Welcome Guest [Log In] [Register]

Kia Ora
You are currently viewing our forum as a guest. This means you are limited to certain areas of the board and that there are some features you can't use or read.

We are an active community of worldwide senior members participating in chat, politics, travel, health, blogging, graphics, computer issues & help, book club, literature & poetry, finance discussions, recipe exchange and much more. Also, as a member you will be able to access member only sections, many features, send personal messages, make new friends, etc.

Registration is simple, fast and completely free. Why not register today and become a part of the group. Registration button at the very top left of the page.

Thank you for stopping by.

Join our community!

In case of difficulty, email worldwideseniors.org@gmail.com.
If you're already a member please log in to your account to access all of our features:

Username:   Password:
Add Reply
Travel insurance loophole devastates B.C. couple
Topic Started: Mar 10 2012, 01:46 AM (1,696 Views)
Darcie
Member Avatar
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.
Offline Profile Quote Post Goto Top
 
Replies:
LuvSouth
No Avatar
Super Poster
[ *  *  *  *  * ]
I think this issue is mostly caused by the insurance companies themselves.

When travellers bought health insurance, they expected they're covered, as simple as that !

The Canadian government should look into the matter and legislate insurance companies to protect consummers, people like us !
Offline Profile Quote Post Goto Top
 
campy
Member Avatar
Handyman Extraordinaire
LuvSouth
Mar 12 2012, 01:04 AM
campy
Mar 11 2012, 04:47 PM

Quoting limited to 2 levels deep
But according to the news, bill collection agency has been calling the couple for the $160,000 payment.

Can they go after their principle residence ?
They can't attach assets unless they get a court order. They can put a lien against the house so they can collect if it's sold.


Offline Profile Quote Post Goto Top
 
Kahu
Member Avatar

friendshipgal
Mar 12 2012, 05:26 AM
I did read elsewhere that an American judgment is not enforceable in Canada, so maybe all they can do is harass people
Is the reverse true, a Canadian judgement enforceable in the US?

If you have a judgment of a foreign court against a New Zealand resident or an owner of assets in New Zealand, it may be possible to enforce that judgment in New Zealand.

As well as enforcement, a foreign judgment may be used as a defence to a New Zealand court action or pleaded as being conclusive of an issue in an action.
There are three methods of enforcing foreign judgments in New Zealand:Reciprocal enforcement under statute.Enforcement of commonwealth judgments under statute.Enforcement under the common law.The appropriate method depends on the country in which the foreign judgment was given.

Source Link - Foreign Judgements
Offline Profile Quote Post Goto Top
 
LuvSouth
No Avatar
Super Poster
[ *  *  *  *  * ]
I am hoping someone could dig out some old cases to see what the outcomes and if they were enforceable !?

If the hospital bill was 1 million dollars or more (like the case I mentioned earlier in my post), are you going to pay ?

That was a real case from someone I knew and he told me the story of his grand father. So make sure your heart is ok before boarding a plane, remember the bill could be in the excess of $1 million if the plane makes an emergency landing ...

I assume the following are the costs for that emergency landing/hospital treatment/inconvenient costs:
- Re direct the plane to land in Chicago (it was enrouted to Toronto supposingly)
- Associated costs of emergency landing (landing fee, extra fuel, compensation to all passengers ...)
- Ambulance in airport
- Hospital costs
- Other costs

My advise: Stay in Canada or drive if one has heart problem ! Travel by air when one is younger, well, it's not news, is it ?
Edited by LuvSouth, Mar 12 2012, 10:16 AM.
Offline Profile Quote Post Goto Top
 
campy
Member Avatar
Handyman Extraordinaire
The collection agency is in Canada working for the insurance company and the Canadians are the ones insured by a Canadian company.

Really it's the insurance company versus the hospital.

The insurance company doesn't want to pay and are trying to get the insured to pay.

It's an impossible situation for the insured. They need to hire a lawyer.
Offline Profile Quote Post Goto Top
 
friendshipgal
Member Avatar
Guess everyone wants their own Trudashians
Kahu
Mar 12 2012, 08:27 AM
friendshipgal
Mar 12 2012, 05:26 AM
I did read elsewhere that an American judgment is not enforceable in Canada, so maybe all they can do is harass people
Is the reverse true, a Canadian judgement enforceable in the US?

If you have a judgment of a foreign court against a New Zealand resident or an owner of assets in New Zealand, it may be possible to enforce that judgment in New Zealand.
--------------------
Source Link - Foreign Judgements
I don't know, probably, although it may be possible to enforce the order either way. I haven't found anything, I'll do some more searching when I have more time.
I did find this
http://www.collectdebtincanada.com/selectingacollectionagency.php
Many US collection agencies claim they can collect in Canada. In reality, very few can do it legally.

