Travel Insurance/On board Medical Center

On my last cruise I got a sinus infection and had to go to the Medical Center on board. It ending up costing me $585.00 Yikes! I was wondering if I had purchased travel insurance would it have been covered or does it just depend on the coverage you buy?

As with any insurance, you need to make sure that you understand the terms off the specific policy you purchase.

For example, if you do not get insurance that waives the exclusion for pre-existing conditions, then the coverage for what was charged in the medical center or *any* medical facility would depend upon whether the malady was related to a pre-existing condition or not.

On my last cruise I got a sinus infection and had to go to the Medical Center on board. It ending up costing me $585.00 Yikes! I was wondering if I had purchased travel insurance would it have been covered or does it just depend on the coverage you buy?

All charges in Medical centers are charged to your onboard account. They will give you a receipt for submission to your insurance carrier.

On my last cruise I got a sinus infection and had to go to the Medical Center on board. It ending up costing me $585.00 Yikes! I was wondering if I had purchased travel insurance would it have been covered or does it just depend on the coverage you buy?

With any travel insurance, it's reimbursement only.

You pay the bill, then file a claim when you get home.

Yes 15 thousand dollars now I am waiting to see if my AE travel insurance will reimburse me. You pay up front on ships and they do not use our insurance medical codes. Pattie

Let us know how it works out.

The simple answer for the OP is "Yes."

Unfortunately insurance is not simple. A comprehensive travel policy will cover medical and cancellation along with other travel related expenses. The medical portion is usually secondary to your personal coverage, but you can get primary. In either case, you still have to pay the bill and submit the claim for reimbursment. For secondary coverage, that means filing with your regular health plan first and then the travel insurance. It doesn't work the way it does at home where you just show the card, and they do the billing even if you buy the cruise line's insurance and are being treated in the ship's facility.

So - for the OP's specific question, yes it would have reimbursed you (I don't think a sinus infection is a pre-existing condition even if you've had one before.)

Have you submitted a claim to your existing personal health insurance? They should still cover you unless you have Medicare without any kind of supplemental coverage.

The simple answer for the OP is "Yes."

 

Unfortunately insurance is not simple. A comprehensive travel policy will cover medical and cancellation along with other travel related expenses. The medical portion is usually secondary to your personal coverage, but you can get primary. In either case, you still have to pay the bill and submit the claim for reimbursment. For secondary coverage, that means filing with your regular health plan first and then the travel insurance. It doesn't work the way it does at home where you just show the card, and they do the billing even if you buy the cruise line's insurance and are being treated in the ship's facility.

 

So - for the OP's specific question, yes it would have reimbursed you (I don't think a sinus infection is a pre-existing condition even if you've had one before.)

 

Have you submitted a claim to your existing personal health insurance? They should still cover you unless you have Medicare without any kind of supplemental coverage.

I just wanted to clarify something I had posted in another thread. Even if you pay for a Primary plan, when you complete the claims, if you check the box asking if you have other health coverage, the "Primary" insurance purchase is then processed as secondary. GeezerCouple should remember that, because she checked the website after I posted that info.

I just wanted to clarify something I had posted in another thread. Even if you pay for a Primary plan, when you complete the claims, if you check the box asking if you have other health coverage, the "Primary" insurance purchase is then processed as secondary. GeezerCouple should remember that, because she checked the website after I posted that info.

As I posted elsewhere (don't remember which post or which thread), Steve at http://www.TripInsuranceStore.com has checked, and at least one/some of the travel insurers are changing the wording to something like "do you have any other insurance that would cover this" - that is NOT an accurate quote.

The point is that you can declare other medical insurance (if asked, you must do so honestly, etc.), but don't need to file a claim and wait for a denial...

Similarly, one wouldn't have to file with another insurer IF one had the primary travel insurance, even if the "other" insurer would have paid.

[NOTE: Steve has written about one quirk with one's regular insurance such that it is apparently *not* necessarily beneficial to have primary travel insurance. (It wasn't a situation that applied to us, and I don't remember thee details. It might be on his website...?]

My GUESS (that's ALL it is) is that the travel insurance might make a quick check with the other insurer (they'd certainly have the right to do so), to double check that there wasn't any double dipping...

