My work provided Medical Insurance is good outside the US

[klfrodo]

My Health Insurance from BC/BS includes an international rider.

 

Feel free to read thru my entire thread her at    Follow Along with me and we'll see how this claim works out - Page 2 - Cruise/Travel Insurance - Cruise Critic Community

 

or just know that Blue Cross/ Blue Shield reimbursed a whopping $70 on a $3600 claim.  Their reasoning behind paying so much? "Because you used a nonparticipating facility, the allowance has been reduced to the average network facility allowance. This increases your out of pocket responsibility."

 

My advice is to purchase a Travel Insurance policy with Medical listed as "Primary".

[Babr]

41 minutes ago, klfrodo said:

My Health Insurance from BC/BS includes an international rider.

 

Feel free to read thru my entire thread her at    Follow Along with me and we'll see how this claim works out - Page 2 - Cruise/Travel Insurance - Cruise Critic Community

 

or just know that Blue Cross/ Blue Shield reimbursed a whopping $70 on a $3600 claim.  Their reasoning behind paying so much? "Because you used a nonparticipating facility, the allowance has been reduced to the average network facility allowance. This increases your out of pocket responsibility."

 

My advice is to purchase a Travel Insurance policy with Medical listed as "Primary".

Ouch!  But thanks for providing a real-life example of what can happen. 

[Darcy03231]

Same thing happened to me.   Luckily my bill was only $200.

[Hlitner]

I spent over thirty years working in the government health insurance world (and interacted with many private health insurers) and there are times I feel like I know nothing about this crazy convoluted industry....not to mention the oft confusing language in policies.  Only the insurance industry could have a term such as "usual and customary."  The US Health care insurance industry is based on paying hugely (for lack of a better word) discounted rates to hospitals and physicians.  Just read an "Explanation of Benefits" (EOB) and you might see a lab test with a price of $100 for which your insurer paid $5 to settle the bill!  Once you get involved with health care providers outside your country all the rules change.  So in real life you might go to a hospital in a foreign land and pay the bill (out of your own pocket) using a credit card.  That hospital might charge you $50 for that same lab test which you must pay.  When you submit all the paperwork to your usual insurance company (i.e. BC/BS) they might simply reimburse you $5 for that $50 item or perhaps they would be generous and give you $10 (telling you it is usual and customary).  Unlike here in the USA, the insurer is unlikely to have any kind of "provider agreement" or contract with the foreign hospital (there are a few notable exceptions) so your insurer has no leverage to get the bill reduced...and likely could care less since they are reimbursing you and not even dealing with the foreign hospital or physician.

 

The frustrating part of all this is that when you buy a travel policy (or travel medical policy) you have no way to be sure that the insurer will fully pay your claims.  I have yet to see a medical policy that says something like "we will pay the full billed price for all items."  Perhaps Steve Dasseos has found such a policy (in which case he will get my business).   To some degree you have to buy policies based on the reputation and track record of the insurer.  That is where a decent professional broker can be worth their weight in insulin....because they have lots of experience and generally know the good companies as well as the bad.

 

Hank

P.S.  I intentionally omitted mention of the DRG payment system now used by most insurers in the USA.  This makes the entire debate about "usual and customary" even crazier.

[iamtrustworthy]

Hi Hank,

 

> I spent over thirty years working in the government health insurance world (and interacted with many private health insurers) and there are times I feel like I know nothing about this crazy convoluted industry....not to mention the oft confusing language in policies.

 

I would love to talk with you sometimes about your experiences.

 

In my opinion, travel insurance is far more complicated than most other insurance because it combines property and casualty wording with life and health wording. I now have over 515 pages between my websites and my blog because there are so many parts to consider.

 

In addition, there are scores of plans out there along with a lot more places offering travel insurance that tend not to cover the intricate details.

 

> Perhaps Steve Dasseos has found such a policy (in which case he will get my business). To some degree you have to buy policies based on the reputation and track record of the insurer. That is where a decent professional broker can be worth their weight in insulin....because they have lots of experience and generally know the good companies as well as the bad.

 

I have found a very few companies, and thankfully in the last 21 years I have never had a legitimate claim turned down. One reason is that if a travel insurance policy won’t cover what you want (ie – a waste of your money) we tell you the truth and not sell it to you. There have also been a few people who frauduently filed claims, but our recorded phone calls back up that we gave them the right advice contrary to what they told the insurance company.

 

I wrote this on another CC thread today:

"The main reason I intentionally don't offer as many travel insurance plans as others do is their vague policy language. In my opinion, it's a claim nightmare waiting to happen because vague wording often favors the company over the customer in a claim.

 

I prefer to sleep peacefully knowing with plans I trust over making money from every company that is willing to pay me a commission."

 

For example, if someone is not on Medicare with a Medigap policy, they are far better off filing a medical claim as secondary instead of primary because the policy will pay all the gaps that their primary plan won't pay.

 

I hope this makes sense.

 

Steve Dasseos

[Hlitner]

Steve, One of the saddest days of my insurance life was when I became eligible for Medicare and automatically lost my excellent private policy (paid by my ex employer) and had to change to a Medicare Advantage plan (Aetna PPO).  You would think that a lifetime in the business prepared me for being on Medicare and that would be wrong.  Medicare marches to its own drum and I am not a great fan of the beat :).  On the other hand, there are many excellent facets of our Medicare system.  

 

As to your business, bless you for doing what you do and helping travelers.  Good brokers are hard to find and that seems to be even more so when it comes to the minefield known as travel insurance.

 

Hank