# Alberta senior couple have to pay over $100,000 US to an Arizona Hospital



## carverman (Nov 8, 2010)

WARNING! To those travelling in the US; Travel insurance providers are using "escape tactics" to escape paying for US Medical bills based on missing information or
medical information/prescriptions not disclosed. They claim that the travel insurance is a contract, and if you fail to disclose medical information or prescriptions
before you leave, the insurance could be denied if you have a claim while in the US and you will have to pay out of your own pocket.

Heard on CBC news this morning. An Alberta snowbird couple who took out travel insurance with CAA/AAA had their claim (over $100K US for a 5 day hospital stay
in an Arizona Hospital,), was denied by their travel insurance provider, who claimed the woman did not list all medical prescriptions, even the ones that were not
filled out. 



> *North Bay Ont couples experience.*
> In Parr’s case, she misunderstood a date requirement when she filled out the form for insurance with Royal and SunAlliance, sold online as Southbound Travel Insurance.
> 
> *She was asked if she’d been treated for heart problems in the 12 months prior to applying for insurance in August 2011. She answered no, even though she’d been to hospital with chest pains the previous October. *
> ...


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## kcowan (Jul 1, 2010)

The real crime is that they can deny the claim for any reason. It does not have to be related to the illness being treated. So, for example, if you are treated for heart problems and left out a change in diabetes medication, your claim will be denied. This is true even if the change was to lower or eliminate the medication.

OTOH it is not that hard to be thorough. Just don't let a travel agent or other rep complete the form for you. I had a change in blood pressure medication after applying for insurance. I advised them and the rate went up by $150 for the season. However, the following year the rate was back down. I think they see any change in meds as risky.


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## Nemo2 (Mar 1, 2012)

Insurance companies are in the business of selling policies......paying claims is a highly undesirable by-product in their view, and one to be avoided if it all possible.


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## Toronto.gal (Jan 8, 2010)

The case mentioned upthread was from 2013, but every single year we hear about such horror stories.

Here is a worse case from 2012:
http://www.cbc.ca/news/canada/travel-insurance-loophole-devastates-b-c-couple-1.1256056

Considering the amounts involved & potential financial ruin, IMO, those forms that people with medical conditions and/over 60 need to complete, should not be done without some sort of assistance.

I wonder how many people call their insurance company and/or doctor to confirm anything on the form that they may not have fully understood, ie: pre-existing conditions.

I posted this a couple of years ago:

*Tripped Up*
http://www.cbc.ca/marketplace/episodes/2012-episodes/tripped-up


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## bgc_fan (Apr 5, 2009)

While I understand the people are at fault because of filling in the forms incorrectly, and insurance companies want to make money, it strikes me as a bad faith type contract. 
What is happening is that the companies are taking the money, even if the people may not qualify for the terms of coverage. Instead of doing the background checks before providing the insurance (and catching these issues before they happen), they only do it after when it's most profitable as an excuse to deny payout. 
I wonder if a case can be made that the insurance company could be sued for reimbursement of premiums. It probably doesn't help with the overall finances of the people involved, but it would get a lot of play in the media.


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## carverman (Nov 8, 2010)

Toronto.gal said:


> The case mentioned upthread was from 2013, but every single year we hear about such horror stories.


I could not find the CBC news article this morning, but it was featured on the CBC morning program. It may show up later.

From what I was able to understand, they were in a motorhome vacationing in Arizona when the wife got sick..not sure what it was, but she spent 5 days in an Arizona hospital and when the claim was submitted..over $100K US, (what's that $112K Cdn?), the insurance company that CAA used, denied payment after investigating her medical records thoroughly and found out that she had some prescriptions made out for her, (that she claimed were never filled), and that was enough for the insurer to say she was not truthful in reporting her medical condition and the contract was null an void.

Now the couple may have to sell that motorhome to pay the hospital bills. We should be thankful we live in Canada with our provincial health plans. 

If you plan on visiting the US, just don't get sick there! Booze may be cheap but health care there is astronomical!


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## peterk (May 16, 2010)

How does this process work exactly? Do you pay the hospital in full upon departure? how? Did this couple just have 100k in chequing that they were willing to plunk down to a foreign hospital?

Example: You go into a foreign hospital in dire need. They ask you if you have insurance and you show them the travel insurance, and they provide treatment based on this evidence. You then leave, treated, with the bill. Surely 99% of people will say "I don't have 100k right now. You will get it when my insurance pays out.", won't they? What is the hospital going to do... Hold you as prisoner?

Do you have to prove upfront that you have the cash to pay for the treatment in full?

Shouldn't this be a battle between the hospital and the insurance provider?


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## carverman (Nov 8, 2010)

peterk said:


> Example: You go into a foreign hospital in dire need. They ask you if you have insurance and you show them the travel insurance, and they provide treatment based on this evidence. You then leave, treated, with the bill. Surely 99% of people will say "I don't have 100k right now. You will get it when my insurance pays out.", won't they? What is the hospital going to do... Hold you as prisoner?


They bought CAA travel insurance and provided the hospital with the contract and the hospital would submit the entire bill after they left the hospital, I would think.
It's the insurer in Canada that CAA uses that reneged on the payment, so now the hospital sent the couple the full bill.


> Do you have to prove upfront that you have the cash to pay for the treatment in full?


No I wouldn't think so...that is why Canadian travelers need medical insurance down there.



> Shouldn't this be a battle between the hospital and the insurance provider?


Apparently not. The hospital wants to get paid and as far as they are concerned, with the couples medical insurance not wanting to pay..it defaults back to the couple.
Maybe they may get some relief from the Alberta provincial health coverage...but that remains to be seen. Even if they do get some relief from the Alberta medical coverage..
it probably won't cover all the services and only what Alberta would pay for hospital stay in Alberta. Imagine the current exchange on $100K US!


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## fatcat (Nov 11, 2009)

they do the same thing in the usa to people that apply for standard health care coverage plans ... they fill something out without understanding the implications of what it means

it happened to me when i lived in seattle

you are expected to actually have medical knowledge to answer the questions correctly and even more, meticulous record keeping of every medical event in your life and it's significance or non-significance

the insurers have been doing this for years

this is an area ripe for government oversight


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## Spudd (Oct 11, 2011)

I wonder what are the consequences if you don't pay. Probably you can't go to the US ever again, but that might be worth it.


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## Rusty O'Toole (Feb 1, 2012)

If they offer to settle for $10,000 they will probably take it. The hospital will figure they have little or no chance of collecting the whole $100,000, and a $5000 profit is better than nothing.


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## MoneyGal (Apr 24, 2009)

bgc_fan said:


> While I understand the people are at fault because of filling in the forms incorrectly, and insurance companies want to make money, *it strikes me as a bad faith type contract*.
> What is happening is that the companies are taking the money, even if the people may not qualify for the terms of coverage. Instead of doing the background checks before providing the insurance (and catching these issues before they happen), they only do it after when it's most profitable as an excuse to deny payout.
> I wonder if a case can be made that the insurance company could be sued for reimbursement of premiums. It probably doesn't help with the overall finances of the people involved, but it would get a lot of play in the media.


Insurance contracts are specifically governed by the law of utmost good faith (http://en.wikipedia.org/wiki/Uberrima_fides). The issue with travel insurance is that it is not underwritten at the time of purchase, so it is subject to post-claims underwriting. The insurance company was not "digging through" past medical records, they were doing what is required to underwrite a policy (your individually-underwritten life insurance policy will involve a nurse visit, who will come to your house with a scale, urine cup and needle for a blood sample). 

While I am sympathetic to this person's plight I don't think she understands how this kind of insurance works. People should fill these things out with their insurance agent / purchase the insurance from their existing individual carrier.


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## carverman (Nov 8, 2010)

MoneyGal said:


> The issue with travel insurance is that it is not underwritten at the time of purchase, so it is subject to post-claims underwriting.


