Filed a Travel Insurance Claim - What was the outcome?

[ljones]

For those who've had to actually file a claim: 

What was the covered reason for the claim & circumstances?

Who was the Insurer?

Was the coverage Primary or Secondary?  If Secondary, did you have other insurance to cover the occurrence?

And what was the final outcome (i.e Received xx$'s for Benefit coverage of $$ with requested amount of $$$).  

Did Insurer give a reason for the outcome / dollar amount?

What type of documentation was required?

[klfrodo]

2 claims

First was for a lost/stolen/misplaced wedding band.

TravelGuard - Had to show proof from the cruiseline that I had filed a claim with them and that they had investigated and not found the lost/misplaced/stolen item. I also had to provided the "original" purchase receipt (which I had).

Within 14 days, I received a check for $500 which was the max allowed under this policy.

 

Second was a land vacation to Cancun. We stayed at a RIU resort which provided a secondary medical coverage policy thru Helix of Spain. (RIU is a Spain owned company and so is Helix)

My wife stepped off a bus, fell and hurt herself real bad. We saw a different RIU close by and went to them for help. (In Mexico, don't speak the language and figured RIU is RIU). They were very helpful, called in their first aid people, called in their doctor, and recommended we go to the hospital. Went to the hospital and received great treatment. Paid $3600 and walked out.

Since Helix was secondary, filed with Medicare upon return and received their denial letter quickly.

Then filed with Helix. Helix denied us because we had not notified them prior to getting treatment. (In their defense, they were correct. I knew this was required, but in my state of mind, my first concern was my wife. My second thought was " well RIU has documented this and THEY recommended the hospital".  Still,,,, the bottom line is that we did not follow proper procedure.

After that, I filed for reimbursement from our BC/BS policy. BC/BS reimbursed us $2400. This was because we used "Out of Network" facilities and doctors.

Documentation needed was an explanation of what happened, all of the doctors notes along with an itemized billing which we received from the hospital. Since the doctors notes and billing was in Spanish, I scanned everything then used a translation software to translate to English. Was required to send in the Medicare denial letter.

 

Of course all of this information is buried somewhere within this forum. Most of us share our experiences and share what the pitfalls are and how to CYA. Just so others may learn from our experiences.

[ljones]

I'd actually seen a few reports here & there - but thought it would be easier & faster for people to find all in one place.

 

I have not had an incident to report - but looking back - there may have been lesser important things I could have reported...will never know if they would have been actually covered.  As in the "Advise the insurer before you get treatment' - that almost seems like a "gothcha" when it is an emergency / 'painful' incident. 

 

Another is verifying you have been "formally" admitted to a hospital as an Inpatient... 

 

Was BC/BS a Primary payer?  If you had received approval from them before treatment, would they have paid as "In-Network" ?

 

Perhaps we can all learn from others.

Edited November 12, 2021 by ljones
correction

[klfrodo]

26 minutes ago, ljones said:

 

 

Was BC/BS a Primary payer?  If you had received approval from them before treatment, would they have paid as "In-Network" ?

 

Perhaps we can all learn from others.

Since my wife has Medicare, the BC/BS is secondary in all cases.

[ljones]

I have Medicare Advantage.  My insurer is Primary...Requires a call for prior approval to be considered 'In-Network' & then Secondary Insurance also wants 'Prior Approval'...  All under "Emergency" conditions.

[ljones]

Surprised there have been so few insurance claims filed during travel.  It seemed I'd only read a couple so it has been 'Better Safe' than sorry...    

 

Safe & Secure Travels.

[Bo1953]

I think many have posted responses before you even posted the thread... do a search and I think you will find a few other success stories.

 

bon voyage

[Darcy03231]

I've had several, all with Nationwide.

 

1st was for trip interruption and medical.  Primary medical coverage.  They reimbursed the hotel, meals, and medical expenses.  Just had to send in the receipts.  Also received a per port credit as the cruise changed from a western Caribbean to eastern due to a hurricane. (I don't think this type of insurance is even offered anymore).

 

2nd was for trip interruption.  Again just had to submit the hotel/meals receipts and we were reimbursed.

 

3rd was for medical.  Primary coverage.  Submitted the bills and we were reimbursed.

[Jersey42]

I have had two claims and both paid what I expected.

 

Travel Insured: Several years ago I had a small medical claim.  I submitted the bills from the ship.  It took several months, but I was reimbursed in full.

 

Nationwide:  I filed a claim for a March 2020 Panama Canal cruise that we had to cancel because my mother-in-law had a fall two weeks before sailing and needed round the clock care.  I put together a very comprehensive package that included everything the insurance company asked for including a form completed by the doctor, invoices, boarding passes and refund denials.  I received a check in less than two weeks that covered everything.  They covered the airfare even though I could have received a credit from the airline. I needed to sign a form indicating I could or would not the credit and if I later used the credit, I would have to return the amount to Nationwide. 

[ljones]

Those are great to hear.  I have not even looked at Nationwide but will do so.  And I think it is eye-opening (hopefully) that you'll need to keep receipts until you are back home safe & secure instead of tossing them as you go.  Never know if you may need something you didn't consider needing.  I think I will plan to keep all mine in one spot for future trips.  

 

Tried a few different dates, prices & Nationwide quote always came back: "No policy available".   Might be a WA thing again.

 

 

 

Edited November 26, 2021 by ljones
addition