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Travel insurance loophole devastates B.C. couple
Topic Started: Mar 10 2012, 01:46 AM (1,699 Views)
Darcie
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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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campy
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begete_Justicette
Mar 10 2012, 05:06 AM
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.
Let me explain universal health care in what you call the civilized world.

It only works until you get old and are unable to look after yourself.

Then you have to go into a care facility in Canada.

it's not free and can wipe you out financially as well.

And the nice health care facilities are private and cost a mint.

If you can't afford to pay they take your pensions and leave you with enough money each month to perhaps buy cigarettes.

That's one of the best kept secrets of Canadian health care that Americans don't hear about.



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goldengal
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campy
Mar 10 2012, 05:04 PM
.

It only works until you get old and are unable to look after yourself.

Then you have to go into a care facility in Canada.

it's not free and can wipe you out financially as well.

And the nice health care facilities are private and cost a mint.

If you can't afford to pay they take your pensions and leave you with enough money each month to perhaps buy cigarettes.

That's one of the best kept secrets of Canadian health care that Americans don't hear about.



Campy .... You are no doubt referring to nursing homes in Ontario. While I had 15 years experience of a relative I was responsible for in a nursing home years ago, I did considerable research last year when my son in law's grandmother had to move from a retirement home to a nursing home. She pays less than half the amount in long term care (nursing home) than she did in a retirement home.

Government Responsibility
In the province of Ontario, the Ministry of Health and Long-term care is accountable for regulating, inspecting, and setting the fees for nursing home care.

CCAC

The information on rates, as well as information pertinent to those who are unable to pay those rates, are included here:

http://www.ccac-ont.ca/Upload/mh/General/LTCRates/LTCRatesEN-10.pdf

Take care,
Pat
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Darcie
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One of the women in this building moved into a very good and nice nursing home. She pays less than in this retirement building and the cost is based on your income tax assessment each year.

Not a secret.
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friendshipgal
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Guess everyone wants their own Trudashians
I believe the article in the first post does speak to the issue of a higher rate billed to insurance companies too, If there's no insurance, then the rate is cheaper.

Years ago I had to see a doctor (in the U.S.) for a back problem for which he ordered a cat scan, I was new to this so agreed to the appointment. Got a call from the hospital to say my insurance didn't cover cat scans. I was curious so asked the hospital about the cost and was told it was $2,400.00, but if I paid myself, $1,200.00 ohmy 03 (they will cover them if it's an emerg. at the hospital or if you are admitted).

A friend of ours from Nova Scotia is in the hospital now with internal bleeding, his insurance cost him $3,000.00 because he had a heart attack and has a pacemaker... it's not a heart problem but as soon as he's stable they'll ship him home. I doubt that he'll be able to get insurance next year, but who knows.

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campy
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Quote:
 
She pays less than half the amount in long term care (nursing home) than she did in a retirement home.
Quote:
 


Of course. If you can afford it you go into a private retirement home and they are not cheap but in my opinion the care is much better. You need big bucks for that.

You are missing my point.

If you go into the hospital it's covered. All other care is covered. Long term care when you get old is not covered and it can drain your finances and make you broke just as the ones in the U.S. are complaining about.

The U.S. people think everything is covered in Canada under universal health care. It isn't. Long term care is the only private health care allowed.
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campy
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Darcie
Mar 11 2012, 02:32 AM
One of the women in this building moved into a very good and nice nursing home. She pays less than in this retirement building and the cost is based on your income tax assessment each year.

Not a secret.
Sure.

But if all you have is CPP and OAS that is what you pay.

That goes toward your care and all you have left is enough money for cigarettes each month.

That's if you weren't smart enough to transfer all your assets to a family member previously.

When i said it's a secret I was talking about people in the U.S. not knowing how the Canadian system works and thinking it's all pie in the sky in Canada.

It isn't. It's much better to be sick and rich than sick and poor.

I am just trying to clear up a misconception about universal health care in Canada.

This is the quote"
Quote:
 
You, in the still civilized world, have universal health care coverage. We here in the USA do not.
Quote:
 
Edited by campy, Mar 11 2012, 03:16 AM.
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goldengal
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Being admitted to hospital is one thing, but living in a nursing home is altogether different. No matter where we live we have to pay - i.e. we pay rent where we live or mortgage. We cannot expect to move to long term care and pay nothing. We do not eat for nothing at home now do we?

If one moved to long term care (nursing home) and paid nothing, they would be far ahead of poor seniors struggling to stay in their homes or apartments and eat healthy IMHO.