This seems to be the case now. 
In the fine print..sent to you by mail (after you fill out the online form)

"Buy travel insurance from us..answer a couple simple questions ie: Are you on any medication now or have you ever been on any medication; b) Do you have a pre-existing
condition or have you ever had a pre-existing condition...ie: heart issues, blood pressure, tumours, bleeding, fainting/blackouts, falling, trouble walking, trouble breathing, trouble eating, trouble understanding what you answer to on this form....
if you answered NO to the above, we will be happy to take your money.....and hope that you never have a clam with us."

If you answered "Yes" to any of the above,.....sorry but we can't sell you travel insurance, you are too much of a potential risk and we don't like to pay out." 

BTW, if you buy a travel insurance policy from us, you give us free will to go through all your medical records over the last 10 years, and if we find something we don't like and you have filed a claim against us..... then the policy you signed with us is null and void....Happy travelling!




> The insurance company was not "digging through" past medical records, they were doing what is required to underwrite a policy (your individually-underwritten life insurance policy will involve a nurse visit, who will come to your house with a scale, urine cup and needle for a blood sample).
> 
> While I am sympathetic to this person's plight I don't think she understands how this kind of insurance works. People should fill these things out with their insurance agent / purchase the insurance from their existing individual carrier.


Most people buy it as peace of mind..and hope nothing happens enroute or while you are down there.


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## carverman (Nov 8, 2010)

Rusty O'Toole said:


> If they offer to settle for $10,000 they will probably take it. The hospital will figure they have little or no chance of collecting the whole $100,000, and a $5000 profit is better than nothing.


Yes, they may have some options out of this financial mess..



> 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


http://travelinsurancefile.com/headlines/alert-to-snowbirds/


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## bgc_fan (Apr 5, 2009)

MoneyGal said:


> Insurance contracts are specifically governed by the law of utmost good faith (http://en.wikipedia.org/wiki/Uberrima_fides). The issue with travel insurance is that it is not underwritten at the time of purchase, so it is subject to post-claims underwriting. The insurance company was not "digging through" past medical records, they were doing what is required to underwrite a policy (your individually-underwritten life insurance policy will involve a nurse visit, who will come to your house with a scale, urine cup and needle for a blood sample).
> 
> While I am sympathetic to this person's plight I don't think she understands how this kind of insurance works. People should fill these things out with their insurance agent / purchase the insurance from their existing individual carrier.


Maybe bad faith was too strong. It just strikes me as a heads I win, tails you lose type of situation. Of course, if they were underwritten at the time of purchase, that would deal with the issue. Perhaps this is should be more important for the government to deal with than cell phone contracts.

As for "digging through" past medical records, that's the wording the OP's linked article used. Mr. Toljanich has ulcerative colitis, but in remission since 1965. But because he didn't equate taking medication to prevent flare-ups with treatment, he was denied. Ms. Parr made the mistake of interpreting dates since she used the departure date as a reference point instead of the application date.

Besides which, neither were hospitalized due (on the face of it) to their mistakes (colitis vs pneumonia, heart condition vs kidney failure).

BTW the title is misleading as it implies they are a couple together and not 2 unrelated persons.


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## andrewf (Mar 1, 2010)

A large part of the business model is offering lower insurance rates and in turn denying as many claims as possible. The insurance companies obviously realize that there is a high rate of claims that are denied in post-claim underwriting. I think it is questionable to sell these to consumers who don't understand that they aren't insured in the traditional sense.


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## MoneyGal (Apr 24, 2009)

bgc_fan said:


> Maybe bad faith was too strong. It just strikes me as a heads I win, tails you lose type of situation. Of course, if they were underwritten at the time of purchase, that would deal with the issue. Perhaps this is should be more important for the government to deal with than cell phone contracts.


Underwriting is really, really expensive and individually-underwritten insurance contracts are not very profitable for the issuers. Like I said, I am sympathetic to the plight of the people profiled in these stories, but "utmost good faith" extends to the applicant as well, who has an incentive to conceal information from the issuer (this is the adverse selection problem).


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## peterk (May 16, 2010)

I have 60 day international vacation travel coverage through my work for which I pay only $8/year to have. Supposedly this provides me $2m in coverage. I had to do no medical test nor provide any medical or health information whatsoever, simply check a box saying I want it.... Heading for a vacation to California in June...wish me luck I guess...


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## fatcat (Nov 11, 2009)

MoneyGal said:


> Underwriting is really, really expensive and individually-underwritten insurance contracts are not very profitable for the issuers. Like I said, I am sympathetic to the plight of the people profiled in these stories, but "utmost good faith" extends to the applicant as well, who has an incentive to conceal information from the issuer (this is the adverse selection problem).


gal, you are being naive, i suspect that very few middle class canadians with assets to protect are going to risk a 100K medical bill, by concealing information and trying to get treatment in the usa, very few

do people try to cheat insurance companies ? absolutely, and the companies have a right to defend themselves against fraudulent claims 

but i have filled enough of these applications out to know that they are often ambiguous and misleading and require a level of understanding that is not made clear when the application is made

they often ask "have you ever been treated for xxxx" ... that can mean all kinds of things as can "have you ever been diagnosed with xxx" ... anyone with chronic medical problems knows that there are all kinds of hypothesis kicked around for certain diseases and many illnesses have vaguely understood causes, symptoms and possible treatments

the insurance companies know this and when a large claim comes in they will go back over the application looking for plausible denial

the best answer is that if you are sick in the usa, only go in to the hospital for true life saving emergencies, otherwise, get on a plane home


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## carverman (Nov 8, 2010)

andrewf said:


> A large part of the business model is offering lower insurance rates and in turn denying as many claims as possible. The insurance companies obviously realize that there is a high rate of claims that are denied in post-claim underwriting. I think it is questionable to sell these to consumers who don't understand that they aren't insured in the traditional sense.


I agree Andrew. This travel insurance is too competitive with insurers undercutting each other on the premiums to get more business.

While these may be isolated incidents, lets face it..most people that apply for travel insurance while in the US, are not lawyers or understand the implications of the fine print
and get caught up at the most inopportune moment due to a sickness where it is too far to get back to Canada.


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## carverman (Nov 8, 2010)

peterk said:


> I have 60 day international vacation travel coverage through my work for which I pay only $8/year to have. Supposedly this provides me $2m in coverage. I had to do no medical test nor provide any medical or health information whatsoever, simply check a box saying I want it.... Heading for a vacation to California in June...wish me luck I guess...


Yes, please don't get sick or get involved in an accident and you should be able to enjoy your vacation.


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## carverman (Nov 8, 2010)

fatcat said:


> the best answer is that if you are sick in the usa, only go in to the hospital for true life saving emergencies, otherwise, get on a plane home


If you can. My teenage daughter (a few years ago in 1995) travelled to Puerto Rico with her aunt to a timeshare that the aunt bought. While there she got very sick (twisted intestine/scar tissue) due to a previous related operation done at Sick Kids (Toronto) two years back. She was "blocked", and because of the surgery done, the doctors in PR were scared to do an operation to correct the scar tissue issue, so a medical evac flight was arranged to fly her back to Sick Kids for corrective surgery.
The travel insurance and my Nortel health insurance each share 50% of the cost of her emergency assessment and the medical evac.


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## carverman (Nov 8, 2010)

Here is the story on the Alberta couple...finally...
http://www.cbc.ca/news/canada/edmon...ejected-by-travel-insurance-company-1.2642212


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## MoneyGal (Apr 24, 2009)

fatcat said:


> gal, you are being naive, i suspect that very few middle class canadians with assets to protect are going to risk a 100K medical bill, by concealing information and trying to get treatment in the usa, very few
> 
> do people try to cheat insurance companies ? absolutely, and the companies have a right to defend themselves against fraudulent claims
> 
> ...


I'm not suggesting it is deliberate. People seeking insurance, as a rule, have an incentive to conceal information from the counterparty. Whether any one individual (or class of individuals, as you suggest) actually does it is not the point: there is an incentive to do so. This is the adverse selection problem.


