Filing Travel Insurance & Medicare

[Richst48]

Has anyone had to file a medical expense claim with Medicare before filing with your travel insurance?

 

On a recent cruise my wife had to spend 2 days in the ships medical unit. The charges which was over $4k was charged to her sea pass which of course was then charged to our credit card! To file the claim the first thing the travel insurance claim form asks is what did the primary insurance pay. In our case that is Medicare. I have sent everything twice. They keep asking me to submit a form that I have already submitted. You submit the forms to a third party processing company and there is no way to call them. When I call Medicare all they say is they have no control over that other company and cannot do anything until the third party enters the charges in the system!

 

 

This is all very frustrating and I know I’m dealing with the government but I was just wondering if anyone else has gone through this and how long it took to get it processed?

[Grandma Dazzles]

Does your travel insurance know that your primary insurance is Medicare? Unless you have a Medicare advantage plan or supplement you normally would have no coverage. Medicare ordinarily does not cover you on a cruise ship or out of the country. Can you contact whomever you purchased your travel insurance from - there is normally an 800 number on your policy or paperwork.

[SRF]

Most insurance companies will want a statement of coverage from your primary medical, even if they know that Medicare will not pay anything.

 

They need it in writing.

 

When my SO had a medical claim, they needed proof of residency. A foreign passport and national ID card were not enough.

[Richst48]

Does your travel insurance know that your primary insurance is Medicare? Unless you have a Medicare advantage plan or supplement you normally would have no coverage. Medicare ordinarily does not cover you on a cruise ship or out of the country. Can you contact whomever you purchased your travel insurance from - there is normally an 800 number on your policy or paperwork.

 

I did that and they said Medicare probably will not pay but they need proof from Medicare on that and Medicare says they have to process the claim first and they can’t do that until that other company enters it in the system.

 

We were told by someone that Medicare might pay if the last port before the illness occurred was a U.S. port, which it was, and it has not been more that 6 days since we were at that port.

[Shmoo here]

I did that and they said Medicare probably will not pay but they need proof from Medicare on that and Medicare says they have to process the claim first and they can’t do that until that other company enters it in the system.

 

We were told by someone that Medicare might pay if the last port before the illness occurred was a U.S. port, which it was, and it has not been more that 6 days since we were at that port.

Um,...no

 

Medicare may pay for medically necessary services and supplies administered aboard a cruise ship if the ship was within United States waters when you got this care, and the doctor was authorized to provide this care to you. The services and supplies must be provided in a United States port or within six hours of departure or arrival at a U.S. port.

https://www.ehealthmedicare.com/faq/does-medicare-pay-for-medical-services-received-aboard-cruise-ship/

[Grandma Dazzles]

Has anyone had to file a medical expense claim with Medicare before filing with your travel insurance?

 

On a recent cruise my wife had to spend 2 days in the ships medical unit. The charges which was over $4k was charged to her sea pass which of course was then charged to our credit card! To file the claim the first thing the travel insurance claim form asks is what did the primary insurance pay. In our case that is Medicare. I have sent everything twice. They keep asking me to submit a form that I have already submitted. You submit the forms to a third party processing company and there is no way to call them. When I call Medicare all they say is they have no control over that other company and cannot do anything until the third party enters the charges in the system!

 

 

 

Not sure what third party you are referring to. Cruise line normally will give you a standard form - I believe it is form 1500 - kind of a universal healthcare insurance form. I know Royal Caribbean does that if you ask. It’s completed with the standard codes for healthcare. You file that with your primary insurance e.g. Medicare. Once Medicare denies you file that same form with your travel insurance. I am not understanding what you mean by third party entering charges in the system.

[lenquixote66]

:o

Has anyone had to file a medical expense claim with Medicare before filing with your travel insurance?

 

On a recent cruise my wife had to spend 2 days in the ships medical unit. The charges which was over $4k was charged to her sea pass which of course was then charged to our credit card! To file the claim the first thing the travel insurance claim form asks is what did the primary insurance pay. In our case that is Medicare. I have sent everything twice. They keep asking me to submit a form that I have already submitted. You submit the forms to a third party processing company and there is no way to call them. When I call Medicare all they say is they have no control over that other company and cannot do anything until the third party enters the charges in the system!

 

is is all very frustrating and I know I’m dealing with the government but I was just wondering if anyone else has gone through this and how long it took to get it processed?[/quote

 

[/color

 

 

 

We had the same experience.It took 6 months to be reimbursed.

[Richst48]

I am not understanding what you mean by third party entering charges in the system.

