Travel Insurance Claims

[Jessejo]

DH and I recently returned from a cruise on Navigator of the Seas out of Galveston, TX. The cruise was Sunday to Sunday. On Friday, just before dinner and just after leaving Cozumel, DH complained of pain in his abdomen. We went back to our cabin and he went to bed. He refused to see the ship's doctor. He stayed in bed all day Saturday. We got off the ship on Sunday morning. He refused to see a doctor in Galveston, or in Beaumont on our way home to Tyler, TX - he just wanted to get home to his own bed. I didn't take him home - I took him directly to the ER where he was diagnosed with a severely diseased gall bladder. He was taken into surgery at 11:30 PM where his gall bladder was removed. He was admitted into the hospital where he stayed until Wednesday. He checked his weight on Thursday and had lost 6 pounds from his pre-cruise weight. He weighed himself again on Friday and had gained 12 pounds. I took him back to the ER where he was diagnosed with congestive heart failure and again admitted to the hospital. On Tuesday he was implanted with 2 stents and on Thursday he had an ablation. He was sent home on Friday with 7 new medications and a fibrillation vest. Now for my question... I wonder if I've read the travel insurance documents right and we have a claim for costs not covered by Medicare??? As I understand the travel insurance policy they will pay for hospitalization until we reach home after the cruise. He had no previous history of gall bladder or heart problems. I would appreciate your input. Thank you.

[NorbertsNiece]

Without seeing the documents concerned I wouldn't be able to comment. I do however wish your DH a good recovery from what must have been a very stressful and difficult time

[Jessejo]

Without seeing the documents concerned I wouldn't be able to comment. I do however wish your DH a good recovery from what must have been a very stressful and difficult time

 

Thanks for your input. I'm basically wondering if anyone has made a claim and received payment. The policy is the basic policy offered by our TA.

[megr1125]

That's a question for your insurance company honestly. I would open a claim, get the necessary forms, see what info is needed from the doctor for the claim, file it and see what they say. They may reject it the first time, in which case you can probably submit it again.

 

Worst they can do is say no. You've really got nothing to lose....they may say wait to see what your own insurance covers first.

 

I have made several claims and received payment, but NOT for a situation like yours....again, I'm using deductive reasoning only, based on the info you provided....and not knowing the details of the policy, no one will have the exact answer other than the insurance company...

 

Speedy recovery to your husband as well...been there done that with the gall bladder, but the docs have not removed mine......

[reallyitsmema]

Thanks for your input. I'm basically wondering if anyone has made a claim and received payment. The policy is the basic policy offered by our TA.

You are going to have to call the insurance company and open a claim. All insurances are different. If the TA is only selling Cruise Care through the cruise line, you can find the information on the cruiseline's website. If they are selling an independent companies policy, you need to find out who the company is and contact them.

 

Good luck. I am in the process of possibly cancelling an upcoming cruise and Berkley has been very helpful (they are Cruise Care).

[beshears]

I hope you find the answer you want. I always take out cruise insurance when cruising and flying, and it has come in handy on more than one occassion.

 

My last time, I had to do a LOT of proving why I wanted to be reinbursed back. I wound up in the hospital before we were to leave, and I was under doctors care that I could not do anything for a month, and naturally, that was during the time we were to cruise. To make the long story short, I had Travel Guard, and I had to send them around 10 - 15 papers as proof of me being in the hospital, and seeing the doctor/s, etc. They finally came through, but I was ready to give up. :( It seemed like so much RED TAPE to go through as proof that I was in the hospital and could not travel until my doctor released me.

[Marie51]

I hope everything works out for you. Contact the insurance company to see if a claim is in order.

 

However if you only purchased insurance for the cruise itself then the cost of his treatment may not be covered since you were off the ship when he finally saw a doctor and you have no documentation that he was ill on the ship.

 

For this reason I always buy insurance to include the entire trip period, not just the cruise itself.

