Berkeley Unreasonable Document Requirment

Anyone have suggestions as to how I might approach the following? Had a similar bad experience? I normally forego trip insurance, however we planned a Christmas sailing and booked a Grand Suite so I made an exception this one time due to the high cost of our cabin ($6,500). The Carnival website touted the virtues of purchasing travel insurance, and the $500 non-refundable cost seemed to be a reasonable hedge in the unlikely event of need for cancellation. Four days prior to our scheduled embarkation the unlikely occurred: my elderly father required high risk emergency life/death surgery. I immediately contacted Carnival, explained the circumstances and expressed the desire to change my sail date to March. I was willing to make an even swap even though the March Sailing was priced $1,300 less than the Christmas cruise I had booked. Carnival refused, and told me that I would have to contact Berkeley and file a claim. I was provided a claim form and since the claim was based upon medical emergency page five of the form was emphasized by the Berkeley agent. Page five requires description of the patient's condition, physician contact information, and most critically it requires that the patient sign their agreement to release ALL of their medical history to Berkeley insurance. My father was not part of those planning to cruise with Carnival nor was he a party to the cruise insurance contract with Berkeley, however as a "direct family member" his medical emergency was clearly a contingency covered by the insurance contract. I could not compel my father to release his lifelong medical records, I share his concerns about how such private information might be abused, and see no reason that Berkeley would require such documentation. When my father declined to agree to provide Berkeley unfettered access to his medical records, Berkeley refused to honor their contractual obligation to refund the cost of my cruise. At least Carnival has agreed to apply 75% of the value of my cruise to a future sailing (thank you Carnival), however I paid to insure 100% of my cruise and this still leaves me out over $1,500 plus the nearly $500 I paid to Berkeley.

If I am reading this correctly you want reimbursement from Berkeley due to dad's illness but are unable to provide Berkeley with any medical documentation of his illness. Is this correct?

Berkeley was provided with a description of my father's medical condition (aggressive colon cancer) as well as with contact information for my fathers physician. Berkeley made no use of this information. Documentation specific to my fathers current medical emergency would not satisfy Berkeley. Berkeley demanded authorization for unlimited access to my father's entire 77 year medical history. My father deemed that to be intrusive and unreasonable. I agree, others may not.

Berkeley was provided with a description of my father's medical condition (aggressive colon cancer) as well as with contact information for my fathers physician. Berkeley made no use of this information. Documentation specific to my fathers current medical emergency would not satisfy Berkeley. Berkeley demanded authorization for unlimited access to my father's entire 77 year medical history. My father deemed that to be intrusive and unreasonable. I agree, others may not.

I understand your concern (and your father's) about releasing *all* medical information, especially in this day and age. (As an aside, I fear that in the future, there won't be much privacy of any sort at all. But I digress...:( )

However, it isn't clear what permissions were given here.

For one thing, although it might not help in principle, in reality, I doubt that anyone at any insurer really wants to go back decades, especially if there is NOT any pre-existing condition exclusion. (Was there, for a "non-traveling family member"?)

Here is one possible problem: If your father didn't want to give permission to review his entire medical record, was there ANY signed permission actually given?

If not, with current HIPAA laws/regs, his physician really cannot give ANY information to the insurer.

Just giving the physician's name/contact info without a signed release form they can send won't allow the physician to respond in a meaningful way.

Is it possible to ask Berkeley (we've have zero experience with them) if it would suffice for them to get unlimited records about this immediate medical condition/crisis and any surgical report, etc.?

In some cases, there are medical information forms that allow a specified time period, such as "within the past 12 months" or such.

Would that provide the information that Berkeley needs?

(They have a right to be sure that nothing material is being withheld.)

You need to understand that they do have the right to determine that there was *really* a legitimate medical emergency, and it's not situation where someone changed their mind and is trying to use a (fake) medical emergency to get a refund.

Unfortunately, because there are a few bad apples around who do try this type of thing, everyone has to be careful to get full documentation, etc...

Is there someone at Berkeley you can speak with?

I'd suggest trying calmly (hard though it might be) to find out if there is anything less than 77 years of medical history that would suit their needs for determining if the claim is valid.

Whether their bureaucracy allows for anything less than "lifelong records" is another thing. Try to find out WHAT exactly their concern is, what they truly need to determine the validity of the claim.

A "description of a medical condition" is not adequate.