 

It is Novitas Solutions. No one submits claims directly to Medicare. All hospitals, doctors and other healthcare providers submit to Novitas. They enter the claims in to the Medicare system for processing.

[Grandma Dazzles]

It is Novitas Solutions. No one submits claims directly to Medicare. All hospitals, doctors and other healthcare providers submit to Novitas. They enter the claims in to the Medicare system for processing.

 

Not familiar with Novitas. They may handle claims for your particular state.

 

I filed a claim directly with Medicare using their main government website information page. Had several numbers and addresses. It’s a while back but I am pretty sure I either mailed or may have just faxed information (form and letter).

 

I used the standard form received from doctor/clinic on ship (universal form previously mentioned). Claim was denied - which I expected. Received a standard denial letter with codes saying not covered by Medicare. Then filed Medicare denial with travel insurance. Travel insurance paid.

 

Claim was around $200 - Wrist xray and doctor visit on ship. Travel insurance paid. I think it took about 8 weeks total.

 

Good luck. Hope you get it sorted out. Try the Medicare information page for phone numbers to see if they can help.

[Hlitner]

Some insurance companies/policies will insist that you first submit any claim to your Primary Insurance and get an EOB (Explanation of Benefits) which then becomes part of your claim documentation that you submit to your secondary provider.

 

The way to prevent this hassle is to purchase travel medical insurance that is "primary." For example, our annual GeoBlue policy is primary for international claims. We recently had a major claim (for DW) for extensive treatment on a cruise ship plus outpatient surgery in a Japanese Hospital. I made sure to get extensive documentation of all her treatment and simply submitted a large claim package to GeoBlue. They paid all the medical bills within 2 weeks. Why? Because they were primary and we did have decent documentation. And we are talking about thousands of dollars of claims.

 

As to Medicare, a large majority of their claims are adjudicated within 30 days. However payments for non-electronic claims are supposed to be held until at least the 27th day after submission. But this rule does not apply to denied claims which are often adjudicated in a more timely fashion. Also keep in mind that Medicare claims are not processed by the government, but rather by private "fiscal intermediaries" who have contracts with the Feds.

 

But all of these issues with Medicare go away if your travel medical insurance is "primary" so that is the easiest solution to the OP's problem.

 

Hank

[Glide_Path]

Some insurance companies/policies will insist that you first submit any claim to your Primary Insurance and get an EOB (Explanation of Benefits) which then becomes part of your claim documentation that you submit to your secondary provider.

 

The way to prevent this hassle is to purchase travel medical insurance that is "primary." For example, our annual GeoBlue policy is primary for international claims. We recently had a major claim (for DW) for extensive treatment on a cruise ship plus outpatient surgery in a Japanese Hospital. I made sure to get extensive documentation of all her treatment and simply submitted a large claim package to GeoBlue. They paid all the medical bills within 2 weeks. Why? Because they were primary and we did have decent documentation. And we are talking about thousands of dollars of claims.

 

As to Medicare, a large majority of their claims are adjudicated within 30 days. However payments for non-electronic claims are supposed to be held until at least the 27th day after submission. But this rule does not apply to denied claims which are often adjudicated in a more timely fashion. Also keep in mind that Medicare claims are not processed by the government, but rather by private "fiscal intermediaries" who have contracts with the Feds.

 

But all of these issues with Medicare go away if your travel medical insurance is "primary" so that is the easiest solution to the OP's problem.

 

Hank

 

Hi Hank, is the GeoBlue plan you're talking about the annual medical only plan? Would you happen to know if the plan is primary or secondary when the medical cost is incurred within the US?

[Scrapnana]

I have switched to travel insurance that is primary so as not to deal with the problem OP mentioned. Won't help you now but it is something to consider for the future.

[SRF]

Not sure what third party you are referring to. Cruise line normally will give you a standard form - I believe it is form 1500 - kind of a universal healthcare insurance form. I know Royal Caribbean does that if you ask. It’s completed with the standard codes for healthcare. You file that with your primary insurance e.g. Medicare. Once Medicare denies you file that same form with your travel insurance. I am not understanding what you mean by third party entering charges in the system.

 

MediCare uses a 3rd party contractor to process your claim. It is not processed by USG employees.

[Hlitner]

Hi Hank, is the GeoBlue plan you're talking about the annual medical only plan? Would you happen to know if the plan is primary or secondary when the medical cost is incurred within the US?

 

We have their annual Trekker Plan. While it is primary for claims outside the USA and its territories. GeoBlue does not provide coverage for medical inside the Home Country (which would be the USA for us). I should add that GeoBlue does require that their policy holders have other primary insurance (including Medicare). If you need insurance for traveling inside the USA, you would want to look at other policies.