[njmomof2]

I don't know about the basic cruise line policy, but private policies have a start and end date for your travel, so anything that happens within that time frame may be covered. I don't know if the cruise line insurance covers you while traveling to and from the ship, which you were doing on the way home.

 

You'll need to contact the insurance company and see what they say.

 

Speedy recovery to your DH.

[Ken076]

What specific insurer/policy do you have?

 

I suspect you're going to find that your Travel Insurance expired when you returned home from the cruise and before any medical treatment.

 

Had DH had gone to the ship infirmary your expenses probably would have been covered, and most policies provide continuing coverage for 6 months or a year after your return home.

 

Having said all that, aren't most all of these expenses, all at home, covered by Medicare, after satisfying the initial deductible?

 

ken

[Jessejo]

Thanks all. I, too, have had to cancel cruises and had little trouble being reimbursed by travel insurance. Different circumstances though - once was when my BIL died 4 days before our cruise. The second was when my late husband was diagnosed with kidney cancer and scheduled for surgery. Never go without travel insurance!!!

 

I will contact the insurance company. No, we don't have proof that he was sick on the ship except that the room steward knew he was in bed all day Saturday because of his pain. I understand that the insurance covers from the time you purchase it until you return...

 

I'm sure it will take a lot of time to get paperwork and I'll have to wait awhile for that.

Edited April 23, 2014 by Jessejo

[SeaPete]

My SIL passed 5 days before our cruise last week and we had to cancel. The insurance company is requesting with the paper work a copy of the death certificate. Does anyone know if this is a normal request? I hate bothering family with this at this time.

[Guest maddycat]

My SIL passed 5 days before our cruise last week and we had to cancel. The insurance company is requesting with the paper work a copy of the death certificate. Does anyone know if this is a normal request? I hate bothering family with this at this time.

 

That sounds like a reasonable request to me.

[Guest maddycat]

Thanks for your input. I'm basically wondering if anyone has made a claim and received payment. The policy is the basic policy offered by our TA.

 

Your TA should be helping you with the insurance. After all, you did purchase it through him.

[Merion_Mom]

My SIL passed 5 days before our cruise last week and we had to cancel. The insurance company is requesting with the paper work a copy of the death certificate. Does anyone know if this is a normal request? I hate bothering family with this at this time.

 

Absolutely standard.

[Jessejo]

My SIL passed 5 days before our cruise last week and we had to cancel. The insurance company is requesting with the paper work a copy of the death certificate. Does anyone know if this is a normal request? I hate bothering family with this at this time.

 

I sent one in with my request, along with a copy of the obit, and receipts for our airfare to attend the funeral.

[papaflamingo]

My SIL passed 5 days before our cruise last week and we had to cancel. The insurance company is requesting with the paper work a copy of the death certificate. Does anyone know if this is a normal request? I hate bothering family with this at this time.

 

Yes. It is a condition of the policy. I had to cancel a cruise when my mother passed away a few years ago and the insurance company was very respectful and helpful (as was my TA). But anytime a death is involved with a cancellation, etc. you need a death certificate. Otherwise people would take advantage of the situation and simply "claim" a death to get out of something.

 

As for the OP, if you went home after the cruise, it's unlikely that the insurance will kick in, depending of course on the policy. My wife fell on the ship and dislocated her collarbone. There was no associated costs on the cruise as the ships doctor treated her for no charge. But when we got home she has been seeing an Orthopedic Surgeon and undergoing physical therapy. This is covered by our regular insurance. The Travel insurance only covers costs incurred while on the cruise. I suspect you'll find the same issue.

I wish your husband a speedy recovery.

[Ken076]

jessejo -

 

It's difficult to help not knowing the specific insurer/policy.

 

A few policies cover only emergency treatrment during the cruise - others provide continuing coverage of a medical event on the cruise for 6 months to a year following. Not getting treatment on the ship (and therefore medically documenting the condition) may have hurt your case.

