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Travel insurance loophole devastates B.C. couple
Topic Started: Mar 10 2012, 01:46 AM (1,693 Views)
Darcie
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Skeptic
The travel health insurance that millions of Canadians buy may offer no protection at all if they answer a single question incorrectly — no matter how innocent the error — on a medical questionnaire full of convoluted language, confusing clauses and tricky definitions, the CBC's Marketplace has learned.

For some people, the result can be financial ruin when their claims are denied.

That’s what happened to Bill Jennings, 67, and his wife Tracy, 48, of Gold River, B.C., who bought travel insurance from Manulife before leaving on a trip to Fort Walton, Fla., in December 2010.

They filled out the application, including the medical questionnaire, online and thought they were covered in case of illness during their trip.

In Florida, Bill had chest pains and numbness in his arm. He discovered he had suffered a heart attack and needed emergency surgery to remove five blockages in his heart.

The surgeon explained that Bill could not be flown home because a change in altitude could bring on another heart attack


Which is why we bought insurance in the first place — unexpected emergency," Tracy said. "This was unexpected."

Recovering back home, Bill was stunned to receive a letter six months later, saying his travel health insurance claim was denied and he owed $346,000 US in medical bills.

"I was just in shock," he said. "I’ve always had travel insurance whenever I’ve left the country. Just in case something happens."

Added Tracy: "We're in financial ruin."

The problem, according to his insurer, Manulife, was the way the Jennings filled out the medical questionnaire.



Manulife says Bill should have answered yes to this question about two conditions:

"In the last two (2) years, have you been prescribed or received treatment for and/or been hospitalized (as an in-patient or seen in the emergency department) and/or been prescribed or taken medication for any of the following conditions: diverticular disorder or gastrointestinal bleeding?"

Bill insists that he didn’t know what was spelled out in his medical file or that he’d been diagnosed with those two conditions. He thought all his symptoms were related to the colon cancer he’d had surgery for 19 months earlier.

"Most importantly to me would be the question, 'What does anything, what does anything related to this have to do with Bill’s heart?'" Tracy said. "Absolutely nothing. Absolutely nothing."

Susan Eng of CARP, a Canadian advocacy group for people over 50, says the system is set up for claims to be denied.

"Ordinary people are out thousands and thousands of dollars because they did not get the protection they thought they had — only because they made a mistake on the form that they could not possibly have done correctly," she said.

While people do have the responsibility to fill out the medical questionnaires correctly, the bar is set too high, she said.

"They have to do their best. But as we’ve looked at some examples, the best is not good enough. They simply have all the cards stacked up against them."

http://www.cbc.ca/news/canada/story/2012/03/08/travel-insurance-marketplace.html

Never realized that people trusted insurance companies. Carp is right on about them.
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goldengal
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This is precisely why this year I requested something in writing from RBC that while I no longer take medication for Osteoporosis it is not because it is controlled or I no longer have Osteoporosis, but rather the meds were causing other problems, and I refuse to take it. On the questionnaire, it states if one does not take medication, they can tick off NO. In the past when I called them to clarify this, I was told I didn't have to tick Yes since the Osteoporosis is now under control which is not the case.

This year I decided I was taking no chances so wrote and told them I wanted something in writing, and my last trip I had used another insurer just because of this one question. Thus I now have something in writing, but will it stand up?

Take care,
Pat
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Bitsy
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And now you see what we experience daily dealing with private insurance companies in the states. This is a common occurrence and the reason we have so many bankruptcies; people think they are being responsible and have medical insurance coverage but too often the insurance companies have legal means to avoid paying certain claims.
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friendshipgal
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Guess everyone wants their own Trudashians
goldengal
Mar 10 2012, 02:05 AM
This is precisely why this year I requested something in writing from RBC that while I no longer take medication for Osteoporosis it is not because it is controlled or I no longer have Osteoporosis, but rather the meds were causing other problems, and I refuse to take it. On the questionnaire, it states if one does not take medication, they can tick off NO. In the past when I called them to clarify this, I was told I didn't have to tick Yes since the Osteoporosis is now under control which is not the case.

