Travelguard gold policy, misleading!

I took out travel insurance for our cruise in April. I bought Traveguard's gold policy because of its raving reviews on this site. There was a minor incident where my wife needed to see the ships Dr. during the cruise. The total bill for seeing the Dr. was approx $225. Upon arriving home and submitting the claim, Travelguard has denied the claim. Even though everything on their site I can find says they cover all medical incidents which occur during the trip up to $25,000. This was not a pre-existing condition.

What travelguard says is being we have medical insurance (blue cross) of our own, we need to submit to them first. If blue cross wont cover, they will. Here's the catch, blue cross says they will cover the claim even though it happened outside of the US. But obviously, the year's deductible on the medical plan is far from being reached. So the money paid to the ship's Dr, will go towards the years deductible, but nothing will be reimbursed.

Here's my beef. If everything Traveguard is telling me is correct, they need to re-work their website and stop misleading customers about how they cover medical claims. It even states they are the PRIMARY carrier when it comes to medical claims. Which means they pay first! Sorry, I'm frustrated about this whole mess. I know its only a couple of hundred bucks, but to me its more about purchasing something that only later turns out to be something else. I mean, medical issues are why a lot of people buy travel ins, in the first place. Anyone else run into this situation?

Well you know, we always get Travel guard and we also have Blue Cross Blue Shield. We will still buy Travelguard as that is not misleading. all insurance works that way, if you and your wife both have policies at your work, they do the same exact thing .Travelguard will pay the deductible out of pocket when you submit that to them after you go through your insurance.

Besides, $225 for the doctor when you have just spend $1000's on a vacation? My worry is something costing hundreds of thousands while out of the country which is why I buy Travelguard.

You are nitpicking and I believe if you read the site's fine print you will discover they do tell you.

That's the way Travel Guard Gold and other insurances work. It's perfectly reasonable. Your travel insurance is secondary to your primary health insurance.

Blue Cross technically covered it, but they did not reimburse you because it went toward the deductible.

You can submit to Travelguard now with the EOB from Blue Cross stating that it went to the deductible and Travelguard will now pay it. They just want to make sure you don't get paid from Blue Cross before they approve the payment from them.

My boss' son had an appendectomy in the Dominican Republic last year. Our company health insurance (Blue Cross) paid all but the $2000 deductible. He submitted a claim to his travel insurance company (I'm not sure who it was) and they paid him the $2000. So he was totally reimbursed between the two insurance companies.

Blue Cross technically covered it, but they did not reimburse you because it went toward the deductible.

 

You can submit to Travelguard now with the EOB from Blue Cross stating that it went to the deductible and Travelguard will now pay it. They just want to make sure you don't get paid from Blue Cross before they approve the payment from them.

 

My boss' son had an appendectomy in the Dominican Republic last year. Our company health insurance (Blue Cross) paid all but the $2000 deductible. He submitted a claim to his travel insurance company (I'm not sure who it was) and they paid him the $2000. So he was totally reimbursed between the two insurance companies.

Great post.

That is how it should work.

Whomever OP spoke with at Travelguard should have told him to resubmit after he finishes up with Blue Cross on this claim.

I went to Travel Guard's website and offhand I can't find where Travel Guard advertises that the coverage is primary.

If you read your policy, you'll see that Travel Guard policy states it is excess insurance (with one important exception...if you purchased the policy within 15 days of your initial trip payment), which means you have to attempt to collect first from any other insurance you may have. That also means that whatever covered expenses are not paid by your primary health insurance will be paid by Travel Guard.

When you get the explanation of benefits from your primary insurer showing everything was absorbed into the deductible you need to refile your claim with Travel Guard and you should then be reimbursed for your covered expenses.

Here's the exact wording of the applicable provision of the policy. Note the last sentence, which says the the coverage will become primary if you purchased the policy within 15 days of your initial trip payment.

EXCESS INSURANCE LIMITATION

The insurance provided by the Policy for all coverages except

Trip Cancellation, Trip Interruption and Car Rental Collision

Coverage shall be in excess of all other valid and collectible

insurance or indemnity. If at the time of the occurrence of any

Loss payable under the Policy there is other valid and collectible

insurance or indemnity in place, the Company shall be liable only

for the excess of the amount of Loss, over the amount of such

other insurance or indemnity and applicable deductible. Accident

Sickness Medical Expense will become Primary if the plan is

purchased within 15 days of Initial Trip Payment.

I have had 2 claims with Travel Guard, both paid whatever my primary insurance did not pay. Once it was because of the deductible needing to be met and once they paid the co-insurance which was 20%.

I was fully aware at the time of purchase that the Travel Guard policy was secondary. If I had wanted primary, I would have paid a bit more and selected a company that provided primary insurance.

Knowing there are many different policies out there by each provider, perhaps the OP doesn't have coverage but I sure would call Travel Guard and make sure. Posting here doesn't solve the problem.

OP needs to get in writing that his Blue Cross will not pay anything because of the deductible and then resubmit the claim.