The rates for either public or private long term care homes in Ontario are set by the government. There was one private nursing home where Oma would have loved to reside, but the waiting list is so long there she would never be admitted in her life time - and it costs the same as in ones that are not as nice.

Take care,
Pat
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campy
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goldengal
Mar 11 2012, 03:25 AM
Being admitted to hospital is one thing, but living in a nursing home is altogether different. No matter where we live we have to pay - i.e. we pay rent where we live or mortgage. We cannot expect to move to long term care and pay nothing. We do not eat for nothing at home now do we?

If one moved to long term care (nursing home) and paid nothing, they would be far ahead of poor seniors struggling to stay in their homes or apartments and eat healthy IMHO.

The rates for either public or private long term care homes in Ontario are set by the government. There was one private nursing home where Oma would have loved to reside, but the waiting list is so long there she would never be admitted in her life time - and it costs the same as in ones that are not as nice.

Take care,
Pat
And you are missing my point again.

I am trying to get across the point that there is private care in Canada that is not covered by universal health care.

If you have money you get better care.

The U.S. readers don't think there is private care of any kind in Canada because we have 'universal' health care.

Universal health care means everyone gets the same treatment regardless of income.

I am not against it. All I am doing is setting the record straight.

Look at the rates again and what it costs. How many seniors getting only old age pension cheques can afford any of it?
Edited by campy, Mar 11 2012, 03:30 AM.
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friendshipgal
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Guess everyone wants their own Trudashians
campy
Mar 11 2012, 03:12 AM
That's if you weren't smart enough to transfer all your assets to a family member previously.

Well, in one the eastern provinces you can only do that so many years ahead as they check into it.

If you want to get out of paying retirement home costs, you have to plan ahead by giving your kids your assets well ahead of time, at least 5 years.. ohmy 03

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Durgan
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Or die gracefully by your own hand. There is always an happy hunting ground alternative.
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campy
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What I was surprised at in a nursing home was how few visitors some of the residents get from family.

So if you do transfer assets make sure there is a visitation clause.

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Daniel
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I watch CBC's Marketplace. This is another reason to hate insurance companies. That's on top of all those excuses to reject your claim when you covered on normal group extended health care and not recognizing lost market value of your automobile when you've been in an accident.
Erica Johnson mentioned they tried to contact all four related associations and none would comment. I would think this would fall under the jurisdiction of consumer protection. The wording in these contracts seem to be deliberately designed to be confusing, ambiguous and subject to interpretation of the insurer for various situations. If not directly, this seems to tread the borderline of consumer fraud in which they'll take your money for a service but find loopholes not to provide you that service - the maximum they'll refund you is your purchase payment.

Terminology must be clear and consistent with what the medical profession uses.

BTW this kind of trickery is not limited to the insurance industry; we've seen it with the cell phone industry, credit card, banking and lending, you name it, etc

Does this make you feel good about the economic theory of competition in which the best services will be offered at the best prices?

Does this kind of thing make you feel confident that the marketplace is where all our problems will be looked after?
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goldengal
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My friend in New Hampshire had a friend move into her home last year, and recently the woman has become very ill. She continually tried to get out of bed so the health care aid who was hired to watch over her during the nighttime hours said she could no longer be responsible for her.

My friend called nursing home after nursing home Wednesday in an effort to have her admitted, and they all wanted $11,000 up front. Finally, at one home she was told if she could call 911 and get her friend admitted to hospital for 3 days she could then be transferred to a nursing home. I just emailed my friend to ask her about the cost of a nursing home in the U.S. and this is her response:

"Entry into a nursing home here is approximately $11,000 per month private pay. When a person's assets are used up, an application is made to Medicaid (state welfare) and, if approved, the state government pays the bills. In Helen's case, her Medicare will pay for 100 days of "skilled care" in the nursing home. After that, she will have to go on Medicaid because she simply does not have any financial resources."

So if anyone thinks the cost of our nursing homes is horrific, this is a real eye opener.

Take care,
Pat
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campy
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The U.S. home care is all private.

Canadian home care isn't. it's part private and part health care and the only part of health care in Canada that is private.

No private hospitals in Canada and no private health care either.

You take your place in line.

If you have the bucks you can get private care for about $11,000 also.
Edited by campy, Mar 11 2012, 06:20 AM.
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goldengal
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You still are not comprehending ohmy 03 when one lives in a long term care/nursing home, they are not a patient but a resident - resident being the key word.

Take care,
Pat
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