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## fatcat (Nov 11, 2009)

MoneyGal said:


> I'm not suggesting it is deliberate. People seeking insurance, as a rule, have an incentive to conceal information from the counter-party. Whether any one individual (or class of individuals, as you suggest) actually does it is not the point: there is an incentive to do so. This is the adverse selection problem.


yes, and in most kinds of insurance the question of incentive to hide information is much more straightforward and clear "have you made previous claims" "have you been in an accident" and so on ... the information is straightforward and fraud, when it occurs is also easier to denote as deliberate but health insurance is another category altogether ...

to be clear, i am suggesting that insurance companies could do a much, much better job of both writing better applications and providing clearer guidance on the definition of terms as well as more clarity about how to review one's own medical history but they don't

and their omission is deliberate, they specifically write applications that are vague in order to create ammunition to possibly deny claims down the road


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## Synergy (Mar 18, 2013)

Fill out the forms with a professional knowledgeable and skilled in travel health - if such a person exists. A good agent should be able to draw out the important information that should be included within the application. If the agent makes a mistake they will have errors and omissions insurance to cover their negligence. One could record the application process on their phone just in case!



fatcat said:


> and their omission is deliberate, they specifically write applications that are vague in order to create ammunition to possibly deny claims down the road


I don't think that's a fair statement. Insurance companies and their regulators make ongoing efforts to create applications in plain language. I'm not sure about travel health but the industry has made recent improvements in their home and auto policies.


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## Synergy (Mar 18, 2013)

kcowan said:


> The real crime is that they can deny the claim for any reason. It does not have to be related to the illness being treated. So, for example, if you are treated for heart problems and left out a change in diabetes medication, your claim will be denied. This is true even if the change was to lower or eliminate the medication.


I don't think that is accurate - they can not deny the claim for any reason It has to be related to some form of an exclusion.

Diabetes is closely related to cardiovascular health so any change in medication could signify a higher risk situation.

Sometimes when medication is lowered or eliminated there are potential adverse consequences. This could lead to risk and should be disclosed in my opinion.


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## carverman (Nov 8, 2010)

fatcat said:


> and their omission is deliberate, they specifically write applications that are vague in order to create ammunition to possibly deny claims down the road


It's very competitive and also lucrative business for the underwriters of these travel insurance plans..while they do expect some payouts, just like homeowners (fire insurance) companies,
they have to keep premiums low enough for the public to be interested in buying from them in the first place...but...for some reason, these underwriters don't always specify upfront
what the rules regarding payouts are.

I know my homeowners insurance has 5 pages of "fine print" specifying under which conditions and how much they agree to pay and for some conditions they will not pay..
Ie: if the claim for loss is the result of a crime that has been committed on the premises with your knowledge...such as deliberate fire being started (arson). 
ie: If you and your ex have split up and there is a lot of anger afterwards, and you decide to set the place on fire to "teach her a lesson", or drive a backhoe through the house...they won't pay.

(There was a case that went all the way to the SOC (Supreme Court) regard suspicious fire in a garage that burned down the entire house.)

I do believe that the travel insurance policies (contracts) sent out afterwards to your home address specifiy what they will and will not pay and under what conditions, but maybe
not all of them do. I remember buying a travel insurance policy for a 2 week vacation trip to the US...and I received it in the mail with pages of fine print of what they will and
what they wont cover..so like they say..WHEN IN DOUBT READ THE FINE PRINT...the legalise, and be informed.

Of course, the fine print is not much good when you are lying in a hospital in the US that is charging $10,000 or $20,000 a day and you are in a coma from a car accident or
suffering an unexpected heart attack from a round of golf at some US golf club, after seeing a doctor/hospital to be tested for heart conditions in Canada a few months back.


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## kcowan (Jul 1, 2010)

carverman said:


> Here is the story on the Alberta couple...finally...
> http://www.cbc.ca/news/canada/edmon...ejected-by-travel-insurance-company-1.2642212


There was an exposee on the CBC about this travel insurance fiasco. All the situations were underwritten by Manulife.

Our MediQuote travel insurance is underwritten by Global Excel. I had three claims this year and they were excellent at covering 100% of the costs. OTOH I have had pseudo legal training and I go over the application very carefully. I disclose everything. If there is any doubt, talk to the insuring company, not the agent. It is well worth a phone call.


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## fatcat (Nov 11, 2009)

Synergy said:


> Fill out the forms with a professional knowledgeable and skilled in travel health - if such a person exists. A good agent should be able to draw out the important information that should be included within the application. If the agent makes a mistake they will have errors and omissions insurance to cover their negligence. One could record the application process on their phone just in case!
> 
> 
> 
> I don't think that's a fair statement. Insurance companies and their regulators make ongoing efforts to create applications in plain language. I'm not sure about travel health but the industry has made recent improvements in their home and auto policies.


it is more than just the language and the wording, it is also the individual making medical determinations as a layperson, the possibility of a doctor using medications off label, poor memory on part of both the patient and the doctor ... if you are over 60, doing a full inventory of your health history is not easy

when i bought my most recent of these from my friendly little storefront insurance place that has all my other insurance the agent told me it was a good and comprehensive policy ... it turned out that it didn't cover heart attacks, not at all, they were excluded completely ... and this wasn't under pre-existing conditions


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## carverman (Nov 8, 2010)

kcowan said:


> There was an exposee on the CBC about this travel insurance fiasco. All the situations were underwritten by Manulife.
> 
> Our MediQuote travel insurance is underwritten by Global Excel. I had three claims this year and they were excellent at covering 100% of the costs. OTOH I have had pseudo legal training and I go over the application very carefully. I disclose everything. If there is any doubt, talk to the insuring company, not the agent. It is well worth a phone call.


Ah yes..ManuLife..who advertise on TV about life , dental and health insurance. You pay hefty monthly premiums for the life insurance and you may NOT be able to collect if you have a previous
condition which causes you to die while the policy is active. Very similar to the mortgage insurance scam that the major banks were selling for hefty premiums..there was a CBC/CTV expose
on that as well as some widows were not able to collect anything when their husbands died because the underwriters investigated the medical backgrounds and determined there was
a pre-existing condition that might have led to an early mortality...so they denied the claim, refunded the premium paid (without interest) and left the widows on the hook with big hefty
mortgages.

Same with the ManuLife health/dental...you pay out hefty premiums, and they only allow about 33% of the claim, (they only pay a max of 80%), but then they subtract the co-pay, and other discounts so in the end,
you may a well set up a health dental acct and pay out of it yourself...at least you will get full use of the money and not have most of it end up in ManuLife's pocket.


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## fatcat (Nov 11, 2009)

carverman said:


> Ah yes..ManuLife..who advertise on TV about life , dental and health insurance. You pay hefty monthly premiums for the life insurance and you may NOT be able to collect if you have a previous
> condition which causes you to die while the policy is active. Very similar to the mortgage insurance scam that the major banks were selling for hefty premiums..there was a CBC/CTV expose
> on that as well as some widows were not able to collect anything when their husbands died because the underwriters investigated the medical backgrounds and determined there was
> a pre-existing condition that might have led to an early mortality...so they denied the claim, refunded the premium paid (without interest) and left the widows on the hook with big hefty
> ...


well said, insurance companies are like lawyers, necessary unfortunately, but you want to have as little dealings with them as possible

most of these dental policies for example are useless and not worth the trouble ... they must be based on the low premiums ... but they market the hell out of them


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## Synergy (Mar 18, 2013)

fatcat said:


> it is more than just the language and the wording, it is also the individual making medical determinations as a layperson, the possibility of a doctor using medications off label, poor memory on part of both the patient and the doctor ... if you are over 60, doing a full inventory of your health history is not easy
> 
> when i bought my most recent of these from my friendly little storefront insurance place that has all my other insurance the agent told me it was a good and comprehensive policy ... it turned out that it didn't cover heart attacks, not at all, they were excluded completely ... and this wasn't under pre-existing conditions


Sure, aging complicates the process (multiple doctors, therapists, etc.) all having their own diagnoses, treatment plans, medication lists, etc. It may not be an easy process but what are the alternativees? How can an agent select an appropriate plan and how could an underwriter do their job without full disclosure - accurate past medical history, etc.