I took out travel insurance for our cruise in April. I bought Traveguard's gold policy because of its raving reviews on this site. There was a minor incident where my wife needed to see the ships Dr. during the cruise. The total bill for seeing the Dr. was approx $225. Upon arriving home and submitting the claim, Travelguard has denied the claim. Even though everything on their site I can find says they cover all medical incidents which occur during the trip up to $25,000. This was not a pre-existing condition.

 

What travelguard says is being we have medical insurance (blue cross) of our own, we need to submit to them first. If blue cross wont cover, they will. Here's the catch, blue cross says they will cover the claim even though it happened outside of the US. But obviously, the year's deductible on the medical plan is far from being reached. So the money paid to the ship's Dr, will go towards the years deductible, but nothing will be reimbursed.

 

Here's my beef. If everything Traveguard is telling me is correct, they need to re-work their website and stop misleading customers about how they cover medical claims. It even states they are the PRIMARY carrier when it comes to medical claims. Which means they pay first! Sorry, I'm frustrated about this whole mess. I know its only a couple of hundred bucks, but to me its more about purchasing something that only later turns out to be something else. I mean, medical issues are why a lot of people buy travel ins, in the first place. Anyone else run into this situation?

That is how many travel insurance policies work. They are secondary. Insured submits claim first to primary insurer then when that is paid, credited or declined, the secondary then pays.

Did TravelGuard tell you that they wouldn't reimburse the deductible? That rep is not correct if that is what you were told.

After you have your insurance paper from Blue Cross showing that nothing was paid, just deductible credited, you submit that info to Travel Guard and you're then paid whatever you are out of pocket. In this case your deductible.

I'm confused too......I have always made sure I purchased a travel insurance policy that specified it was primary and not secondary and specifically paid for the higher policy that included that feature.

I was under the assumption (probably my own ignorance) that a primary travel policy would mean I would file any claim with them first. Am I wrong?

What am I missing?

I took out travel insurance for our cruise in April. I bought Traveguard's gold policy because of its raving reviews on this site.

Were those reviews from people who actually had to submit a claim?

I'm confused too......I have always made sure I purchased a travel insurance policy that specified it was primary and not secondary and specifically paid for the higher policy that included that feature.

 

I was under the assumption (probably my own ignorance) that a primary travel policy would mean I would file any claim with them first. Am I wrong?

If the travel insurance policy says it's primary for medical, then you can submit the claim to them and they will reimburse you, subject to any coverage rules, deductible, coinsurance, and/or maximum coverage, as applicable. You won't need to submit to your regular insurance first.

If the travel insurance policy says it's primary for medical, then you can submit the claim to them and they will reimburse you, subject to any deductible, coinsurance, and/or maximum coverage, as applicable. You won't need to submit to your regular insurance first.

That's why you buy the insurance within the 15 day period after you make your first payment for your vacation. If you buy after that, the insurance becomes secondary for reimbursements.

I always buy my insurance within that period. For me, it is worth the effort to do that so I don't have to hassle with both insurances in the event I need to use the insurance. It came in very handy when I had a serious accident in Italy. I had Travel Insured that time. They took care of everything - hospital bill (10,000EU), transportation from hospital to airport, change fees for my flights, translation services between hospital and the insurance and my home medical providers…

Were those reviews from people who actually had to submit a claim?

I wrote a rave review. I helped an older couple who are friends of ours. He had serious medical issues 2 weeks before their Alaska land/cruise vacation. Due to his surgery and recovery, they had little time to deal with insurance. I handled most of it for them. It was a very expensive claim and Travelguard was spectacular. When I offered to help - I expected that I would have to spend a ridiculous amount of time to get all the reimbursements. The rep was so helpful and paid the claim in just weeks. I would recommend them in an instant!!!

That's why you buy the insurance within the 15 day period after you make your first payment for your vacation. If you buy after that, the insurance becomes secondary for reimbursements.

Yes, but I see OP's point that it's not clear that you have to buy within 15 days for primary coverage. On insuremytrip, the TravelGuard gold policy simply lists Medical Coverage as $25k, with no asterisks or footnotes. You have to click on it to see that it's "Excess Coverage" unless purchased within 15 days.

Yes, but I see OP's point that it's not clear that you have to buy within 15 days for primary coverage. On insuremytrip, the TravelGuard gold policy simply lists Medical Coverage as $25k, with no asterisks or footnotes. You have to click on it to see that it's "Excess Coverage" unless purchased within 15 days.

The OP claims that the insurer's website (not insuremytrip's website) advertises the medical coverage as primary, and that claim appears to be untrue. As far as I can tell neither site advertises the coverage as primary. The OP apparently made an incorrect assumption...and to boot the OP clearly doesn't understand how the process works because he doesn't appear to understand that he will be reimbursed for the deductible once he submits the proper documentation of the claim falling within the primary insurance deductible.

When you purchase trip cancellation insurance you're afforded a free look period, usually about 10 days to 2 weeks that allows you to read the policy provisions in detail. If you're not satisfied you can cancel the policy and receive a refund.