 

There is an interesting incentive in policies like GeoBlue which worked in DW's favor with our recent claim. GeoBlue's annual policy also includes $500,000 of medical evacuation insurance. In our situation, once their case manager realized the seriousness of DW's medical situation they had a powerful incentive to get her home :). Keeping her in Japan would have meant that GeoBlue was on the hook for all her medical bills incurred in Japan...which would have become very expensive over a period of time. But getting her back to the USA meant they were essentially off the hook for her medical claims since we are in an excellent Medicare PPO. Perhaps our situation was somewhat unique, but we were really impressed at how hard GeoBlue worked to get DW home ASAP.

 

I would also add that each person or family should carefully evaluate their own situation and purchase insurance (if needed) that best fits their own circumstances. What works for me may not be good for you :). For those that need help in determining what's best, there are some decent travel insurance brokers that can explain options and make suggestions. IMHO just purchasing a cruise line's insurance plan, or a Trip Insurance Plan offered by a travel/cruise agency..makes little sense until you carefully review your situation and see if that particular plan is the best option.

 

Hank

Edited September 2, 2018 by Hlitner

[iancal]

Agree.

 

We view medical expenses as the greatest risk to our financial and emotional well being when we travel.

 

We pay attention to the offerings. I suspect that many people buy travel insurance as an afterthought. They end up with a travel vendor policy or something that some TA assures them is good.

I had a long time TA for business travel. She would not sell us the policy that her agency flogged or indeed any cruise line insurance when we traveled for pleasure. She believed that they were substandard and overpriced. Once we started shopping we realized that she was absolutely right.

[wwcruisers]

Well, I always say that, every day I learn something new, here on CC. But today, I feel like I've been to graduate school! As someone approaching Medicare age, this thread has been quite a tutorial. Thanks for all of the info, everyone. And, OP -- I hope that you are able to get your insurance reimbursement -- soon!

[Roz]

It's a big revelation to a lot of people that Medicare doesn't provide coverage outside the US. On one of my cruises, one of my tablemates developed a condition requiring medical attention but was not life threatening. They deliberately waited until we reached San Juan or St. Thomas so that they could get care from a Medicare provider. They vowed never to travel out of the country again without adequate medical coverage.

 

Roz

[shrifk]

I became ill on board the ship but prior to leaving from the USA. The ship medical charges were about $2,000. I was evacuated to a local hospital in Ft. Lauderdale. Medicare and my Anthem supplemental insurance paid those charges at 100% combined. However the ship medical charges were charged to my credit card.

 

 

 

I had to submit the bill (I received a detailed bill from the ship) to Medicare that originally denied the charges because they considered the ship was international even though the occurrence occurred in the U.S. (while berthed in Ft. Lauderdale) Finally medicare accepted the claim but denied payment and since they denied it my secondary insurance paid the amount. The cruise insurance would have paid any amount over my supplemental. However they did pay first class airfare home and a few other incidental expenses. The problem was getting Medicare to accept the claim and deny the claim so that any supplemental insurance would cover the remainder.

[Glide_Path]

Thanks all for the valuable info shared here, especially Hank.... that Geoblue plan for 1 year is around the same price as my last trip insurance through USAA.

 

Side story: Last year, my family of 5 took a Baltics Cruise on NCL, bought trip insurance through USAA(Travel Insured International). I only wanted medical coverage, so I was told to put a trip cost of "0".

We were flying in from the US west coast to Europe, book round-trip air on Air Berlin..... 3 weeks before my trip started, the airline declared bankruptcy. Our departure flight went ok, but 1 day after I boarded the ship, the airline cancelled my return flight and started to close air operations. I spend the next 5 days on wifi calls, and used an ipad connected to NCL's dial up speed internet trying to find 1-way flights going back home. It was not fun. Eventually, the insurance company did reimburse the one way return ticket back home (up to $1000 per person), even though I had put down a $0 trip cost. Guess I'd just lucked out.

[SRF]

BTW, GeoBlue is not available to residents of some states. Maryland for one.

[Hlitner]

I became ill on board the ship but prior to leaving from the USA. The ship medical charges were about $2,000. I was evacuated to a local hospital in Ft. Lauderdale. Medicare and my Anthem supplemental insurance paid those charges at 100% combined. However the ship medical charges were charged to my credit card.