Overt exclusions won't be under a pre-exising condition clause. it's not excluded based on a pre-existing condition, it's excluded completely from the policy for everyone. Unless your under 35 yrs of age I don't think your agent did a great job at selecting an appropriate policy for you.


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## carverman (Nov 8, 2010)

Synergy said:


> Sure, aging complicates the process (multiple doctors, therapists, etc.) all having their own diagnoses, treatment plans, medication lists, etc. It may not be an easy process but what are the alternativees? How can an agent select an appropriate plan and how could an underwriter do their job without full disclosure - accurate past medical history, etc.
> 
> Overt exclusions won't be under a pre-exising condition clause. it's not excluded based on a pre-existing condition, it's excluded completely from the policy for everyone. Unless your under 35 yrs of age I don't think your agent did a great job at selecting an appropriate policy for you.


The way it's going with these insurance schemes, it's become just a money maker for the underwriters who do not want to pay out..Even with their health dental, they practically scam you by indicating a Maximum (which BTW, will be less than the 12 months of premiums you pay them, so they always manage to rake some off the top for themselves, before starting to
payout. .... and to get to that maximum you have to pay about 40% out of your pocket anyway to what the druggist/dentist charges you. 

Might as well save that premium money and pay out of your pocket.


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## Synergy (Mar 18, 2013)

carverman said:


> Might as well save that premium money and pay out of your pocket.


I completely agree, I'm not a big fan of traditional extended health care plans and would prefer to pay out of pocket myself. I would however not put all the blame on the insurance industry. I'm sure they have some pretty fancy engineering going on but you also have patient's taking advantage of coverage when it's not medically necessary (massage, custom orthotics, etc.), doctor's writing scripts without performing a proper examination, therapy clinics fraudulently billing insurance companies, lawyers taking advantage of loop holes, etc. And ultimately who pays? - the consumer.


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## carverman (Nov 8, 2010)

Synergy said:


> I completely agree, I'm not a big fan of traditional extended health care plans and would prefer to pay out of pocket myself. I would however not put all the blame on the insurance industry. I'm sure they have some pretty fancy engineering going on but you also have patient's taking advantage of coverage when it's not medically necessary (massage, custom orthotics, etc.), doctor's writing scripts without performing a proper examination, therapy clinics fraudulently billing insurance companies, lawyers taking advantage of loop holes, etc. And ultimately who pays? - the consumer.


That may be so..but it seems they are bent on screwing travellers out of paying huge hospital bills on visits to the US. In this case, you just hope that you as a traveller/visitor in the US
never needs any medical attention of any kind..other wise...better have a platinum Master Card with you.


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## Synergy (Mar 18, 2013)

carverman said:


> That may be so..but it seems they are bent on screwing travellers out of paying huge hospital bills on visits to the US. In this case, you just hope that you as a traveller/visitor in the US
> never needs any medical attention of any kind..other wise...better have a platinum Master Card with you.


I'm not that familiar with the claims process and I probably don't want to be - ignorance is bliss! It is however important to note that a travel health plan is not a primary payer. They only pay after all other sources of coverage have been exhausted - GHIP / OHIP, Extended Heath, Credit Cards, etc.


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## marina628 (Dec 14, 2010)

Or family friends are fighting a nearly $300,000 bill now after he got pneumonia and a virus in Florida and they had to airlift him back home after 9 days in critical care there.He had a stroke years ago and they are trying to blame a previous stroke as the reason he got sick.He disclosed everything and had been going down every year for last 5 years and used same insurance company.They charged him over $2000 in premiums because of the high risk ,I expect in next 3-6 months his case will also be in the media...


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## fatcat (Nov 11, 2009)

marina628 said:


> Or family friends are fighting a nearly $300,000 bill now after he got pneumonia and a virus in Florida and they had to airlift him back home after 9 days in critical care there.He had a stroke years ago and they are trying to blame a previous stroke as the reason he got sick.He disclosed everything and had been going down every year for last 5 years and used same insurance company.They charged him over $2000 in premiums because of the high risk ,I expect in next 3-6 months his case will also be in the media...


classic example ... "he disclosed everything" ... hmmm ... or did he just _think_ he disclosed everything ... presumably he must have if he's forking over 2k in premiums ... nevertheless, insurance companies dont like 300k bills

can you say more about the specific of the basis for denial of his claim ?


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## Synergy (Mar 18, 2013)

fatcat said:


> classic example ... "he disclosed everything" ... hmmm ... or did he just _think_ he disclosed everything ... presumably he must have if he's forking over 2k in premiums ... nevertheless, insurance companies dont like 300k bills
> 
> can you say more about the specific of the basis for denial of his claim ?



Even with full disclosure, the claims process won't likely be black and white.

If a disclosed medical condition (cerebrovascular accident - CVA) is excluded / not underwritten in the policy, perhaps the underwritter is simply doing their due diligence to determine whether any pre-existing condition such as dysphagia (a complication of CVA) has pre-disposed the policy holder to an upper respiratory illiness which ultimately lead to the pneumonia. It may seem like a stretch but there's a pretty strong association between strokes and pneumonia. If he fully recovered from the stroke and had no remaining impairments / complications then you'd think the insurance company would be required to pay the claim. Even if he had some remaining complication from the stroke, they may still be required to pay the claim if it can be proven that the excluded condition did not significantly increase his risk of deleloping the pneumnia. Without all facts it's just a guessing game. Even with all the facts it would take a expert in the field to figure it out.


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## OhGreatGuru (May 24, 2009)

This is a common horror story. But to play devil's advocate, can you really blame the insurance company for trying to get out of paying an exorbitant $100K+ for a 5-day stay with no effective treatment? 

Note from the story: 
_... It said she had answered “no” when asked if she had “*taken and/or been prescribed *six or more prescription medications” in the last four months.

... McShane, who was a nurse before she retired, says she believes she had answered truthfully, because some of the prescriptions had been written but never filled, two were for drugs she hadn’t taken in months, and another was for an antibiotic prescribed by her Canadian doctor in case she contracted an infection while travelling, and that she never took._

Well, I'm sorry, but it does say *"and/or had been prescribed"* The fact that she hadn't taken some of these medications is irrelevant - they were prescribed for her. She decided not to mention them because in her opinion (perhaps an informed one) they were not important to an assessment of her overall health. But it wasn't her decision to make - it was the underwriters'.

Anyway, I guess Step 1 is for the victims to see what Alberta Health Plan will pay for. When they get a cheque for that, send it to the hospital telling them:

a) My travel insurance company has declined to pay your exorbitant bill on a technicality;
b) The enclosed cheque is all that my Provincial Health Care Agency thinks your services were worth. 
c) In spite of 5 days of observations and tests and enormous expense your facility was unable to correctly diagnose the cause of my health problem(s). My 2 daughters flew down there at their/my expense) to conduct me home. Once admitted to a competent hospital in my province I was immediately diagnosed with a hiatus hernia, something which you had failed to do.
d) Under the circumstances I do not consider that the remaining portion of your bill is justified. If you disagree then I would be pleased to have my lawyer correspond with you about your medical competency and diagnostic errors.