Keep in mind that IF "pre-existing conditions" in the non-traveling family member would be excluded, with a diagnosis like this, chances are slim that there would be coverage. Might that be the underlying problem?

Good luck.

GeezerCouple

I don't think it's a matter of what information Berkeley need, Geezer. I think it's a matter that Berkeley don't want to pay up so are putting unreasonable conditions in the way.

I don't think it's a matter of what information Berkeley need, Geezer. I think it's a matter that Berkeley don't want to pay up so are putting unreasonable conditions in the way.

I understand and agree that it is certainly possible that Berkeley is stalling... or worse. That's apparently the name of the game for some insurers.

But just in case it is not, then it could be that some modicum of official medical records would be sufficient.

I'm thinking back to DH's claim from a last minute medical emergency cancellation about a year ago. I'm not sure if DH's medical permission was for "anything, ever" or at all restricted (perhaps to the specific physician?).

But I'm also CERTAIN that all that was actually required were copies of the medical records (signed by physician, etc.) for the immediate events.

We know this, because WE submitted the signed forms from the physician (the forms from the insurer, completed by the physician), and we know from the physician that the insurer did not request any additional medical records.

Now... we had coverage that waived the pre-existing conditions exclusion, so the insurer did NOT need to ferret back in any attempt to find any previous possibly linked health condition as a grounds to deny coverage.

Without that waiver, maybe it would have been very, very different.

I have no doubt that there are, um, less reputable insurers.

It's a reason we've never tried to find the "cheapest" insurance - for any type of coverage. There's no point to having insurance if there's going to be a problem collecting when and if it is actually needed.

GeezerCouple

Just to make 1 portion clear.

Carnival is NOT offering to give you a 75% future cruise credit because they are being nice guys.

Under the terms and conditions of the insurance you purchased from Carnival, the policy has a "Cancel For Any Reason" rider built into the policy. Carnival is allowing you the opportunity to option the CFAR rider which will then provide you with a 75% future cruise credit.

However, here's my confusion. I don't think you can do both.

I don't think you can option the CFAR and also claim for 100% reimbursement for trip cancellation.

Maybe someone here can clarify.

Despite having his physician's contact information, that information is utterly useless to the insurance company without a medical records release, as it would be quite illegal for the doctor to discuss your father's illness with the insurance company without that release.

Understandably, the insurance company is not going to take your word for it when you describe his medical problem that caused you to cancel. It's correct that your father is not a party to the insurance contract, but that does not mean that it's unreasonable for the insurance company to not pay without a means of verifying the medical condition.

The reason the request is so broad is because the insurance company is not going to know precisely what is going to be required until it receives the first batch of records. A broad release means they don't have to keep going back to you for more releases. (Which would instead prompt complaints about repeated requests for paperwork, stretching out the claims process.) They are trying to save both you and them time and effort.

Perhaps you could discuss the issue with Berkeley. Perhaps they could send a specific records request to you (the claimant) who can relay it to your father, who in turn relays it to his doctor for fulfillment. It makes sense for Berkeley to try and cut out the middle-man (it's certainly going to take longer this way), but maybe you can work something out.

As a warning, as a policy without a pre-ex waiver, the request is going to be broad. At the least, they are probably going to need the entire history of the cancer... they need to find out when it was discovered, when symptoms manifested themselves, and if the cancer was known prior to booking, the timing of the prognosis.

And klfrodo is right; if you've already claimed the 75% credit, you cannot also collect a refund. I actually have no idea if there's any mechanism to return the credit, should your refund claim be approved.

Billy - this is just the way it is. You want to file a claim, you have to provide the information. And, as already stated, you can't double dip; you won't get all your money back and a cruise credit.

I am not sure why your dad objects to providing this information. What difference does it make? If he has medical coverage, many people have access to this information now anyway. What does he think This company is going to do with it? The insurance company will not go through 77 years of his records; they wouldn't be available anyway.

Is there anyone left who really believes any of our records are truly private anymore? Medical records inaccessible? Highly doubtful.

I understand your Dad's reluctance and given his age, he might be among the seniors (I am senior so don't get upset with me) who are very uncomfortable in this information age and think they really can keep some privacy in their lives. They can't.... sadly.

I'm sure your Dad doesn't want you to be unable to collect on insurance claim made so you could be present when he needed you with him. Have a sensible, calm chat with him and see if he can rethink his position. He has far more profound things to be bothered with right now than privacy.

I hope his surgery was successful and provides him with many more years of happiness and health.