Pre-exisiting condition - have you ever been denied a claim because of one?

[KyleClark]

This topic doesn't apply to me, but I buy a lot of travel insurance like to know the moving parts on how it works.  So my question is how does a travel insurance check for a pre-exisitng condition after you submit claim?  

[GeezerCouple]

34 minutes ago, KyleClark said:

This topic doesn't apply to me, but I buy a lot of travel insurance like to know the moving parts on how it works.  So my question is how does a travel insurance check for a pre-exisitng condition after you submit claim?  

 

We get travel insurance that does not have any exclusions for pre-existing conditions.

For policies that do have that restriction, the insurer can request medical records.  See the specific terms of your policy (or which policy someone has, etc.) to see what is agreed to when getting the policy.

 

One good "side effect" of not having the pre-existing condition exclusion is that in some cases, the claim may be processed faster because there's no need to request and then read through the previous medical history.

 

Also keep in mind that "pre-existing condition" is usually defined in travel insurance differently from what we think of in everyday life.  That can be better or worse, depending upon the situation.

 

Note that some of the complaints about travel insurance include when an insurer asks to see the medical records... and the insured tries to argue they have no right to see that.  Okay, but then they may not pay the claim...  it all depends upon the policy terms.

 

GC

[klfrodo]

3 hours ago, KyleClark said:

This topic doesn't apply to me, but I buy a lot of travel insurance like to know the moving parts on how it works.  So my question is how does a travel insurance check for a pre-exisitng condition after you submit claim?  

You agree in the claim to give the insurance company access to any and all necessary medical records.

If you don’t agree, they deny the claim.

[KyleClark]

I am just wondering now of examples where your claim would be denied for a pre-existing condition.  If you have high blood pressure and had a stroke or heart attack on your cruise is this a reason to deny any payment if you didn't have the p.e.c. waiver?   

[KyleClark]

Just now, KyleClark said:

I am just wondering now of examples where your claim would be denied for a pre-existing condition.  If you have high blood pressure and had a stroke or heart attack on your cruise is this a reason to deny any payment if you didn't have the p.e.c. waiver?   

I think I answered my own question, If it is controlled for a certain number of days and no prescription changes you would good?

[GeezerCouple]

32 minutes ago, KyleClark said:

I think I answered my own question, If it is controlled for a certain number of days and no prescription changes you would good?

 

As I wrote above, what does the specific insurance policy state?

There isn't anything uniform about this that applies to *all* travel insurance.

 

GC

[Smitheroo]

On 10/5/2023 at 9:03 AM, GeezerCouple said:

 

We get travel insurance that does not have any exclusions for pre-existing conditions.

For policies that do have that restriction, the insurer can request medical records.  See the specific terms of your policy (or which policy someone has, etc.) to see what is agreed to when getting the policy.

 

One good "side effect" of not having the pre-existing condition exclusion is that in some cases, the claim may be processed faster because there's no need to request and then read through the previous medical history.

 

Also keep in mind that "pre-existing condition" is usually defined in travel insurance differently from what we think of in everyday life.  That can be better or worse, depending upon the situation.

 

Note that some of the complaints about travel insurance include when an insurer asks to see the medical records... and the insured tries to argue they have no right to see that.  Okay, but then they may not pay the claim...  it all depends upon the policy terms.

 

GC

can you give names of insurers who dont have a pre-existing condition clause?   

[GeezerCouple]

19 minutes ago, Smitheroo said:

can you give names of insurers who dont have a pre-existing condition clause?   

You'll need to read through policies, or, what we do, work with a good travel insurance broker who is familiar with many insurers, each of whom usually has several different types of policies.

And.... it can depend upon when you purchase the policy (from the same insurer/policy).

 

Many of us use www.TripInsuranceStore.com - but CALL... it's so much better to discuss these questions.  "Online summaries" simply can't capture everything.

 

As for why I'm not directly answering your question, even for a policy that we get that has the waiver, insurance is regulated by the states.  So what we get may not be available to someone in some other states, and we'd have no way to know that.  Again, this is where a broker can really help.

 

GC

[Smitheroo]

On 10/5/2023 at 8:22 AM, KyleClark said:

This topic doesn't apply to me, but I buy a lot of travel insurance like to know the moving parts on how it works.  So my question is how does a travel insurance check for a pre-exisitng condition after you submit claim?  

I like to know the moving parts too-  I like that

[Smitheroo]

On 10/5/2023 at 12:10 PM, KyleClark said:

I am just wondering now of examples where your claim would be denied for a pre-existing condition.  If you have high blood pressure and had a stroke or heart attack on your cruise is this a reason to deny any payment if you didn't have the p.e.c. waiver?   

I agree with other comments that it depends on the policy, there are not general rules. But... since I am also one who likes to know how the moving parts work- I'll give it a go.

 

From my research I have learned that what we would think a pre-existing condition might be is different where travel insurance is concerned.  Insurers have what is called a "look back period" which differs by insurer but some are 60 days.  You can have a medical condition- your example of hypertension is a good one- that might be completely stable for years, no changes in meds, no changes during the look back period.  Travel insurance would not consider that as a "pre-existing condition".  And it would be really hard, I would think (keeping in mind I'm not a doctor or a travel insurance agent) to say definitely that a heart attack was caused by your chronic hypertension, especially if it has been stable for a long time.  I have read this in the various sources I have found.  Maybe if you had changes in meds recently, or your doctor told you that you need to reduce salt or otherwise change your diet (this would be a change of advice) and then you have a heart attack....it gets murky.  People have heart attacks who dont have hypertension or even high cholesterol.  

 

I have learned that its a good idea to consult someone who knows insurance, like you might consult a financial advisor or a travel agent.  In order to ask questions though you need to have questions to ask and I get that by researching and reading the forum.  

[CDNPolar]

I think that this is one of the most engaging discussions, and I have read far too many policies and had far too many discussions with insurance companies around the pre-existing condition thing...

 

Pre-existing condition can go a step further to something that is undiagnosed, or rather in the process of being diagnosed.

 

If you have a recommendation from your doctor for a certain procedure or surgery or treatment and it is scheduled for the future, this can be the reason your insurance will not pay out.  You may consider yourself stable, but the fact that this test is ordered can knock your claim out from being paid.

 

For example a friend that travels extensively had an arrhythmia 3 years ago and not another one since.  Has been treated with beta blockers for rate control since and not had one issue in 3 years.  A year ago his doctor suggested ablation to correct this from ever happening again, but a date was never set.  This recommendation however is on his file.  In calling several insurance companies that do cover pre-existing conditions that are considered stable, because of this future procedure recommendation they will not insure him.  Basically they said he needs to have the procedure and be stable for 6 months and then they will insure him with a pre-existing condition, but with the outstanding procedure on his file, NO GO.

 

You have to disclose everything to the insurance and understand what "Stable" means and that is not the same definition for every insurance.  We often think that being able to stop a medication is a good thing but stopping that medication needs to be disclosed for the stable period too. 

 

The insurance company will find any way possible to tie to something that will allow them to not pay out.