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## fatcat (Nov 11, 2009)

Synergy said:


> Even with full disclosure, the claims process won't likely be black and white.
> 
> If a disclosed medical condition (cerebrovascular accident - CVA) is excluded / not underwritten in the policy, perhaps the underwritter is simply doing their due diligence to determine whether any pre-existing condition such as dysphagia (a complication of CVA) has pre-disposed the policy holder to an upper respiratory illiness which ultimately lead to the pneumonia. It may seem like a stretch but there's a pretty strong association between strokes and pneumonia. If he fully recovered from the stroke and had no remaining impairments / complications then you'd think the insurance company would be required to pay the claim. Even if he had some remaining complication from the stroke, they may still be required to pay the claim if it can be proven that the excluded condition did not significantly increase his risk of deleloping the pneumnia. Without all facts it's just a guessing game. Even with all the facts it would take a expert in the field to figure it out.


marina said that all conditions were fully disclosed and the claimant was paying 2K in premiums ... i am therefore assuming that he disclosed a previous stroke and that it was covered as opposed to being excluded as you hypothesize

insurance companies keep lawyers on retainer so its probably a safe bet that when a really costly claim comes in they will dig deep for potential association between the current illness for which the claim is being made and any possible previous condition

nobody particularly wants to sue an insurance company so they may just go for trying to reduce their responsibility in a settlement or something 

i remain convinced that the insurers are talking out of both sides of their mouth, they want to attract business with very low premiums and then keep an edge when it comes to paying claims

the best way to keep an edge is to keep the application confusing

they could easily get together and produce a standard travel insurance application and begin to train people to understand how to work their way through it


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## Synergy (Mar 18, 2013)

fatcat said:


> marina said that all conditions were fully disclosed and the claimant was paying 2K in premiums ... i am therefore assuming that he disclosed a previous stroke and that it was covered as opposed to being excluded as you hypothesize


If it was covered why would marina specifically state "they are trying to blame a previous stroke as the reason he got sick". Why would an insurance company do that? Maybe because a stroke represents at pre-existing condition that was excluded under the policy and the insurance company is trying to get out of paying for the claim?.


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## fatcat (Nov 11, 2009)

Synergy said:


> If it was covered why would marina specifically state "they are trying to blame a previous stroke as the reason he got sick". Why would an insurance company do that? Maybe because a stroke represents at pre-existing condition that was excluded under the policy and the insurance company is trying to get out of paying for the claim?.


well, he might have disclosed it but declined to pay for pre-existing conditions ... or perhaps wasn't covered for pre-existing conditions

the insurer is saying "you wouldn't have gotten sick if you didn't have this previous stroke" ... and he (the insured) is thinking that the pneumonia is unrelated to the stroke

the insurer should have made it clear that it considered stroke to predispose one to respiratory complications and thus anything like that wouldn't be covered

we just don't know enough ... i hope marina can fill in the details


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## marina628 (Dec 14, 2010)

Stroke was over 10 years ago I do not know all the nitty gritty details except they now have paid a lawyer a $10,000 retainer to fight for them .The issue that put him on life support was the virus ,he nearly died and spent almost 2 months in hospital here when he returned.Insurance did start paying for some things even had their car shipped back to Canada for them ,this happened 5-6 months ago and I guess there is a point where they fight regardless if they have a case or not.


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## carverman (Nov 8, 2010)

marina628 said:


> Or family friends are fighting a nearly $300,000 bill now after he got pneumonia and a virus in Florida and they had to airlift him back home after 9 days in critical care there.He had a stroke years ago and they are trying to blame a previous stroke as the reason he got sick.He disclosed everything and had been going down every year for last 5 years and used same insurance company.They charged him over $2000 in premiums because of the high risk ,I expect in next 3-6 months his case will also be in the media...


..and so it continues (the implicit scam) as more and more cases come to light!


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## carverman (Nov 8, 2010)

fatcat said:


> well, he might have disclosed it but declined to pay for pre-existing conditions ... or perhaps wasn't covered for pre-existing conditions
> 
> the insurer is saying "you wouldn't have gotten sick if you didn't have this previous stroke" ... and he (the insured) is thinking that the pneumonia is unrelated to the stroke
> 
> ...


That's like saying..you broke your arm x years ago..when you tripped on the icy sidewalk in a Ontario ice storm, but you didn't disclose that to us, 
then you went on vacation in Florida (or where ever in the US), and broke your arm again (or other arm), accidently by doing something you weren't supposed to do.
(maybe like falling out of bed?).... and you had to go to a US hospital for emergency treatment and they ran up a bill of $20,000 plus to put a cast on
your arm....
sorry..but we are cancelling your policy and you are responsible for paying on your own because ..you did not disclose a "pre-existing condition",
that you had broken the same arm (or even the other arm)...when you filled out the application for insurance.

Do CMF readers see how ridculous these Travel health plans they are trying to sell unsuspectiing buyers are now?)..
as long as you DON'T submit a claim, your policy is good until you return to Canada.


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## andrewf (Mar 1, 2010)

It really is just "insurance". Seems like you buy the policy and hope that you don't get sick or injured, because there is still a high probability of a financially crippling expense if you do.


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## fatcat (Nov 11, 2009)

andrewf said:


> It really is just "insurance". Seems like you buy the policy and hope that you don't get sick or injured, because there is still a high probability of a financially crippling expense if you do.


it's certainly true that people often just get themselves to a us hospital and pass on the chance to go home ... that should be a cardinal rule for anyone traveling in the usa, if you get sick and you are able to stand a 2 hour plane ride home, _always_ go home for treatment

but i agree with carverman, the insurance companies are talking out of both sides of their mouth on this one ... they want to collect the bounty on nice low premiums and not have to pay up on the other end ... this is clearly a profitable business or there wouldn't be the intense competition in the market where we see dozens and dozens of companies offering travel policies

but they are abdicating their responsibility to adequately inform their customers of the risks involved

insurance companies always have lawyers at the ready and a single individual is always at a disadvantage in any possible trip to court


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## marina628 (Dec 14, 2010)

What all this will do is give people incentive to vacation in other countries.We went to Italy in 2008 and somebody from our group got a ear infection and was in so much pain we took him into the hospital.He ended up staying over night and got some medications ,he paid for the prescription but not a dime for the hospital.I love USA and have investments there but probably would not plan to spend 3-4 months a year there in my retirement because of the healthcare situation.


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## kcowan (Jul 1, 2010)

When we were deciding where to retire, we investigated Palm Springs, San Diego, and Florida, both coasts for a month each.

We decided on Mexico because the US estate taxes were so onerous on Canadians (2007). Since then we have gained a new appreciation for the COL, namely food, booze and medical. Our budget has been coming in 35% lower than planned. And a trip to the hospital is not a life changing event. We give them our Visa to guarantee $5k and then easily collect that after the fact from Global Excel in Montreal. BTW the medical care is great. We get the results of MRIs to keep. I have COPD but it is not a big issue thanks to those MRIs.

We are returning 5/31 and we will both be ready.


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## Tom Dl (Feb 15, 2011)

US medical care and the us in general, is beeped; and the insurance industry is completely beeped, unless they are in some narrow area with heavy government regulation, like auto. Combine the two and you might as well vacation in hell.

To a certain extent, the old folks are kidding themselves. They hit the health services hard; travel is not low stress. Everyone knows the US is kitting it's hospital costs. Who better to gouge than people that don't even live in the country. At some point the bill comes due. These old folks are going to the US to spend their Canadian earnings and government pensions, and to fall back on hospitals that are super expensive, while expecting something in Canada to pick up the bill.


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## fatcat (Nov 11, 2009)

united states healthcare is facing a fundamental problem, they are selling a product that is far outpacing the ability of their customer to buy it

it's somewhat like the best seats at major league sports that are now so expensive only businesses can afford to buy them

except people die in the former scenario


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## carverman (Nov 8, 2010)

fatcat said:


> united states healthcare is facing a fundamental problem, they are selling a product that is far outpacing the ability of their customer to buy it
> 
> it's somewhat like the best seats at major league sports that are now so expensive only businesses can afford to buy them


Because down there, most hospitals (except the military ones or federally appointed research/teaching hospitals are FOR PROFIT. Unlike our provincial health plan hospitals that cost us a fortune paid through taxes, they charge through the nose to turn a profit...But $20,000 a day, for 5 days stay is nothing but a money making scam. 
No wonder the insurance underwriter found an "out clause"...the insurance companies are in business to make a profit. 
If they consider your health care excessive, then they just refuse to pay, and refund your premium..their rational is proportional to what the bill is.


