Cautionary tale about insurance

[hoopslover]

After 25 cruises and trips all over the world the unexpected finally happened to us.  We were on 2 cruises with a day in between in Civitavecchia.  My husband had seen a dentist before we left and he was given permission to travel and was prescribed antibiotics for a cracked tooth.  After being gone 14 days he woke up in severe pain and his gum and cheek were swollen.  He called his dentist in the US and was advised to return home.

We moved our flight home from the next week to the next day and changed our transportation to Rome airport. This was on a Thursday.  It took us an additional day and a half to reach home with 3 connecting flights and we arrived home on Saturday totally exhausted.  The dentist had called in another prescription which he picked up on Saturday and waited for his appointment on Monday morning.

I cancelled our cruise which was supposed to begin that day and made a hotel reservation near the Rome airport for that night.

After we returned home I looked at the Allianz policy I had purchased when we made our Delta Air reservations.  I gathered all of the documents I had and scanned them all and started a claim for trip interruption with Allianz.  They asked for a letter and medical records from the dentist which I was able to obtain a week later and I submitted them.

They said it was under final review.  It has been another 2 weeks and I just received my rejection letter.  It only said that I need to read my policy to determine why the claim was rejected.  They referred me to the Trip Interruption section of the policy.  After reading it I am still not sure but this is what I can surmise. Either I did not start my claim within 72 hours of when we woke up in Civitavecchia or that my husband didn't see a dentist within that same 72 hours.  They didn't say why the claim was denied but referred me to the policy to figure it out.  

Even after reading the policy again I am not sure that we could have complied as it took us from Thursday until Saturday to get home and the dentist doesn't work on weekends.

I don't know if I will ever purchase anything other than an annual medical policy for travel.  Even after reading the entire policy I don't know how our claim could ever have been considered.

Thanks for letting me share by story.

 

 

[GeezerCouple]

If the policy states that a physician must be seen... then a physician must be seen.

Full stop.

 

We've had this happen out of the country a couple of times.  In both cases, the hotel sent for a physician to come to the hotel to see the patient.  Note that this cost was *covered* by the travel insurance, so there is zero reason not to do it.

In one case, a trip to the ER was required, but in others, it was not.
However, in all cases, the insurance covered all of the claimed costs.

 

Note that similarly, if the insurance policy specificies that a *receipt* must be submitted, then... a receipt must be submitted.

Full stop.

 

There is a reason that the policy describes the terms and conditions of coverage.

They aren't trying to hide these requirements.

 

Also, travel insurance companies tend to be available 24/7 (all? most??) so calling them to ask "what to do" is another possibility.  And at least for our policies, that choice is also stated in the T&Cs.

(Our insurer accepts collect calls from overseas.  However, we handled this by email with our travel insurance agent, who gave us advice about how to proceed in the more complicated case, which also resulted in some changes to the remainder of our itinerary.  If we didn't have an agent or couldn't reach them [that was Steve, at www.TripInsuranceStore.com], we'd have called the travel insurer directly.  Or done that if directed to by the agent, obviously.)

 

ETA:  We've had quite a few travel insurance claims, totalling in the tens of thousands of dollars.  Everything was paid in a very timely fashion with no arguments except for one very small item for which we had no receipt. Yes, we could have gotten a receipt, but didn't think of it at the time.  We might have been able to request reconsideration, but it was less than $10, and not worth our time.

GC

Edited July 14 by GeezerCouple

[hoopslover]

Thank you for your input.  Since we already knew that the tooth was cracked and would be scheduled for extraction upon our return and that he had an antibiotic waiting for him at home we didn't even consider trying to see a dentist in Civitavecchia.  Lesson learned.  Our cruise was not included in the claim so we knew we were losing that cost.  We were really only seeking hotel and meals at the Rome airport that were caused by the trip interruption.  Our flight was just rebooked with no cost to us.  Minor expenses but lesson learned about having to see a doctor in order for insurance to cover any expenses.

 

[GeezerCouple]

2 hours ago, hoopslover said:

he woke up in severe pain and his gum and cheek were swollen. 

 

50 minutes ago, hoopslover said:

and that he had an antibiotic waiting for him at home we didn't even consider trying to see a dentist in Civitavecchia. 

 

One other thing,,, waiting a couple of days for an antibiotic that is needed... can be a mistake.

Of course, non-physician types may not know whether an antibiotic is actually needed.  So seeing a physician (or dentist, of course) is advisable anyway, not just for "getting that visit with a doctor" documented.  But also to make sure that any necessary treatment is started in a timely fashion.

 

And because any such expenses are probably covered by the travel insurance, there's no reason to hesitate or postpone being seen.

BTW, this has been one of the ways that travel medical insurance is different from our "regular home insurance".  Unless it's some extreme situation, the insurer is just going to cover the costs.  There isn't a requirement to get any sort of "pre-approval" or any [reasonable!?] limit on the charge.  The cost could be more or less than what one would pay at home.

 

Indeed, when I was in hospital overseas, there was NO attempt to get any insurance or billing information.  When I left, we tried to pay, and they refused.  We tried to insist (we used their services, we weren't local taxpayers, and we had insurance!), but they in turn insisted that they had NO way even to collect any money!

 

Contrast that when DH was taken to an ER in a different country.  While they took him to a room, I was escorted to "Billing".  Fortunately, we always travel with several charge cards with high limits, so I just handed one over rather than wasting time until I could get back to DH.  (As an aside, there were signs on the walls in Billing that they would only accept payment arrangements from a list of several specific travel insurers.  Ours was one of them, but I wanted that treatment to start asap, and *not* wait for communications with some corporate office back in the USA.  IF something bad was happening, we could take care of "additional expenses" over our credit limits after DH's condition was better understood and any true emergency was handled...)

