverage and they need to see a denial from the primary before they pay.

[reallyitsmema]

I am filing a travel insurance medical clam for $156 to the Travel Insurance carrier that I purchased trip insurance from. The claim is for Medical Center billings from the cruise ship. Why would the travel insurance carrier require that I submit an EOB (Explanation of Benefits) from my primary health insurance carrier when the main reason we all buy travel insurance is because none of our primary health insurance carriers cover any international medical expenses?

 

Is this just an insurance company ploy to make it difficult to file a claim?

 

Why should I file my claim with my primary health insurance carrier when they expressly state they do not cover international medical expenses (and the travel insurance policies know this)?

 

If you are talking about the cruise line insurance, it is secondary coverage and they require you to submit to your primary insurance first. I just had to do this too after a recent cruise, wasn't a big deal.

[jr8934]

I had a medical issue on a cruise. The travel insurance I'd purchased would only pay once I submitted proof that I'd been turned down by Medicare and my other insurance co. I had to submit the ship's bill to each provider and send their response to the travel insurance co. Joyce

[katiel53]

As others have posted, your travel insurance sounds like it was secondary insurance and they aren't trying to rip you off or give you a hard time. I had to do what is being requested of you and now my insurance that is purchased for a cruise has primary medical coverage.

 

I don't purchase my insurance through the cruise line. I buy it from a third party site and only look at policies that have exactly what I want.

[M&M cruiseaholics]

Thank you all for the replies.

 

It's a shame that even though the insurance is secondary, I know of no primary health carrier that will pay international medical expenses. Again, that is why we all buy Travel Insurance.

 

I will now file a claim with my primary carrier.

[Clarea]

Thank you all for the replies.

 

It's a shame that even though the insurance is secondary, I know of no primary health carrier that will pay international medical expenses. Again, that is why we all buy Travel Insurance.

 

I will now file a claim with my primary carrier.

Just a note for the future, there are travel insurance policies that offer primary medical coverage.

[cruisinfanatic]

I am filing a travel insurance medical clam for $156 to the Travel Insurance carrier that I purchased trip insurance from. The claim is for Medical Center billings from the cruise ship. Why would the travel insurance carrier require that I submit an EOB (Explanation of Benefits) from my primary health insurance carrier when the main reason we all buy travel insurance is because none of our primary health insurance carriers cover any international medical expenses?

 

Is this just an insurance company ploy to make it difficult to file a claim?

 

Why should I file my claim with my primary health insurance carrier when they expressly state they do not cover international medical expenses (and the travel insurance policies know this)?

All the insurance is doing is being sure you aren't compensated twice for the same thing. You'll get that question every time you call your provider.

[SRF]

Yeap.

 

Just had to jump through the hoops for a close friend. Had to provide that she did not reside in the US to ensure that she did not have other primary coverage.

[Ski-Lady]

Thank you all for the replies.

 

It's a shame that even though the insurance is secondary, I know of no primary health carrier that will pay international medical expenses. Again, that is why we all buy Travel Insurance.

 

I will now file a claim with my primary carrier.

 

We found out that my partner's Medigap policy covered out of country medical expenses. Twice he has received medical treatment onboard a ship. Medicare did not cover the treatment but his secondary insurance did. There was a deductible that was covered by our trip insurance. We had to provide EOBs from both Medicare and the other insurance. It took about 2 months to get all the paperwork together.

[Xport]

I am filing a travel insurance medical clam for $156 to the Travel Insurance carrier that I purchased trip insurance from. The claim is for Medical Center billings from the cruise ship. Why would the travel insurance carrier require that I submit an EOB (Explanation of Benefits) from my primary health insurance carrier when the main reason we all buy travel insurance is because none of our primary health insurance carriers cover any international medical expenses?

 

Sorry but your assertion is not necessarily true...

• Prior to my retirement, my company's health plan provided world-wide coverage with full benefits...
  
• And now that Medicare is my primary health care carrier, my Medicare Supplement ["Medigap" Policy; I happen to purchase Plan F (it's the most comprehensive and is the most popular choice among those who purchase a Medicare Supplement; there are others with varying provisions)] covers certain medical expenses incurred while traveling internationally on a cost-sharing basis subject to a plan maximum...
  
  • If appropriate, following is a link to the Medicare website in which there is a summary of Medigap benefits--including those related to claims incurred internationally--by Plan [if offered for purchase in your home area, the policy terms--but not the premiums--are identical from supplemental carrier to supplemental carrier]...
    
    • https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html
      
    • If curious, you will find additional information relative to international medical coverage by Medigap Plan type via web search...
      

    [*]As someone who travels extensively and has a pre-existing condition, I still purchase private travel insurance [not, for instance, through a cruise line; there are better options at similar cost] with substantial medical coverage to further supplement both Medicare and my Medigap Policy so as to "kick in"--on a tertiary basis--in the event of a substantial claim...