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## fatcat (Nov 11, 2009)

carverman said:


> If they consider your health care excessive, then they just refuse to pay, and refund your premium..their rational is proportional to what the bill is.


i'm not sure about "refuse" but they surely get out their magnifying glasses and their lawyers and start to look very seriously and meticulously to try and find a way to kick you off health care ... insurers don't like sick people

which is why for-profit health care is ultimately doomed ...

the insurers know this, which is why they came to the table for obamacare, it's their hail mary pass, their last hurrah before their car drives over the cliff

i am not necessarily saying that some fair degree of profit that would take place under a system of government overseen but privately delivered healthcare wouldn't be ok

in obamacare the insurers are mandated to return at least 80% of premiums to their insured ... it's still too much


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## Rusty O'Toole (Feb 1, 2012)

Hospitals and medical care in general, is the only business where you don't have to tell the customer what you charge until AFTER you render a service, are exempt from all anti trust and gouging laws, are protected from legal competition and are allowed to charge different customers wildly different amounts for the same service. No wonder medical costs have gone up by leaps and bounds. If the medical trust was forced to do business under the same laws as other businesses prices would drop by 90%. This is proven by the few medical facilities that practice "fair trade" and by the cost of the same drugs and procedures outside the US where they are cheaper by 90% or more.


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## carverman (Nov 8, 2010)

Edit function not working..I'll place the CBC story here..
One customer said of the big banks that gladly sell you expensive insurance that you won't be able to collect.
Gov't has to step in and squash this scam..it is going too far. Currently there is no regulation and the insurance companies can do whatever they want.



> “I was tricked, because they never had any intention of paying this claim. And I find that totally incredible.”


http://www.cbc.ca/news/canada/briti...oesn-t-pay-for-these-bank-customers-1.2651318

So what the travel insurance companies have decided is that unless you are between the ages of 16 and 30 and in PERFECT HEALTH, and never been to a doctor or
hospital for even a cut finger or a broken bone...and the bill is LESS than the premium you paid them...then you are covered..otherwise they will not pay. 

So don't bother wasting your money then with false assurances. Get a Platinum Master Card or American Express and use that for health emergencies abroad..
if you end up paying money anyway for your treatment, don't pay the scam artists up front!


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## Nemo2 (Mar 1, 2012)

carverman said:


> One customer said of the big banks that gladly sell you expensive insurance that you won't be able to collect.


As I noted on page one of this thread


> Insurance companies are in the business of selling policies......paying claims is a highly undesirable by-product in their view, and one to be avoided if it all possible.


Although we, out of necessity and with the fervent hope that we never have to file a claim, take out policies every time we leave the country, in no way do we believe that the insurer is our friend......in fact just the opposite.


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## Toronto.gal (Jan 8, 2010)

Nemo2 said:


> in *no way do we believe that the insurer is our friend*......in fact just the opposite.


Because that's not their role.

Insurance policies = cold/complicated legal contracts, and both parties have responsibilities. Mistakes under such contracts are rarely forgiven, and let's face it, mistakes are made and insurance companies have the legal right to deny, and deny [and abuse] they do! However, I do agree that something needs to be done with respect to the legalese of such contracts, which has led to innocent mistakes/unpaid claims.

Of course insurers are in the business to make money, but they also pay, and pay plenty, like in the auto sector for example, which is not surprising considering the idiotic low fines & minor legal consequences for careless driving, and that goes from speeding [unless it's over 50km], to DUI, to you name it. When did it become illegal to use cellphones here while driving? In 2009, while it's been illegal in other countries for 10+ years!

- Drive while using a hand-held device, which can/has cost lives = only recently doubled from $155 to $280 [thanks chief justice of the Ontario Court of Justice, but NOT high enough].

- Drive without a seat-belt, which can/has cost lives = $200 [?]

- Fail to stop at a red light, which can/has cost lives = $260 [?]

WTF????????? Then people are surprised why their premiums are high.

*Nemo:* feeling better I hope?


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## Nemo2 (Mar 1, 2012)

Toronto.gal said:


> *Nemo:* feeling better I hope?


Sauntering the path to recovery, thanks......truncated elliptical workouts have already resumed.


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## Toronto.gal (Jan 8, 2010)

Great!


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## carverman (Nov 8, 2010)

Toronto.gal;255233
- Drive while using a hand-held device said:


> .
> 
> - Drive without a seat-belt, which can/has cost lives = $200 [?]
> 
> - Fail to stop at a red light, which can/has cost lives = $260 [?]


What does ^ have to do with the travel insurance scam? Nothing as far as I can tell. :confused2:


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## Toronto.gal (Jan 8, 2010)

My points were that 1) insurers do pay big time, and 2) that they are not the only ones guilty of abuse.


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## OhGreatGuru (May 24, 2009)

It should be noted that Canadian hospitals charge pretty stiff rates to non-residents too, though I don't think they would be in the class of $100K for 5 days of non-intensive care, no surgery, and just a battery of tests. See the following site for a selection of costs in BC hospitals for example:
http://www.david-cummings.com/documents/canadian_hospital_rates.htm


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## carverman (Nov 8, 2010)

OhGreatGuru said:


> It should be noted that Canadian hospitals charge pretty stiff rates to non-residents too, though I don't think they would be in the class of $100K for 5 days of non-intensive care, no surgery, and just a battery of tests. See the following site for a selection of costs in BC hospitals for example:
> http://www.david-cummings.com/documents/canadian_hospital_rates.htm


Hospital stays are expensive, even in Canada, but the doctors can charge fees that may not be covered by the provincial medicare plan. However, unless you are a visitor to Canada and unfortunate to require surgery and stay for 5 days or more in intensive care, the rates Canadian Hospitals charge are no where near some of these privatized US Hospitals charge.

Personally, after reading these stories about seniors travelling to the US and having to visit hospitals, I would not be trusting the travel insurance schemes anymore..because, I do have a pre-existing
medical condition and on a drug that I have to take everyday. So even if somehow they didn't refuse at the beginning to give me a x day travel policy, there is no way on this green earth that
I would trust these scam artists to be there for me when I need them the most.

I would be taking out an Master card Platinum that has reasonable income qualifications. I would also apply for Master Assist Plus in my case and using that to pay for any medical in the US
and if I was concious, I would be asking for estimates on how much this will cost and that will cost in writing first. 
Too much in my estimation .and I'm on the next plane back to Ontario.



> MasterAssist™ Plus
> This benefit is a supplement to the MasterAssist program. *MasterAssist Plus provides eligible cardholders with coverage up to USD 25,000* (€30,000 in Europe) for *Medical Expenses. Emergency Medical Evacuation, Repatriation of Remains, Hotel Convalescence Costs, and Emergency Family Travel Costs also are covered when cardholders charge common carrier transportation to an eligible MasterCard card *and are traveling outside of their country of residence. For travel to Europe, MasterAssist Plus provides proof of travel/health/accident insurance in compliance with the Schengen Agreement.
> 
> All medical services can be provided on a cashless basis, which means that the provider will contact the hospital/clinic directly and process the payment, without the need for any disbursement from the cardholder, provided that the services are for eligible Medical Expenses.


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## carverman (Nov 8, 2010)

OhGreatGuru said:


> It should be noted that Canadian hospitals charge pretty stiff rates to non-residents too, though I don't think they would be in the class of $100K for 5 days of non-intensive care, no surgery, and just a battery of tests. See the following site for a selection of costs in BC hospitals for example:
> http://www.david-cummings.com/documents/canadian_hospital_rates.htm


Hospital stays are expensive, even in Canada, but the doctors can charge fees that may not be covered by the provincial medicare plan. However, unless you are a visitor to Canada and unfortunate to require surgery and stay for 5 days or more in intensive care, the rates Canadian Hospitals charge are no where near some of these privatized US Hospitals charge.

