Two insurance checks!

[cruisinjudy]

On Westerdam in September my husband saw the doctor several times for heart issues, about $1300 total. I discovered I had made an error when I bought the insurance and mistyped my husband's birth year, making him younger. I figured the insurance would not pay. When we got home I applied for reimbursement from our HMO and from Travelex, putting the other insurance down on both forms, figuring they could figure out who would pay. We received reimbursement in full from our HMO and heard nothing from Travelex. We cashed the HMO check. Then on Saturday a check arrived for full reimbursement from Travelex. My question: Who should we return the extra reimbursement to?

[peaches from georgia]

I think you would reimburse your HMO, as Travelex is primary insurance, meaning it pays first before your 'at-home' medical insurance.

I would read your Travelex policy before I did anything and if it does say that, I would ask my HMO insurance co. rep what the procedure would be to straighten this out.

[jhannah]

It would depend on what your policies say about coordination of benefits. I would guess there's nothing about that in the Travelex policy ... but there likely is with your HMO policy. I agree with Peaches ... check with your HMO.

[cruisinjudy]

Thank you. I just called my HMO and they said it would depend on which insurance I had first, which would be the HMO. So they said I should send the check back to Travelex! This is the first time we have made a claim, so I was surprised that we got a response from both. Now I know that our HMO covers all medical so I don't need to add to that section of travel insurance.

[mambopalace]

KEEP it !!

[RuffinReady]

My experience is that your health care provider is primary, and the travel insurance is secondary. I have Blue Cross/Blue Shield and ran up a few thousand dollars a couple of years ago. BC/BS paid the whole bill. I had called the travel insurance company and they said that they would pick up the remainder, which turned out to be unnecessary. This is why I don't feel that health care coverage is that important on cruises, if you have a good one. Evacuation coverage is VERY important however.


Ruffin

[Spender Nui]

Don't ask, don't tell.

[Stevesan]

Based on a couple of responses, I'm beginning to understand why health premiums are so high.

[kryos]

KEEP it !!
LOL ... that's exactly the advice I was gonna give her. She had two insurance policies? Why then, why not two checks?

I'd put the extra check toward my next cruise. :)

Blue skies ...

--rita

[kryos]

Based on a couple of responses, I'm beginning to understand why health premiums are so high.
She paid extra for the Travelex policy, didn't she?

She's not doing anything wrong if she would decide to keep the second check.

Personally, if it were me ... in this situation, I'd sure as hell keep it. If I got sick on a cruise and my medical provider paid some doctors' charges, and the travel insurance sent me a check as well ... to be honest, I'd keep it too.

It's not the same thing as, say, having your auto insurance pay some medical bills for an accident, while your medical provider paid them as well. That's different. That's two entirely different kinds of insurance ... you would probably be required to reimburse the healthcare provider since they would be entitled to ... I think it's called subrogation rights ... against the auto provider.

This case here would seem to be a situation where there was a special travel insurance policy that was taken out in addition to whatever regular healthcare coverage was already in force. I say since an extra premium was paid for the specific travel policy, that benefits check is "found money."

I'd keep it.

Blue skies ...

--rita

[mambopalace]

Health premiums are so high because of unscrupulous hospital fee schedules, and the system allowing for payment of services never received.
If you paid for the cruise insurance, then you are entitled to keep whatever they reimburse you for. Read some of the horror stories where cruise policies refused to pay for legitimate claims. The same thing applies to HMO's. Take the money - it's yours with absolutely no Guilt Trips.

[viennacruiser]

keeping the 2 checks would amount to insurance fraud and stealing...return one ..
insurance premiums are so high because malpractice premiums are high and getting higher, driven up by frivolous lawsuits

[mambopalace]

Not fraud after she advised her HMO that she has other coverage and they still sent her the amount. She didn't do anything wrong - there is no malpractice or frivolous lawsuit involved here - just a very honest person thinking they are doing the right thing. Do what your heart and mind tell you to do. I would guess no one on the cruise critic board should influence you in any way.:cool: keeping the 2 checks would amount to insurance fraud and stealing...return one ..
insurance premiums are so high because malpractice premiums are high and getting higher, driven up by frivolous lawsuits

[sail7seas]

She must have wished to be 'influenced' by CC posters or she would not have asked the question.


IMO, it is immoral to keep both checks. I would return the check sent by the HMO. She should, by all means, 'come out whole', but IMO should not be enriched by her husband having to make a claim.

JMHO......

[Krazy Kruizers]

Agree that cruisinjudy should not keep both checks - fraud. Besides calling her HMO, hope she also called Travelex and explained everything to them.

[boards]

I wonder what they will do and say when the insurance realizes the mistake and asks for the money to be returned. Will they readily returned? They seem to know its a mistake, so why not return it and sleep better. We had an situation kind of similar and returned the money.

[peaches from georgia]

LOL ....... She had two insurance policies? Why then, why not two checks?

I'd put the extra check toward my next cruise. :)

Blue skies ...

--rita

If accepting checks from several insurance companies for a single loss is no ethical problem, then why not go really big time. Why not book the Penthouse and then insure against cancellation with several 3rd party insurers. Make your final payment so you would have maybe $14-15,000 invested, but then cancel. I'm sure it wouldn't be hard to 'catch a virus' and get a letter from your doc that you were sick.