While the claims process can be cumbersome, I fully understand why your Travel Insurance carrier requires that they receive an Explanation Of Benefits from each of your insurance carriers before considering your claim... At any age, there are no universals as to one's health care coverage; an EOB trail determines your entitlement...

Edited January 31, 2018 by Xport

[Baron Barracuda]

After illness aboard ship couple of years ago couldn't believe how hard it was to get rejection notice from my primary Blue Cross carrier. Despite the policy having no out of network coverage they had me submit paperwork 4 times and wanted more info from ships doctor. For 6 months I kept begging them to deny claim. When they finally did travel insurance (Nationwide) paid within one week.

[slvrbllt]

After illness aboard ship couple of years ago couldn't believe how hard it was to get rejection notice from my primary Blue Cross carrier. Despite the policy having no out of network coverage they had me submit paperwork 4 times and wanted more info from ships doctor. For 6 months I kept begging them to deny claim. When they finally did travel insurance (Nationwide) paid within one week.

 

Some Blues companies will offer international coverage in case of emergency, so they were probably just trying to be thorough in their evaluation. We had a client that got a claim paid for a bad fall in Israel, took a bit more paperwork, but it was paid as if she was at home.

[actuarian]

Just a note for the future, there are travel insurance policies that offer primary medical coverage.

 

I have not seen a travel insurance policy like that and it is difficult for United States based travel insurance companies to offer primary medical coverage. The problem is that some employer health insurance policies and some Medigap policies do cover international care and they process claims as primary. If you have two insurance policies and they both process claims as primary, then the claims are likely to generate taxable income to the policy holder. For example, if you have $1,000 in medical expenses and each of the policies pays 80% or $800, then the total insurance benefit is $1,600 and the policy holder has $600 of taxable income but the cost of having an accountant deal with it may be well over $600!

[Clarea]

I have not seen a travel insurance policy like that and it is difficult for United States based travel insurance companies to offer primary medical coverage. The problem is that some employer health insurance policies and some Medigap policies do cover international care and they process claims as primary. If you have two insurance policies and they both process claims as primary, then the claims are likely to generate taxable income to the policy holder. For example, if you have $1,000 in medical expenses and each of the policies pays 80% or $800, then the total insurance benefit is $1,600 and the policy holder has $600 of taxable income but the cost of having an accountant deal with it may be well over $600!

I use http://www.squaremouth.com and am able to choose policies with primary medical coverage.

[actuarian]

I use www.squaremouth.com and am able to choose policies with primary medical coverage.

Do they require you to sign an agreement affirming that you do not have other international medical coverage or do they allow total benefits to exceed the actual costs incurred?

[Clarea]

Do they require you to sign an agreement affirming that you do not have other international medical coverage or do they allow total benefits to exceed the actual costs incurred?

Don't know, I'd never purchased a policy with primary medical coverage. I see it as one of the options when I get a quote for travel insurance.

[toothfary7]

Thank you all for the replies.

 

It's a shame that even though the insurance is secondary, I know of no primary health carrier that will pay international medical expenses. Again, that is why we all buy Travel Insurance.

 

I will now file a claim with my primary carrier.

 

My husband fell last year while in a port and suffered a concusion. His BC/BS insurance DID cover him even though he was out of the country. So cruise insurance was secondary. Only snag was that he had to pay up front for treatment then submit 1st to his insurance and then to cruise insurance.***Lots of frequent flyer miles for that CatScan in Grand Cayman!!

 

It made me also look into my insurance since we have different employers. My insurance also does cover me out of the country as well.

[cruisenfever]

I am filing a travel insurance medical clam for $156 to the Travel Insurance carrier that I purchased trip insurance from. The claim is for Medical Center billings from the cruise ship. Why would the travel insurance carrier require that I submit an EOB (Explanation of Benefits) from my primary health insurance carrier when the main reason we all buy travel insurance is because none of our primary health insurance carriers cover any international medical expenses?

 

Is this just an insurance company ploy to make it difficult to file a claim?

 

Why should I file my claim with my primary health insurance carrier when they expressly state they do not cover international medical expenses (and the travel insurance policies know this)?

When my husband became ill on Rhapsody back in 2014 we were 3 days from Vancouver, our debarkation port.

 

He spent almost an entire day in medical, along with follow-up treatment and the bill, though not outrages, was an unexpected expense which had to be paid for prior to our departure.

 

We did have cruise insurance and when I went to submit the bill to them, they advised me to contact our secondary insurance company first. We called them, submitted our bills, and everything was reimbursed.

 

Had our secondary insurance not covered everything, then we would have submitted the balance to our cruise insurance company and they would have taken care of the difference.