Personally, after reading these stories about anadian seniors travelling to the US and having to visit hospitals, *I would not be trusting the travel insurance schemes anymore*..
because, I do have a pre-existing medical condition and on a drug that I have to take everyday. So even by some chance they didn't refuse at the beginning to give me a x day travel policy,
*there is no way on this green earth that I would trust these scam artists to be there for me when I need them the most.*

I would be taking out an Master card Platinum that has reasonable income qualifications. I would also apply for Master Assist Plus in my case and using that to pay for any medical in the US
and if I was concious, I would be asking for estimates on how much this will cost and that will cost in writing first. 
Too much in my estimation .and I'm on the next plane back to Ontario.



> MasterAssist™ Plus
> This benefit is a supplement to the MasterAssist program. *MasterAssist Plus provides eligible cardholders with coverage up to USD 25,000* (€30,000 in Europe) for *Medical Expenses. Emergency Medical Evacuation, Repatriation of Remains, Hotel Convalescence Costs, and Emergency Family Travel Costs also are covered when cardholders charge common carrier transportation to an eligible MasterCard card *and are traveling outside of their country of residence. For travel to Europe, MasterAssist Plus provides proof of travel/health/accident insurance in compliance with the Schengen Agreement.
> 
> All medical services can be provided on a cashless basis, which means that the provider will contact the hospital/clinic directly and process the payment, without the need for any disbursement from the cardholder, provided that the services are for eligible Medical Expenses.


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## bgc_fan (Apr 5, 2009)

I started to wonder about credit card travel health insurance seeing as you've brought it up a few times. 
I found this story which seems to indicate that you could have the same problems with travel health insurance provided by a credit card.
http://www.thestar.com/business/per...ure_travelling_with_creditcard_insurance.html

When you posted that quote from the website, you left out some important information:


> The information contained herein is provided solely for general informational purposes. It does not intend to be a complete description of all terms, conditions, limitations, exclusions, or other provisions of any program or insurance benefits provided by, or for, or issued to MasterCard. For any questions please contact MasterCard Assistance Center at "1-800-307-7309".


That seems to indicate you could end up getting claims rejected after a thorough review of your health history.


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## carverman (Nov 8, 2010)

bgc_fan said:


> I started to wonder about credit card travel health insurance seeing as you've brought it up a few times.
> I found this story which seems to indicate that you could have the same problems with travel health insurance provided by a credit card.
> http://www.thestar.com/business/per...ure_travelling_with_creditcard_insurance.html
> 
> ...





> However, Firestone says if you buy a policy where you are required to complete a basic or more detailed medical questionnaire when you apply for coverage, the terms of the contract are clearly established.
> “If you disclosed that you have an ulcer problem that has not been stable for 90 days you may not be covered if you need care because your ulcer acts up when you are travelling. But coverage for a brain tumour or a car accident will not be denied,” he says.
> So buyer beware: even if you have a credit card with travel medical coverage, check the fine print in the actual insurance policy carefully.


Saw a clip on this on the CBC news last night. Mansbridge was suggesting that if you are in doubt, you need to get your doctor to fill out the form..at additional expense that most doctors charge
for this service. Probably not a bad idea and for the $100 or so your doctor charges, a letter stating what your pre- existing conditions are...if any. When faced with possible tens of thousands
of medical bills where your claim may be denied, you certainly need a doctors letter and if they still deny..a lawyer to sue the insurance companies. 
All I was trying to say is this:
Most people don't know about what constitutes a pre- existing condition before travelling..and whether the 90 day, 180 day or 365 day exclusions apply.

However, it seems more and more that if you have the time before travel and plan to be in the US or some other country, best not to take ANY CHANCES these days.
Your family doctor should have a file on your medical history. Even if you have to pay him $100 or more for his medical opinion before hand, it is wise to have this
ammunition to fight the insurance company, if you have a medical emergency and they decide not to pay for the claim.
With a doctor's letter and his medical opinion on your pre-existing condition you can take that to a lawyer.


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## carverman (Nov 8, 2010)

bgc_fan said:


> I started to wonder about credit card travel health insurance seeing as you've brought it up a few times.
> I found this story which seems to indicate that you could have the same problems with travel health insurance provided by a credit card.
> http://www.thestar.com/business/per...ure_travelling_with_creditcard_insurance.html
> 
> ...


 excerpt from the star article link above:


> However, Firestone says if you buy a policy where you are required to complete a basic or more detailed medical questionnaire when you apply for coverage,
> the terms of the contract are clearly established.
> “If you disclosed that you have an ulcer problem that has not been stable for 90 days you may not be covered if you need care because your ulcer acts up when you are travelling.
> But coverage for a brain tumour or a car accident will not be denied,” he says.
> So buyer beware: even if you have a credit card with travel medical coverage, check the fine print in the actual insurance policy carefully.


Saw a clip on this on the CBC news last night. Mansbridge was suggesting that if you are in doubt, you need to get your doctor to fill out the form..at additional expense 
that most doctors charge for this service. Probably not a bad idea these days, and for the $100 or so your doctor charges, you will have a letter stating what your pre- existing conditions are...if any.
When faced with possible tens of thousands of medical bills where your claim may be denied, you certainly need a doctors letter and if they still deny..a lawyer to sue the insurance companies. 

*Most people don't know about what constitutes a pre- existing condition before travelling..and whether the 90 day, 180 day or 365 day exclusions apply.*

However, it seems more and more that if you have the time before travel and plan to be in the US or some other country, best not to take ANY CHANCES these days.
Your family doctor should have a file on your medical history. Even if you have to pay him $100 or more for his medical opinion before hand, it is wise to have this
ammunition to fight the insurance company, if you have a medical emergency and they decide not to pay for the claim.
With a doctor's letter and his medical opinion on your pre-existing condition you can take that to a lawyer.


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## bgc_fan (Apr 5, 2009)

That point I was making is that depending on credit card travel health insurance is no different than purchasing travel health insurance. In the case of the MasterAssist Plus coverage you have mentioned, it points out that you have to call them to determine the exact terms and conditions of the coverage. I'm assuming that no forms are being filled out for this coverage and that it's an automatic over the phone type thing, but you can tell me otherwise.

As for having the doctor filling it out, it sounds like a good idea regardless.


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## carverman (Nov 8, 2010)

bgc_fan said:


> That point I was making is that depending on credit card travel health insurance is no different than purchasing travel health insurance. In the case of the MasterAssist Plus coverage you have mentioned, it points out that you have to call them to determine the exact terms and conditions of the coverage. I'm assuming that no forms are being filled out for this coverage and that it's an automatic over the phone type thing, but you can tell me otherwise.
> 
> As for having the doctor filling it out, it sounds like a good idea regardless.


 Some of the fine print:


> Cardholders are automatically eligible for the MasterAssist Plus benefits when they charge
> common carrier transportation to their Scotiabank Platinum MasterCard card. They should retain
> their common carrier tickets and proof that their tickets were charged to their Scotiabank Platinum
> MasterCard card because they will be asked to submit these if a reimbursement for any of the
> MasterAssist Plus benefits is requested.





> The MasterAssist Plus benefits are in excess over any valid and collectible insurance or other
> form of indemnity. This includes treatment paid for or furnished under any individual or group
> policy, or other service or medical pre-payment plan arranged through your employer to the
> extent so furnished or paid, or under any mandatory government program or facility set up for
> treatment without cost to any individual.


Any loss, fatal or non fatal, or any medical expenses* WHICH ARE CAUSED BY OR A RESULT FROM A PRE-EXISTING CONDITION are NOT ELIGIBLE FOR RE-IMBURSEMENT.*
A pre-existing condition is a medical condition for which medical care or treatment or *ADVICE was recommended by or received from a physician within a TWO YEAR PERIOD*
preceding the departure date of the trip or a condition for which *hospitalization or surgery was required WITHIN A FIVE YEAR PERIOD * preceding the departure date of the trip.

So there you have it folks..you can still buy it, but if you get sick in the US or involved in an accident, you may not be covered!

And if you still qualify for re-imbursement:



> Accident & Sickness Medical Expenses US$25,000
> Emergency Medical Evacuation US$50,000
> Repatriation of remains US$25,000
> Hotel Convalescence Costs US$150 per day
> Max. Number of Days – 5


Emergency Family Travel Costs US$150 per day, plus round-Max. 
Number of Days - 5 trip economy class airfare


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## Nemo2 (Mar 1, 2012)

> treatment or ADVICE


"Doc says exercise is good for one's heart"......ADVICE!