From Travelguard's website: And yes, the policy was purchased within 15 days of the trip payment

$25,000 Accident Sickness Medical Expense

Pays for medical expenses incurred while on a trip

Medical Expense (Primary)

From Travelguard's website: And yes, the policy was purchased within 15 days of the trip payment

 

$25,000 Accident Sickness Medical Expense

Pays for medical expenses incurred while on a trip

Medical Expense (Primary)

I'm glad you came back to further respond. Please let us know if you will resubmit the claim with proof that Blue Cross did not pay, and how that eventually turns out.

And at the risk of being redundant to the other responses, it is not misleading for Travelguard to use the word "primary". They will function as primary insurance IF you do not already have one. But since you do, you must submit the claim to that insurer first, and Travelguard will pay whatever amount they do not. You won't find them explaining that to you because...well, that just how the insurance industry works. Way back in my (first) college years I had a Finance professor who would respond to a question he felt the student should already know with "that is intuitively obvious". I guess that's how the insurance industry feels about the only-one-primary-policy concept.

But if heaven forbid you needed to use the medical evacuation coverage, I am fairly certain Travelguard would pay first.

OP needs to get in writing that his Blue Cross will not pay anything because of the deductible and then resubmit the claim.

A copy of the Blue Cross Blue Shield EOB will be sufficient to submit to Travel Guard.

That's why you buy the insurance within the 15 day period after you make your first payment for your vacation. If you buy after that, the insurance becomes secondary for reimbursements.

 

I always buy my insurance within that period. For me, it is worth the effort to do that so I don't have to hassle with both insurances in the event I need to use the insurance. It came in very handy when I had a serious accident in Italy. I had Travel Insured that time. They took care of everything - hospital bill (10,000EU), transportation from hospital to airport, change fees for my flights, translation services between hospital and the insurance and my home medical providers…

Also make sure about that 15 day period...I believe if you have used a Next Cruise Certificate it could affect that timing or so I've read with certain policies...something some might not realize.

Below is from a site that reviews travel insurance companies

http://www.travelinsurancereview.net/tips-and-advice/understanding-travel-insurance/primary-vs-secondary/

What is Primary vs. Secondary Medical Coverage?

Travel insurance plans offer primary travel medical coverage or secondary medical coverage, so what does that mean exactly?

"Primary medical coverage pays first regardless of any other insurance coverage you may have".

Secondary medical coverage starts paying after any other insurance coverage has paid whatever it will pay. This means that secondary medical coverage will pay the deductibles, co-pays, and additional out-of-pocket expenses up to the policy limit.

Primary medical coverage pays first regardless of any other insurance coverage you may have.

Primary coverage can make payment easier

For example, with some plans, the company will arrange for advance payment if necessary for the insured to gain admission to a hospital.

These following are primary coverage plans that will arrange for advance payment:

The Allianz Deluxe plan

The following plans from Travel Guard:

Platinum (Cruise, Tour & Travel)

Gold

This tells me I'm not over reacting, or expecting too much from Travelguard. The coverage is listed as primary on their site. According to the info above, the primary coverage should cover regardless of other insurance. I'm not trying to stack or collect payment from both blue cross and TG. Thanks to our lovely politicians the deductible on our blue cross coverage went from a $1500 deductible to $6250 yearly deductible.

From Travelguard's website: And yes, the policy was purchased within 15 days of the trip payment

 

$25,000 Accident Sickness Medical Expense

Pays for medical expenses incurred while on a trip

Medical Expense (Primary)

Then you need to bring those facts to the attention of a supervisor at Travel Guard. Mistakes are sometimes made by claims adjusters.

And by the way, the site you gave that reviews trip insurance isn't an official source...you can't rely on what they say...and they're wrong about the Gold policy, because that's only primary if the policy is bought within 15 days of your initial trip payment. What is official is the language of your policy that I quoted in an earlier post.

You don't say where you live. All of Travel guards policies are sometimes specific to the State you live in(Primary residence as you indicated at the time you bought the policy). So the general rule of Travel guard may or may not apply to you. If after you have appealed to Travel guard to review your claim as primary they still deny you, file a complaint with whomever supervises insurance companies in your state.

Also make sure about that 15 day period...I believe if you have used a Next Cruise Certificate it could affect that timing or so I've read with certain policies...something some might not realize.

Generally speaking it does effect the time. When I inquired the insurance company told me that in order to have pre-existing conditions waived that the policy would have to be purchased within 15 days from actually purchasing the Next Cruise Certificate. Reason being that insurance company still considered the Next Cruise Certificate as having purchased a cruise. This is the reason I do not purchase the certificates. I either actually book on board or forego purchasing a Next Cruise Certificate.

You don't say where you live. All of Travel guards policies are sometimes specific to the State you live in(Primary residence as you indicated at the time you bought the policy). So the general rule of Travel guard may or may not apply to you. If after you have appealed to Travel guard to review your claim as primary they still deny you, file a complaint with whomever supervises insurance companies in your state.

This! I don't think OP that you understand how medical insurance works when you are covered by two policies.

This is not a major issue. As you've already been told, either a mistake was made by the TG, in which case you can appeal, or you simply need to submit your claim first to your regular medical insurance, and then forward that denial to TG, who will then pay whatever they allow for these charges.

I have filed several success claims with TG with no problem.