This year I decided I was taking no chances so wrote and told them I wanted something in writing, and my last trip I had used another insurer just because of this one question. Thus I now have something in writing, but will it stand up?

Take care,
Pat
Interesting that you got something in writing as I had a problem with a particular question with CAA travel insurance a couple of years back, not knowing how to answer it. They wouldn't give me an answer, so I checked with my dr., answered it and hoped it wouldn't come back to bite me, fortunately it didn't.

However, I've met a lot of Canadians over the years who have had some horror stories about their insurances and am well aware of what can happen if you inadvertently answer something incorrectly. A friend of ours answered that he took 4 meds when in fact he took 5, he had forgotten, or just didn't think it was that important. Wrong, they refused to pay his $25,000.00 med bill. Once the hospital knows you have no insurance, they will cut the bill, in his case they cut it in half, which he paid. I can tell you some other stories, but one has to be very, very careful filling out those forms.

What really amazes me are the number of Canadians who are willing to take a chance and come down with no insurance - a PEI friend is down again with no insurance, which he can't get now anyway. Long story short - he had a major heart attack and a subsequent bypass down here, was in the hospital for a month or so, complications and all. He got a bill at home for 3/4 million dollars - yikes - he told them I can give you $100.00 a month or $25,000. cash. They took the cash. Believe it or not, he's down here again with no insurance and isn't feeling good, we have urged him to go home now, but he won't. Says, if he has a problem they'll fix him up and he'll offer them $50.00 a month. biggrin 04 biggrin 04
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agate
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I guess the best defence is to not go there.
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Bitsy
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friendshipgal
Mar 10 2012, 02:36 AM
What really amazes me are the number of Canadians who are willing to take a chance and come down with no insurance - a PEI friend is down again with no insurance, which he can't get now anyway. Long story short - he had a major heart attack and a subsequent bypass down here, was in the hospital for a month or so, complications and all. He got a bill at home for 3/4 million dollars - yikes - he told them I can give you $100.00 a month or $25,000. cash. They took the cash. Believe it or not, he's down here again with no insurance and isn't feeling good, we have urged him to go home now, but he won't. Says, if he has a problem they'll fix him up and he'll offer them $50.00 a month. biggrin 04 biggrin 04
How infuriating to know that my tax dollars go to subsidize a foreign visitor’s medical procedures, and once is not enough, he is back on our dole once again if he needs medical treatment and obviously he thinks it is funny.

:blowup:
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campy
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And now you see what we experience daily dealing with private insurance companies in the states. This is a common occurrence and the reason we have so many bankruptcies; people think they are being responsible and have medical insurance coverage but too often the insurance companies have legal means to avoid paying certain claims.


Just so you don't think it's only U.S. firms. it's a common occurence in Canada as well with insurance companies.

And to set the record straight.

John Hancock insurance in the U.S. is now owned by ManuLife a Canadian company.
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Deleted User
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I think the point Bitsy was trying to make is that in the USA we have no choice other than private insurance to cover our health care costs, so the type of mistake that can bring financial ruin to Canadians when they travel, is something that happens to many USians every time we sneeze.

You, in the still civilized world, have universal health care coverage. We here in the USA do not. You may get better or faster treatment if you also have private insurance, but unless you answer ALL of the questions correctly in the USA, you face financial ruin any time you are seriously ill.

And that's why we liberals are still so angry at Obama. Instead of a single payor - the gov't - system like you have in Canada, his health care plan requires us to buy insurance from insurance companies.

So the conservatives call this socialism, and the liberals feel he is trying to make insurance companies/big business even richer and we in the USA are the only western country without universal health care.
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Durgan
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Total government spending per capita in the U.S. on health care was 23% higher than Canadian government spending.
http://www.durgan.org/URL/?PGYOS Comparison of the health care systems in Canada and the United States
http://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States For the long url people.