 

GC

[CDNPolar]

2 hours ago, hoopslover said:

After 25 cruises and trips all over the world the unexpected finally happened to us.  We were on 2 cruises with a day in between in Civitavecchia.  My husband had seen a dentist before we left and he was given permission to travel and was prescribed antibiotics for a cracked tooth.  After being gone 14 days he woke up in severe pain and his gum and cheek were swollen.  He called his dentist in the US and was advised to return home.

We moved our flight home from the next week to the next day and changed our transportation to Rome airport. This was on a Thursday.  It took us an additional day and a half to reach home with 3 connecting flights and we arrived home on Saturday totally exhausted.  The dentist had called in another prescription which he picked up on Saturday and waited for his appointment on Monday morning.

I cancelled our cruise which was supposed to begin that day and made a hotel reservation near the Rome airport for that night.

After we returned home I looked at the Allianz policy I had purchased when we made our Delta Air reservations.  I gathered all of the documents I had and scanned them all and started a claim for trip interruption with Allianz.  They asked for a letter and medical records from the dentist which I was able to obtain a week later and I submitted them.

They said it was under final review.  It has been another 2 weeks and I just received my rejection letter.  It only said that I need to read my policy to determine why the claim was rejected.  They referred me to the Trip Interruption section of the policy.  After reading it I am still not sure but this is what I can surmise. Either I did not start my claim within 72 hours of when we woke up in Civitavecchia or that my husband didn't see a dentist within that same 72 hours.  They didn't say why the claim was denied but referred me to the policy to figure it out.  

Even after reading the policy again I am not sure that we could have complied as it took us from Thursday until Saturday to get home and the dentist doesn't work on weekends.

I don't know if I will ever purchase anything other than an annual medical policy for travel.  Even after reading the entire policy I don't know how our claim could ever have been considered.

Thanks for letting me share by story.

 

 

 

 

I may have the answer to this, but this is just my thinking...

 

I do not see here that you called Allainz while you were away and before you made your cancellations and rebooked your flights?

 

Did you contact them before doing all of this?

 

I think that perhaps if you did not contact the insurance company when all this was happening, within a certain time frame, and by waiting until you got home, this is the reason why they are not paying.

 

Insurance as I know it requires you to contact them for their assistance before you do anything - unless of course it is a life threatening medical emergency.

 

Could this be the case?

 

Our experience was a full cancellation for a covered reason, but I called the claim line before cancelling or making any steps towards cancelling.

 

I would hope that if you call them and ask for a direct reason that they denied your claim that they would be obligated to do so and not just direct you to the policy language....

 

 

 

Edited July 14 by CDNPolar

[hoopslover]

34 minutes ago, CDNPolar said:

 

 

I may have the answer to this, but this is just my thinking...

 

I do not see here that you called Allainz while you were away and before you made your cancellations and rebooked your flights?

 

Did you contact them before doing all of this?

 

I think that perhaps if you did not contact the insurance company when all this was happening, within a certain time frame, and by waiting until you got home, this is the reason why they are not paying.

 

Insurance as I know it requires you to contact them for their assistance before you do anything - unless of course it is a life threatening medical emergency.

 

Could this be the case?

 

Our experience was a full cancellation for a covered reason, but I called the claim line before cancelling or making any steps towards cancelling.

 

I would hope that if you call them and ask for a direct reason that they denied your claim that they would be obligated to do so and not just direct you to the policy language....

 

 

 

I did not even think about the insurance which was my fault. I questioned them about the denial and it wasn't because of the delay in starting a claim. It was because we needed to find a dentist in Italy to say that his tooth had abscessesd and we shouldn't go forward on our trip. He had enough antibiotics to make it home but not enough for a 9 day cruise which left that afternoon.  We decided to lose the cost of the cruise and return home where his tooth was removed by an oral surgeon.

Had we known that trip interruption insurance required him to see a dentist before we canceled the cruise and rebooked our flights and transportation before returning home we would have made the same decision. The ship was going to sail without us anyway. 

I have learned a lot through this experience and thank everyone for their replies.

[Coral]

I do think a doctor has to see you and advise cancellation of the cruise/trip in order to pay.

 

I have dealt with Allianz quite a bit. They have a number that they answer quickly if you are on a trip and experiencing a medical emergency (and they will accept a collect call). This should have been your first call. When I have called them (last time was this past October) - they instructed me exactly what to do and what paperwork was needed. They then setup a flight home (I then cancelled my flight home with miles and those got re-instated) and in my situation, a medical escort to go with me. They assigned a caseworker for me and was very easy to work with.

 

Definitely understand your policy - call them if you have questions. I am glad you were not out more money.

 

On a side note - I called my dentist at 7 am last week before getting on a plane for a business trip. I was sort of unsure about flying over a dental thing. No trip insurance involved but I understand how scary this can be.

Edited July 14 by Coral

[Coral]

56 minutes ago, hoopslover said:

I did not even think about the insurance which was my fault. I questioned them about the denial and it wasn't because of the delay in starting a claim. It was because we needed to find a dentist in Italy to say that his tooth had abscessesd and we shouldn't go forward on our trip. He had enough antibiotics to make it home but not enough for a 9 day cruise which left that afternoon.  We decided to lose the cost of the cruise and return home where his tooth was removed by an oral surgeon.

Had we known that trip interruption insurance required him to see a dentist before we canceled the cruise and rebooked our flights and transportation before returning home we would have made the same decision. The ship was going to sail without us anyway. 

I have learned a lot through this experience and thank everyone for their replies.

Hotels have names of dentists and doctors for their guests. FYI for the future.

[ljones]

Lots of great information & reminders!  Thanks to all.