 

 

 

I had to submit the bill (I received a detailed bill from the ship) to Medicare that originally denied the charges because they considered the ship was international even though the occurrence occurred in the U.S. (while berthed in Ft. Lauderdale) Finally medicare accepted the claim but denied payment and since they denied it my secondary insurance paid the amount. The cruise insurance would have paid any amount over my supplemental. However they did pay first class airfare home and a few other incidental expenses. The problem was getting Medicare to accept the claim and deny the claim so that any supplemental insurance would cover the remainder.

 

Those Medicare folks do not even know their own rules :(. You would be eligible for Medicare coverage if on a cruise ship within 6 hours of a USA port. Under their own rules that would be considered domestic travel...so we are puzzled why they balked at covering your claim. I can imagine how they found a reason to ultimately deny your claim (I spent over thirty working in the industry) but there must have been some interesting meetings at the Fiscal Intermediary (that is who processes claims) before they reached their decision :(. One issue with any cruise ship is whether the ship's physician is actually licensed to practice medicine in the USA. Most cruise ships use non-US trained physicians who are well qualified, but likely not licensed by the State of Florida. If I were reviewing a cruise ship claim this would be one of my first questions....when determining if we would even consider such a claim. If we got passed that issue then it would be reviewed similar to any other claim. If you are in a Medicare PPO or HMO it should then be considered as an out-of-network claim.

 

The 6 hour rule I mentioned is really a strange Medicare rule. When I worked for PA Medical Assistance (Medicaid) I actually discussed this with a Medicare counterpart during a phone call. At the time, as a frequent cruiser, I was curious as to how on earth they could interpret "within 6 hours of a port." My question was based on the argument would it be 6 hours at 5 knots, or 6 hours at 20 knots :). The question "blew the mind" or my Medicare friend who did not have a clue (she had never seen such a claim). One could certainly argue the 6 hour rule if the ship were cruising from or to a US port...but what if a ship were simply cruising 70 miles off the US Coast. That means they could likely reach a port within 6 hours (if they tried)...so does that meet the 6 hour rule? Nobody seemed to have a clue.

 

In your case, since the ship was at the port it certainly met that 6 hour rule! If I had been involved in reviewing your claim, the "fun question" (for claims folks this would be fun) would have to do more with the legal issues around the providers of the care. Apparently there is still a lot of unsettled law when it comes to Medical Care on cruise ships. For now, the cruise line's simply adhere to international maritime norms which require them to have adequate medical care available on the ship. This is actually a very complicated part of law (I am not a lawyer) that a lawyer friend calls "unsettled law." One might suspect that one reason that most cruise lines no longer hire physicians licensed in North America (Canada/USA) is to further muddy the waters. Consider the issue whether a passenger can sue a cruise line and its medical staff for malpractice...and in which court would this lawsuit go forward. It boggles the mind. Cruise lines used to rely on the so-called Barbetta Rule which was tossed by a Court of Appeals in 2014. So one can only wonder what will happen with any future legal actions. I suspect many passengers would be shocked at how much about medical care on cruise ships is still "out to sea" or up in the air.

 

We, as cruisers simply keep cruising and reasonably expect our ship to have competent Medical staff and care. But most of us have no clue as to all the issues that lie behind medical care until we need help.

 

 

Hank

Edited September 2, 2018 by Hlitner

[janert]

I had insurance with the cruise line. Princess. I had 11 visits to medical and minor surgery. Bill was about $3,000. Called insurance company for Princess. When I said my primary was Medicare they asked if I had secondary insurance. I do, so they told me to submit directly to them. They did pay some and the Princess insurance paid the rest. Took about 2 months to be reimbursed by all parties. I think I was very lucky because all was paid in what I considered was reasonable time.

[jlp20]

You have to find out a more basic question. Medicare does not cover you OUTSIDE the U.S. border. If you have travel insurance make the claim.

[Zlasmcruising]

Hank or anyone else who might know..I have Medicare and a Bluecross supplement insurance. I bought Geoblue Voyagers Choice for my cruise. Who would I file with if I have any medical costs outside the U.S. during a cruise. Would Geoblue be my primary insurance in this case? I turned 65 last year and went on a cruise with just Medicare. I had no clue this was the situation on a cruise.TIA[emoji4]

 

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[Zlasmcruising]

Hank or anyone else who might know..I have Medicare and a Bluecross supplement insurance. I bought Geoblue Voyagers Choice for my cruise. Who would I file with if I have any medical costs outside the U.S. during a cruise. Would Geoblue be my primary insurance in this case? I turned 65 last year and went on a cruise with just Medicare. I had no clue this was the situation on a cruise.TIA[emoji4]

 

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I found the answer to my question. I am posting for anyone else who might need this information!![emoji4]

 

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