See the potential here? Collect from both (or even more???) insurance companies, reimbursing yourself for your initial expense of paying for the cruise with payment from company #1 and at the same time collecting a cool $14,000+ from the other(s) to put in your pocket. After all, you paid the premiums for each policy, so you deserve to collect from each company. Right?

Sound more like fraud when the $$$ are bigger? The principle is exactly the same as in Judy's dilemma. :o

[ewheelock]

Well said Peaches

[setsail]

It is against the law to collect(more than once) the full amount for one event from different insurance companys.

[iluvcruzin]

It is against the law to collect(more than once) the full amount for one event from different insurance companys.

which governing law? - I'm asking because this is a statement with no back up. - not because I'm disagreeing, just would like to see proof.

I would imagine in this day of age if there is co-insurance for claims, they eventually catch up with you by cross referencing ss# (which I know they aren't supposed to do but insurance companies still do it). Double-dipping is something that eventually catches up with you.

My only advise is do what your conscience says is right.

[jhannah]

A note of information, not determination. (I'm not a lawyer.) I have a copy of the Travelex Evidence of Coverage for Travel Plus and TraveLite plans. Under "Emergency Medical Benefits" there is NO mention of coverage under another policy. However, under "Medical Evacuation/Repatriation Benefits" there IS a clause stating "If benefits are payable under Medical Evacuation/Repatriation and you have other insurance that may provide benefits for this same loss, the company reserves the right to recover benefits from such other insurance." It seems strange that the same language does not appear under the other category in which crusinjudy's claim fell. So there is no issue here with Travelex that I can see. Subrogation only applies to money recovered under a judgement (lawsuit.) So now we're back to what language is contained in the HMO contract which would be under the heading "Coordination of Benefits" or something similar.

[kryos]

A note of information, not determination. (I'm not a lawyer.) I have a copy of the Travelex Evidence of Coverage for Travel Plus and TraveLite plans. Under "Emergency Medical Benefits" there is NO mention of coverage under another policy. However, under "Medical Evacuation/Repatriation Benefits" there IS a clause stating "If benefits are payable under Medical Evacuation/Repatriation and you have other insurance that may provide benefits for this same loss, the company reserves the right to recover benefits from such other insurance." It seems strange that the same language does not appear under the other category in which crusinjudy's claim fell. So there is no issue here with Travelex that I can see. Subrogation only applies to money recovered under a judgement (lawsuit.) So now we're back to what language is contained in the HMO contract which would be under the heading "Coordination of Benefits" or something similar.
There are medical policies that cover for lost wages. They make no distinction as to whether or not you're being paid by your employer. You collect from them regardless.

It is this exact thing I'm referring to with the medical policies. The travel insurance policy is a different animal from the HMO one. Those benefits could very well be in addition to any benefits she gets from her HMO.

I'm not advocating fraud here ... believe me, that's not my intent. I'm just saying that she may be PERMITTED to recover from both policies because they are entirely separate types of insurance.

Now, another poster mentioned insuring the cancellation of a suite with multiple insurance policies. That, in my opinion, would clearly be fraud ... because I am sure those policies each exclude benefits paid by another. In fact, she could very well wind up screwed under this arrangement because the coverages afforded by each could cancel out the other if she had multiple policies.

Taking out a policy with the intent to defraud is far different than simply taking the benefits afforded by the policy in the event of a legitimate loss.

Blue skies ...

--rita

[steveweese]

Party on the Veendam??????!!!!!!!!!!1

[JDee]

Just as a follow up to Jhannah's above post, went to Insuremytrip. The Travelex fine print on their policy states:

"Benefits will not be paid for expenses reimbursed or services provided by any other source. Benefits cannot be duplicate".


I also looked up the find print for Acess America, and they are: EMERGENCY MEDICAL AND DENTAL BENEFITS: Benefits may be coordinated with other excess coverage you may have and any benefits paid in excess of your actual loss may be recoved.

It would appear to me, that all insurance companies pretty much follow the general rule that they will not pay or reimburse for costs that have been paid by another source. The fact really is, the OP had no financial loss after receiving payment from the HMO. Sorry, but no duplicate payments allowed using either Travelex, Acess America and most probably every other insurance company doing busines.......

[cruisinjudy]

Actually my original question was simply who do I give the money back to? The answer from my HMo is that it depends on which I got first. I thought it was simple, and that the HMO came first so I send the money back to Travelex, and I was ready to do that, then it occurred to me that actually my husband just hit 65 this summer and his plan changed, so now I need to find out when his insurance date would be considered to have started.I think they are both July.

[Ziggy7]

Our friend who is an insurance agent says to check both insurance policies, if your health insurance is primary and your second policy (travel insurance) , it's likely your health insurance will not have stipulations on second and third policies, but your second and third may or may not have stipulations. According to him if your second and/or third policy dont stipulate these restrictions, the money will be paid by both and is yours to keep as you paid for the policies seperately, however if they have these stipulations and you keep the money, it then becomes insurance fraud. :)