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## kcowan (Jul 1, 2010)

You should be aware that credit cards just act as agencies for insurance companies. Any claims are handled by the insurance companies.

Medipac is currently using Global Excel. Before that they have used Royal/Sun-Alliance and Manulife. I just had a claim paid by them for retinal surgery in Mexico. No Problem!


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## carverman (Nov 8, 2010)

kcowan said:


> You should be aware that credit cards just act as agencies for insurance companies. Any claims are handled by the insurance companies.
> 
> Medipac is currently using Global Excel. Before that they have used Royal/Sun-Alliance and Manulife. I just had a claim paid by them for retinal surgery in Mexico. No Problem!


Why didn't you get the surgery done here?


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## PuckiTwo (Oct 26, 2011)

carverman said:


> Mansbridge was suggesting that if you are in doubt, *you need to get your doctor to fill out the form.*.at additional expense that most doctors charge for this service. Probably not a bad idea and for the $100 or so your doctor charges, a letter stating what your pre- existing conditions are...if any. When faced with possible tens of thousands
> of medical bills where your claim may be denied, you certainly need a doctors letter and if they still deny..a lawyer to sue the insurance companies.
> 
> *Your family doctor should have a file on your medical history. *Even if you have to pay him $100 or more for his medical opinion before hand, it is wise to have this ammunition to fight the insurance company, if you have a medical emergency and they decide not to pay for the claim. With a doctor's letter and his medical opinion on your pre-existing condition you can take that to a lawyer.


Easier said than done! This only works if your family doctor 
a) has your medical history up to date and 
b) he is willing to fill out the questionnaire. 
c) And even if he fills it out, it is you yourself who signs for what he filled out and will he stand up in court for what he filled out?

We experienced two scenarios during our recent 2-months overseas trip

1. When we randomly checked our phone calls home in Canada there was a notification by my spouse's cardiologist that he would have an appointment on xx date. We were totally unaware of such an appointment request and phoned the cardiologist's office to postpone the appointment because we wouldn't be back in Canada in time. Meanwhile we are back and this meeting with the cardiologist has happened. The cardiologist was very surprised to see my spouse and surprised about the appointment "why are you coming to me? is there any new development". We found out that our family doctor had requested an appointment mid January, basically weeks before we left and did not inform us about it. He also did not attach any new report but sent the old one from the year before. Both, the cardiologist and my spouse were in the dark. 
The point here is that we should have mentioned this appointment request to the Travel Insurance Company (but did not know anything about it). Fortunately, my spouse did not need any treatment overseas. When we talked to the Insurance Company about it, there response was: "you need to read our policy" (well, we did). "you need to discuss this with your doctor" (we will but it will not help - he will not do it). The discussion with the insurance company went around in circles and eventually I hung up. 
But what do you do in a case like that and you have an emergency when outside the country? We are trying to get all reports from our family doctor but he often doesn't have them, he doesn't update his files in the computer, etc.

2. Same family doctor: I have taken for years a medication which this doctor quadrupled when we became his patients. About 1 1/2 years ago he informed me that there was new research out that this drug could have an impact on some kind of electrolyte imbalances and the doctors were advised to ask patients to reduce as much as possible. I told him I would go back to my original dose (from 8X20 mg to 2x20mg) as I had been fine with that before. He agreed but did not want to change it in the computer until he would prescribe me a new set (I had so many of those, I did not want to throw them away). Every routine visit to the doctor I have asked him or his replacement to change the dose in the computer. Two weeks ago, after almost 2 years the old dose is still in the computer. What do I tell the insurance company? They say: talk to your doctor. I did.

This whole issue goes far beyond the fact that the insurance companies do whatever they want. And I assume that many people do not go against their family doctor because they are glad to have one (in our province it is impossible to change the doctor).


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## Beaver101 (Nov 14, 2011)

carverman said:


> Why didn't you get the surgery done here?


 ... I'm guessing 'cuz Mr. Kcowan can't wait for 6 to 12 months for the procedure? Our health care's waiting times for such critical procedures is ludicrous but then no surprise with the eHealth POS waste spectacle.


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## fatcat (Nov 11, 2009)

carverman said:


> Some of the fine print:
> 
> 
> 
> ...


anyone who has illness or chronic health problems will have had many, many conversations with his or her doctor/s ... many of my doctors are totally casual about what they say and what they write in their notes ... MANY doctors write things in their notes that they don't even tell their patients

the notion that any person who has significant medical issues will actually have a clear understanding of what advice or even what treatment they received is laughable ... doctors consultations and the record keeping (or lack thereof) that follows is often chaotic uneven and confusing, many patients just trust their doctors and often don't even know fully what they have or what they are being treated for

the policy you cite carverman is only one of dozens, all of which have different wording ... you can buy policies that cover pre-existing conditions but even that is problematic if you have a substantial medical history

consulting with the doctor before the trip is a very good idea and always trying to get home in any emergency is the best course of action


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## carverman (Nov 8, 2010)

PuckiTwo said:


> Easier said than done! This only works if your family doctor
> a) has your medical history up to date and
> b) he is willing to fill out the questionnaire.
> c) And even if he fills it out, it is you yourself who signs for what he filled out and will he stand up in court for what he filled out?
> ...


So my question then to everyone out there..why bother buying this Travel insurance if it won't help you in an emergency? Might as well get a CC with a large max ($25,000) and go on your trip
with that. Since the insurers will try to make you "self insured", might as well be self insured and avoid the hassles of months of fighting with them. That is what I will be doing if I ever
decide to go an visit my daughter in AZ. I do have a pre-existing conditiion, so I am sure as the day is long that they will renege on any claim I may have.

Going back to family doctors and the legality of it all..in 2002, when I retired from Nortel with my pre-existing condition (poly-myositis) which has now put me in a wheelchair, I had to fight
my ex in the courts over indefinite mionthly support payments. I asked my family doctor to write a letter to the court explaining my condition..which he did and charged me $100.
He told me at the time, that his responsibility ends with the letter, he would not go to court for me to testify on my behalf that I was already partially disabled at the time.

If you have a pre-existing condition, then more than likely you will not be able to collect on your claim, but this is only from the cases I've heard in the news so far.
Sad that's the way it seems to be going now.


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## kcowan (Jul 1, 2010)

carverman said:


> Why didn't you get the surgery done here?


They had that option. I didn't. They would pay for the airfare and then Canadian medicare would have covered the expense. They chose to pay $500 in local medical charges rather than $1200 in return airfare. I think they made the right decision.


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## carverman (Nov 8, 2010)

kcowan said:


> They had that option. I didn't. They would pay for the airfare and then Canadian medicare would have covered the expense. They chose to pay $500 in local medical charges rather than $1200 in return airfare. I think they made the right decision.


This is not explained very well...but if there was huge delays in the Ontario health care system and OHIP was willing to pay for the surgery elsewhere , then I can believe it..but this is
a lot different from the travel insurance scam discussed in this thread..where you have an medical emergency and the travel insurance company refused to pay after a claim is submitted.


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## kcowan (Jul 1, 2010)

carverman said:


> This is not explained very well...but if there was huge delays in the Ontario health care system and OHIP was willing to pay for the surgery elsewhere , then I can believe it..but this is
> a lot different from the travel insurance scam discussed in this thread..where you have an medical emergency and the travel insurance company refused to pay after a claim is submitted.


It was considered urgent but not emergency surgery. So the procedure was pre-approved. It is always a good idea to seek pre-approval if the timing allows it. This also involves an estimate from the caregiver of how much the likely cost will be.


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## fatcat (Nov 11, 2009)

stories like this litter the healthcare landscape in the usa:

http://sanfrancisco.cbslocal.com/20...hem-blue-cross-after-paying-100k-in-premiums/


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