The Canadian version of the FDCPA includes commercial as well as consumer debt and is enforced at the provincial level.


campy: It's not between the insurance company and the hospital when the insurance refuses to pay, you are on your own, it's between you and the hospital, unless you can afford a lawyer. Depending on the amount involved I'd try the lawyer.

Oh Oh, found this, read it and weep

American Hospitals Can Sue Canadians Travelling Without Insurance
excerpted
Occasionally, even if you have travel insurance, you may find the hospitals coming after you for payment that your insurer did not cover: perhaps you had a pre-existing condition you insurer didn’t know about, or you didn’t disclose your complete medical history when applying for medically underwritten insurance. This happens rarely, but it does happen. And if it happens to you it can be calamitous. Claims for $25,000 to $30,000 for a two-day stay are not unusual.

What do you do if you are faced with such a claim? First of all, don’t panic. You’ll have to come to some kind of settlement just as you would with any other legitimate claim for payment. When you were in hospital, you or your travelling partner surely signed forms confirming that you were ultimately responsible for payment of services rendered to you—even if you had travel insurance. Everybody signs such forms. Or you may have signed a credit card deposit. All of these are legitimate commitments and they are designed to cover those contingencies where insurers deny your claim or pay only parts of it, or you are responsible for co-payments, or you have no insurance.

The worst thing to do is write a cheque for the full amount billed and send it off. No hospital expects to be paid full “retail price.” If you do that you will have overpaid. On average, U.S. hospitals collect only about one third of the retail charges they bill with domestic U.S. health insurers, so don’t be afraid to negotiate and start low, be tough, don’t hesitate to put up a “take it or leave it” stance, and before you send away one dollar, get a properly certified letter from a high authority at the hospital that your payment will be considered payment in full, no other collection efforts will be made. Sending away a cheque marked “payment in full” without having such a letter in hand is worthless. And a letter from a lowly accounting clerk won’t do it.
Edited by friendshipgal, Mar 12 2012, 01:28 PM.
Offline Profile Quote Post Goto Top
 
campy
Member Avatar
Handyman Extraordinaire
campy: It's not between the insurance company and the hospital when the insurance refuses to pay, you are on your own, it's between you and the hospital, unless you can afford a lawyer. Depending on the amount involved I'd try the lawyer.

Not if there is a dispute with the insurance company and a loophole interpretation.



Edited by campy, Mar 12 2012, 01:51 PM.
Offline Profile Quote Post Goto Top
 
Delphi51
Member Avatar
Member title
Travel in senior years is sounding risky! Personally, I love travelling in my own country.

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

It seems to me that health insurance is one area where competition doesn't work. The company must offer a low rate or it won't get your business. Then it can't afford to properly cover the costs so it has to get nasty. The customer doesn't learn this until it is too late to choose a more expensive alternative.

Long term care cost in Alberta has a base rate of $50 a day. Private operators must offer a portion of their places at that rate. They can charge as much as they like for better accommodation and service.
Offline Profile Quote Post Goto Top
 
LuvSouth
No Avatar
Super Poster
[ *  *  *  *  * ]
campy
Mar 12 2012, 12:54 PM
The collection agency is in Canada working for the insurance company and the Canadians are the ones insured by a Canadian company.

Really it's the insurance company versus the hospital.

The insurance company doesn't want to pay and are trying to get the insured to pay.

It's an impossible situation for the insured. They need to hire a lawyer.
Why is it between the hospital and the insurance company as you said ???

When the insurance company refuses to pay, the hospital will go after the patient who received the service, as simple as that !
Offline Profile Quote Post Goto Top
 
Trotsky
Member Avatar
Big City Boy
I despise the whole idea of insurance. It is set up so that whenever an insurance company WISHES to avoid payment they can and of course while they merrily pay the nickel and dime claims whan a catastrophic loss occurs they point to the fine print always in their favor.

So I avoid insurance when possible. I am furious at my co-op demanding I buy co-op insurance covering a lot of gobbledygook that I KNOW is covered by the cooperative corporation's master policy. And having read the policy (ALLSTATE) I can see many outs for the company should the company wish to employ them.

I despised mandatory car insurance when I had a car, I despised apartment insurance when I lived in a rental (but at least I didn't have to buy it,) I despise my co-op owner's insurance, and most of all I despise the system of "private health insurance" that is now being implemented as MANDATORY in the United Ststes.

It is bad enough to let the fox in the henhouse but when LAWS are passed to make sure that every henhouse MUST house a rapacious fox, then something is radically broken.
Offline Profile Quote Post Goto Top
 
campy
Member Avatar
Handyman Extraordinaire
LuvSouth
Mar 13 2012, 12:37 AM
campy
Mar 12 2012, 12:54 PM
The collection agency is in Canada working for the insurance company and the Canadians are the ones insured by a Canadian company.

Really it's the insurance company versus the hospital.

The insurance company doesn't want to pay and are trying to get the insured to pay.

It's an impossible situation for the insured. They need to hire a lawyer.
Why is it between the hospital and the insurance company as you said ???