[Zeta3]

I have not seen a travel insurance policy like that and it is difficult for United States based travel insurance companies to offer primary medical coverage. The problem is that some employer health insurance policies and some Medigap policies do cover international care and they process claims as primary. If you have two insurance policies and they both process claims as primary, then the claims are likely to generate taxable income to the policy holder. For example, if you have $1,000 in medical expenses and each of the policies pays 80% or $800, then the total insurance benefit is $1,600 and the policy holder has $600 of taxable income but the cost of having an accountant deal with it may be well over $600!

 

 

 

I live in the US and purchase travel insurance with medical primary all the time. If you submit claims as you mentioned it isn’t taxable

Income it is fraud. You are supposed to submit your claim to the primary insurance payer first, if both will pay primary you submit to the one you want to use, in my case, I choose the travel insurance. Once that coverage is determined if as in your example the travel insurance primary pays 80% (I have not seen this, coverage has always been 100% from my travel insurance due to the large coverage limit) you can submit the remaining 20% to your alternate insurance option. You don’t submit the full claim to both insurance carriers.

 

 

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[cruisebabe50]

I am filing a travel insurance medical clam for $156 to the Travel Insurance carrier that I purchased trip insurance from. The claim is for Medical Center billings from the cruise ship. Why would the travel insurance carrier require that I submit an EOB (Explanation of Benefits) from my primary health insurance carrier when the main reason we all buy travel insurance is because none of our primary health insurance carriers cover any international medical expenses?

 

Is this just an insurance company ploy to make it difficult to file a claim?

 

Why should I file my claim with my primary health insurance carrier when they expressly state they do not cover international medical expenses (and the travel insurance policies know this)?

 

Your travel insurance is considered secondary insurance. Even though your primary insurance won't cover it, the secondary (travel) won't be able to pay unless you show that you submitted to primary and they did not pay. The EOB proves that. I worked in insurance billing for years and they will pay but there are hoops to jump through, lol.

[SRF]

I have not seen a travel insurance policy like that and it is difficult for United States based travel insurance companies to offer primary medical coverage. The problem is that some employer health insurance policies and some Medigap policies do cover international care and they process claims as primary. If you have two insurance policies and they both process claims as primary, then the claims are likely to generate taxable income to the policy holder. For example, if you have $1,000 in medical expenses and each of the policies pays 80% or $800, then the total insurance benefit is $1,600 and the policy holder has $600 of taxable income but the cost of having an accountant deal with it may be well over $600!

 

Go to TravelInsuranceStore.com and get a quote.

 

I just did, and 4 of 6 plans offered medical coverage as Primary.

 

Not hard at all.

 

You should not submit the claim to both and recover more than you paid out.

 

Oh, and typically, they WILL find out, and come after you for the extra money.

[shellunderwater]

Let me give you a slightly different take on travel medical claims.

 

My work insurance doesn't cover out of the country medical. So I purchased primary medical with my travel insurance. No biggie.

 

When I had a trip to the med center, I got the billing information, submitted it to my at home insurance carrier, they denied it, but applied it to my deductible/out of pocket requirement for the year. I then submitted the EOB to the travel insurance carrier and was paid the full amount of the billed charges.

 

So, not only was I paid in full, but that amount was applied to my year's deductible.

 

I consider that a win both ways.

 

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[psberg]

This is an old thread but is comparable to my situation.  I purchased travel insurance for my cruise which was specifically sold as primary coverage.  I ended up making a visit to the ship’s medical center (hacking cough).  When I received the claim form from the insurer, it specifically said that they required an EOB from my primary insurer.  Isn’t the purpose of buying travel insurance with primary coverage to avoid the hassle of filing a foreign claim (which has to be done by mail) with my primary?

 

What is the point of paying more for primary coverage if it is going to be treated as secondary coverage?  That should result in a lower premium, shouldn’t it?

[NorthStarStateCruiser]

8 minutes ago, psberg said:

This is an old thread but is comparable to my situation.  I purchased travel insurance for my cruise which was specifically sold as primary coverage.  I ended up making a visit to the ship’s medical center (hacking cough).  When I received the claim form from the insurer, it specifically said that they required an EOB from my primary insurer.  Isn’t the purpose of buying travel insurance with primary coverage to avoid the hassle of filing a foreign claim (which has to be done by mail) with my primary?

 

What is the point of paying more for primary coverage if it is going to be treated as secondary coverage?  That should result in a lower premium, shouldn’t it?

The travel insurance company is simply trying to see if someone else will pick up the bill. Unless explicitly stated in the travel insurance certificate that all claims must first be processed by an existing health insurance policy, simply tell the travel insurance provider that you will not be submitting a claim to your primary health insurance provider. They'll then have to cover the costs according to your travel insurance policy without any extra help.