And if someone tried to do that (double dipping), it would be insurance fraud in this situation.

I don't know if any of the policies have that new kind of wording or if it is a definite plan.

But at least they are aware of the problem, which is encouraging.

As I posted elsewhere (don't remember which post or which thread), Steve at http://www.TripInsuranceStore.com has checked, and at least one/some of the travel insurers are changing the wording to something like "do you have any other insurance that would cover this" - that is NOT an accurate quote.

 

The point is that you can declare other medical insurance (if asked, you must do so honestly, etc.), but don't need to file a claim and wait for a denial...

Similarly, one wouldn't have to file with another insurer IF one had the primary travel insurance, even if the "other" insurer would have paid.

 

The most likely reason for that type of question on a claim form is probably convenience. For example, a company like Travel Guard might have 50 different plans out there (if you count the various state-specific versions of those plans). Some of these might be primary, some secondary, and others secondary with an option to upgrade to primary for an additional premium. One plan might be primary in Missouri but secondary everywhere else.

Travel Guard might figure (as I would) why have different claims dorms for all of the different options? Why not have just one form and include that question? If that information isn't necessary -- for example if the policy is truly primary -- no harm done. Plus, if there's only one form there's zero (hopefully) chance of the client being mailed the wrong form and having the claims process delayed or having to start over.

As I posted elsewhere (don't remember which post or which thread), Steve at http://www.TripInsuranceStore.com has checked, and at least one/some of the travel insurers are changing the wording to something like "do you have any other insurance that would cover this" - that is NOT an accurate quote.

 

The point is that you can declare other medical insurance (if asked, you must do so honestly, etc.), but don't need to file a claim and wait for a denial...

Similarly, one wouldn't have to file with another insurer IF one had the primary travel insurance, even if the "other" insurer would have paid.

 

[NOTE: Steve has written about one quirk with one's regular insurance such that it is apparently *not* necessarily beneficial to have primary travel insurance. (It wasn't a situation that applied to us, and I don't remember thee details. It might be on his website...?]

 

My GUESS (that's ALL it is) is that the travel insurance might make a quick check with the other insurer (they'd certainly have the right to do so), to double check that there wasn't any double dipping...

And if someone tried to do that (double dipping), it would be insurance fraud in this situation.

 

I don't know if any of the policies have that new kind of wording or if it is a definite plan.

But at least they are aware of the problem, which is encouraging.

Hi Geezer Couple - Thank you for following up on Primary policies. Could you please start a thread on this (Primary Policies) so that people can purchase insurance fully informed. I have learned a lot on this forum and talking to Steve; but I am not as knowledgeable as you and others are and wouldn't be able to defend myself when being "flamed." :D

I think I found the relevant wording from the Trip Insurance Store web site:

Primary (aka “First Payer”) Medical Coverage means your medical bills are paid from the first dollar. No “coordination of benefit” claim forms need to be filed. You need to know that many travel insurance plans with primary (aka “First Payer”) medical benefits will still ask on the claim forms if you have other medical insurance. If you answer “yes”, they will likely submit your claim to your other insurance first and process your claim as Secondary coverage. All our companies say the answer should be “no” if they want it processed as primary.

How exactly would they do that? Process your claim as secondary? All that means is that they are going to sit on your claim until you submit documentation that you filed a claim with your regular health insurance provider, the clam was denied or paid less a deductible or co-payment and now they are ready to proceed. So they are willy-nilly changing your policy from primary to secondary and forcing you to file first with your regular insurer? I don't think I would agree to that -- what my advantage? None.The law doesn't allow that without YOUR consent. If you want to do all of the paperwork twice that's fine but it has to be YOUR decision -- the insurer can't make that decision for you just because you checked some box. And they can't submit a claim in your name to Blue Cross or whatever to try to speed up the process. Only you can make a claim against that policy. Just marking a "yes" box does not transfer any of your legal rights to a third-party to deal with your regular health insurance provider. If a travel insurer truly is doing this (and I doubt it) they are breaking the law.

There are a few situations where it is indeed favorable to second your normally "primary" insurance claim to your regular health insurance provider. But that's your decision to make, not the travel insurer. And if you decide that that's the best way to go you have to file first with your regular insurer then with your travel insurer. Your primary travel insurer isn't going to do it for you.