When the insurance company refuses to pay, the hospital will go after the patient who received the service, as simple as that !
Sure they will.

Tell them the insurance company is negligent and to go after them instead of you.

You can't take this kind of thing laying down.

You have to make them take legal action.

They try to intimidate you into paying.

They hate taking legal action. Too expensive across borders.

I personally know a person who told them to shove it and he hasn't been approached or had legal action taken.

The bill was over $10,000.

Plus it's up to the hospital to contact the insurance company to make sure the operation is covered under the policy.
Edited by campy, Mar 13 2012, 02:17 AM.
Offline Profile Quote Post Goto Top
 
LuvSouth
No Avatar
Super Poster
[ *  *  *  *  * ]
>Tell them the insurance company is negligent and to go after them instead of you.
I am sure the BC couple did tell the hospital it was the insurance company which was negligent and go after the insurance instead of the insured.

>You have to make them take legal action.
>They try to intimidate you into paying.
The hospital already had collection agent to harrass the couple, what's next ?

>They hate taking legal action. Too expensive across borders.
Do you know more about past cases ? Do the hospitals really hate taking action across the borders ?

>I personally know a person who told them to shove it and he hasn't been approached or had legal action taken.
>The bill was over $10,000.
When ? Recently ? Long time ago (years) ?

>Plus it's up to the hospital to contact the insurance company to make sure the operation is covered under the policy
I agreed with this, but it was an emergency (heart attack) so the hospital had to admit the patient under the laws.

The problem with Manulife (this BC case) was they used one excuse (the couple answered No instead of Yes in one question) to deny their claims.
Edited by LuvSouth, Mar 13 2012, 02:36 AM.
Offline Profile Quote Post Goto Top
 
campy
Member Avatar
Handyman Extraordinaire

Quote:
 
I am sure the BC couple did tell the hospital it was the insurance company which was negligent and go after the insurance instead of the insured.


And they should stick to their guns.
Quote:
 

The hospital already had collection agent to harrass the couple, what's next ?

Tell them to take legal action

Quote:
 
>They hate taking legal action. Too expensive across borders.
Do you know more about past cases ? Do the hospitals really hate taking action across the borders ?

Of course. The law is different on both sides of the border. Are you going to sue in a U.S. court where they have no jurisdiction over Canada.

Quote:
 
>I personally know a person who told them to shove it and he hasn't been approached or had legal action taken.
>The bill was over $10,000.
When ? Recently ? Long time ago (years) ?

4 or 5 years ago. The person is dead now and no collection for sure.

Quote:
 
>Plus it's up to the hospital to contact the insurance company to make sure the operation is covered under the policy
I agreed with this, but it was an emergency (heart attack) so the hospital had to admit the patient under the laws.


Are you sure they have to admit the patient under the laws? It's still their responsibility to make sure the insurance is valid.

Quote:
 
The problem with Manulife (this BC case) was they used one excuse (the couple answered No instead of Yes in one question) to deny their claims.


We know that. The question is the problem but debatable.

I also know personally of a case where the bill stated was $100,000 until the hospital found out that the insurance wouldn't cover it.

They reduced the bill to $10,000. This was family so I know what I am talking about.

The hospital said they made a mistake in billing. Yeah sure.

And in another case involving family a pacemaker was installed after the relative passed out.

The insurance company was refusing to pay because they said it wasn't necessary and that the policy didn't cover that.

The family got a hold of a lawyer and guess what.

The insurance company paid.
Edited by campy, Mar 13 2012, 04:20 AM.
Offline Profile Quote Post Goto Top
 
LuvSouth
No Avatar
Super Poster
[ *  *  *  *  * ]
Wow, it looks like we need to share more past cases in this forum so that we (consumers) know how to deal with hospitals and insurance companies.

For me, I would try my best to answer those questions correctly, reveal my medication conditions, pay the premium, meaning I do my part and I expect I am covered.

I also heard hospitals milk insurance companies too. I think it's a mess !
Edited by LuvSouth, Mar 13 2012, 08:18 AM.
Offline Profile Quote Post Goto Top
 
campy
Member Avatar
Handyman Extraordinaire
LuvSouth
Mar 13 2012, 08:17 AM
Wow, it looks like we need to share more past cases in this forum so that we (consumers) know how to deal with hospitals and insurance companies.

To me, I would try my best to answer those questions correctly, reveal my medication conditions, pay the premium, meaning I do my part and I expect I am covered.

I also heard hospitals milk insurance companies too. I think it's a mess !
The worst thing you can do is pay what the hospital asks.

They inflate the bills deliberately and will settle for less if push comes to shove.
Offline Profile Quote Post Goto Top
 
1 user reading this topic (1 Guest and 0 Anonymous)
ZetaBoards - Free Forum Hosting
Free Forums with no limits on posts or members.
Go to Next Page
« Previous Topic · General · Next Topic »
Add Reply