I never take insurance coverage when travelling outside the country. These thieves never offer a full coverage plan and there are so many caveats that Christ himself could not sort it out. Also the consumer is often unreasonable. I knew a women who had s stoke in Florida or Texas and the husband and wife insisted on a private jet to fly them home for a few hours flight. Cost around 40 grand as opposed to maybe a few thousand first class on a commercial line. No insurance company can withstand this type of expense. After the age of probably 65 you are on your own, stay home or take the risk.
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As someone mentioned in a funny e-mail I got this morning, in the USA, if you do not have medical insurance, go to the airport.
You will get a free Xray and breast exam, and if you mention Al Quaida, a free colonoscopy. Maybe the solution to the healthcare crisis here, is to replace the TSA examiners with doctors!
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Kahu
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We've been lucky with our travel insurance claims ...... we have had problems, but the insurance company (Southern Cross) has a 24 hr toll free service which I've got to say was excellent. Our travel insurance is available for 3 areas (Australia & Pacific except Hawaii .... World, which includes the UK, Europe etc and SuperWorld which covers travel in the US, Canada, and Japan). We haven't had any heart problems to date, but type II diabetes and controlled cholesterol problems which all were disclosed ..... but we have had physical injuries and sickness which were all covered under the reciprocal health service agreements between the UK and NZ, and did not cost us one cent! I have high praise for the UK Health Service and the assistance we received at the time.

Travelling within NZ ...... BJ and Mrs Tipacanoe have had experience in this area.

Why does ACC help tourists?

ACC’s legislation covers the medical treatment of overseas visitors who are injured while in New Zealand.

However, they cannot get compensation for lost overseas income and their cover does not continue once they leave New Zealand. In the case of serious injuries, ACC will assist them only to the point where they are able to safely return home. There are other exclusions as well.

It is important to note that tourists often pay some form of ACC levy. For example, those who hire rental vehicles pay an ACC levy when they buy petrol, so they do pay towards any road-accident related treatment.

Those who legally worked while in New Zealand paid levies through their wages.

It is important to appreciate that in return for this cover, overseas visitors – like New Zealanders – forgo the right to sue if they are injured here.

If they were allowed to sue, the cost to New Zealand would be significantly more than what ACC pay to cover their treatment. Individual New Zealanders could also have been sued; something that with ACC cover, cannot happen.

Finally, it is most likely that recovering the cost of tourists’ medical treatment from the visitors themselves, or their insurance companies, would be expensive.
Source Link
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Bitsy
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Kahu
Mar 10 2012, 09:47 AM
Finally, it is most likely that recovering the cost of tourists’ medical treatment from the visitors themselves, or their insurance companies, would be expensive.
No doubt it probably would be but what I find infuriating about FSG’s story is that her friend was boasting about how he manipulated our medical system and is back here now with no insurance prepared to do it once again if need be. When we have people here who cannot afford insurance or have $25,000+ cash available for negotiating their treatment.
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Deleted User
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Why does ACC help tourists
?

Alan - I got no help from ACC at all. I got an invoice from the NZ doctor's office which I submitted to my travel insurance company, and they paid all but a small deductible.

Neither the NZ doctor, nor his staff nor my travel insurance company ever said anything about your government paying for the treatment I received after my accident.
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Durgan
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A few years ago I was camping in Vermont. Throwing a log on the open fire a particle struck my eye and made a small cut on the eyeball. My eye was streaming tears and the pain was severe. After a few hours I decided that medical care was required. We drove to a small town and reported. There was only a doctor and nurse in the hospital. I was taken in and got immediate relief and an eye patch. I asked what was the bill and was told that they would send it to me.

At home, about a month later the bill arrived for $175.00. I sent a cheque and submitted to OHIP. OHIP paid $125.00 for the procedure listed. I always remember the treatment with fond remembrances. No fuss, no asking for proof of identity. That is the USA I use to remember.
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Kahu
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begete_Justicette
Mar 10 2012, 01:59 PM
Alan - I got no help from ACC at all. I got an invoice from the NZ doctor's office which I submitted to my travel insurance company, and they paid all but a small deductible.

Neither the NZ doctor, nor his staff nor my travel insurance company ever said anything about your government paying for the treatment I received after my accident.
That's what puzzles me BJ! It looks like no one applied for ACC Compensation in your case. I forget exactly what you did. Didn't the ship's Dr refer you to the hospital in Whangarei? Possible answers maybe a preexisting condition contributed to the injury in some way??? I really don't know. BTW the government doesn't actually pay the compensation ... it's the Accident Compensation Commission (ACC).
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