One example why this is a bad idea.

Client A books a cruise. His regular health insurer through work has a lifetime limit for claims so he specifically picks out an insurance plan that's a primary payer with a high limit.

Unfortunately he has a heart attack n the cruise and by the time everything is added up it's $50,000 of medical/hospital bills. But that's OK because the travel insurer will deal with it and that cost won't go against his lifetime limit on his health insurance through work.

When submitting the claim form he truthfully. marks "yes" when asked if he has other health insurer.

The claims manager sees the claim come through and thinks "I really don't want to send out $50K. There goes my bonus. But wait, I see he marked "yes" when asked if he has other insurance. Let's process this claim as "secondary", dump the $50K cost on Blue Cross or whoever provides his insurance through work. Problem solved!"

When Client A sees that the $50K now counts against his lifetime limit he's pissed. This is not what he thought he was getting when he bought the primary-coverage policy. Now he has a big problem that he's going to make someone else's problem. Does he call a lawyer first or does he call his state's department of insurance first. Either way, the travel insurer is in trouble for trying to wriggle out of it's primary coverage responsibilities just because the client indicated that he has other health insurance. .

One example why this is a bad idea.

 

Client A books a cruise. His regular health insurer through work has a lifetime limit for claims so he specifically picks out an insurance plan that's a primary payer with a high limit.

 

Unfortunately he has a heart attack n the cruise and by the time everything is added up it's $50,000 of medical/hospital bills. But that's OK because the travel insurer will deal with it and that cost won't go against his lifetime limit on his health insurance through work.

 

When submitting the claim form he truthfully. marks "yes" when asked if he has other health insurer.

 

The claims manager sees the claim come through and thinks "I really don't want to send out $50K. There goes my bonus. But wait, I see he marked "yes" when asked if he has other insurance. Let's process this claim as "secondary", dump the $50K cost on Blue Cross or whoever provides his insurance through work. Problem solved!"

 

When Client A sees that the $50K now counts against his lifetime limit he's pissed. This is not what he thought he was getting when he bought the primary-coverage policy. Now he has a big problem that he's going to make someone else's problem. Does he call a lawyer first or does he call his state's department of insurance first. Either way, the travel insurer is in trouble for trying to wriggle out of it's primary coverage responsibilities just because the client indicated that he has other health insurance. .

That is such an excellent explanation! That's why I asked Geezer Couple to start a thread on Primary Policies. So many people are not aware of this, and I'm not fully knowledgable to answer questions from aggressive postings.

Thank you.

I think The Affordable Care Act prohibits lifetime limits on health benefits.

Your example would have made sense at one time, but it isn't applicable now.

I think The Affordable Healthcare Act prohibits lifetime limits on health benefits.

 

Your example would have made sense at one time, but it isn't applicable now.

From the healthcare.gov web site

"Insurance companies can still put yearly or lifetime dollar limits on spending for health care services that aren't considered essential health benefits."

Yep, I guess a heart attack was a bad example. I imagine that would be considered an "essential health benefit". I probably should have used a YEARLY medical benefit as the example since many plans with that feature (?) were grandfathered in. There's many people that still need to worry about exceeding their yearly max benefit.

From the healthcare.gov site: "Protections against annual limits apply to most health plans, but they don’t apply to grandfathered individual health plans. Check your plan’s materials to find out if your health plan is grandfathered."

Thanks for the clarification. I wasn't aware of the grandfathered individual plans.

Does that mean someone who is not covered by a group plan at work? Why would someone want to keep a plan that doen't offer protection against limits for essential care? Does it offer better benefits in other ways? Is it less expensive?

Seems like some of those "Cadillac" plans might still be available for renewal but I'm not sure -- I've always had the Yugo plans. Remember "if you like your plan you can keep your plan"? And of course many folks simply renew their plan without checking other options.

Doesn't sound like a "Cadillac" plan if it imposes yearly limits on benefits. I was thinking "grandfathered in" meant granting special status in order to preserve someting good. Maybe not.

The last time I looked at a Medicare supplement plan, I think I saw a $50,000 lifetime limit on emergency care for foreign travel. In that case, it might make sense to have a primary travel policy because Medicare won't pay even if the supplement does.