 

It sounds that you took DH to the ER in your hometown before specifically returning to your house - depending on the wording in your Policy, this might help if your coverage is "door to door" and this may be where you have to concentrate your claim efforts.

 

ken

Edited April 24, 2014 by Ken076

[Jessejo]

jessejo -

 

It's difficult to help not knowing the specific insurer/policy.

 

A few policies cover only emergency treatrment during the cruise - others provide continuing coverage of a medical event on the cruise for 6 months to a year following. Not getting treatment on the ship (and therefore medically documenting the condition) may have hurt your case.

 

It sounds that you took DH to the ER in your hometown before specifically returning to your house - depending on the wording in your Policy, this might help if your coverage is "door to door" and this may be where you have to concentrate your claim efforts.

 

ken

 

We have T.G. - basic policy sold by our TA. Yes, we went straight to the ER on Sunday where he was admitted to the hospital after the surgery and was released to go home on Wednesday. The way I understand the policy is that it is door to door. As to collecting on the insurance, it did not even occur to me until after his release from the hospital - no preplanning to see the doctor on the ship or going straight to the hospital... Thanks for your input.

[Ken076]

We have T.G. - basic policy sold by our TA. Yes, we went straight to the ER on Sunday where he was admitted to the hospital after the surgery and was released to go home on Wednesday. The way I understand the policy is that it is door to door. As to collecting on the insurance, it did not even occur to me until after his release from the hospital - no preplanning to see the doctor on the ship or going straight to the hospital... Thanks for your input.

 

Jessejo - I took a look at the TravelGuard Basic Policy. Below are a few items to prepare to address/argue w/ the Insurance Company:

 

1. The Policy provides "secondary coverage" meaning they coordinate claims with all your other insurances (medicare?), and they pay (in this case up to $10,000 and a $50 deductible) of the remaining charges after everyone else has paid their obligation.

 

2. Be aware that The Basic policy has no "Waiver of pre-existing Conditions" and has a lookback window of 180 days for pre-existing conditions: if in the 180 days before your effective coverage, your husband's condition is shown to have actually initially occured, or if it was being treated and undercontrol but then the RX changed or he had to see a doctor/hospital to be treated for same, he wouldn't be covered. See the Policy for the precise words!

 

3. The "Trip" is defined as "a period of travel away from home to a destination outside the insured's city of residence".

 

The "return date" is "the date on which the insured is scheduled to return to the point where the trip started".

 

The "coverage ends" "the earliest of:

• the date the trip is completed
  
• the scheduled return date
  
• the insured's arrival at the return destination"
  

They don't explicitly say "door-to-door" coverage but seems to me that a reasonable person would read this as same.

 

If your husband's condition is verified to not be pre-existing, It will be interesting to see how the Claim Adjusters next react to the stop on the drive from the cruise port to your home for treatment - maybe they'll try to nit-pick it, hopefully they won't. I think it will be "key" that you didn't first take him home to your house before visitng the ER, which would have concluded the covered "trip".

 

This looks to mbe a Policy that only covers Emergency treatment during the trip (and does not provide continuing treatment for some number of days after the trip, as some do). "The Insurer will reimburse the Insured for Medically Necessary Covered Expenses incurred to treat such Injury or Sickness during the course of the Trip provided the initial treatment was received during the Trip."

 

I didn't, but you might want to check the Policy itself (usually at the very end) for any Texas-specific added coverages (or exclusions) that might affect you.

 

IMO you played it pretty close but (in the absence of a pre-existing condition determination) may well be coverd! If you get a chance, keep us updated?

 

Ken

Edited April 24, 2014 by Ken076

[Jessejo]

Ken076, thank you so much for this info. I think I interpreted it the same. While DH probably had preexisting conditions they were not known to us and therefore had not been treated. Yes, he only has Medicare (I have Medicare Advantage coverage, he is too stubborn 😁)

 

I will continue this when I know something.

 

Again, thank you all,

JoAnne

[Kellie Poodle]

From your post it appears that even though your DH fell ill on the ship, he did not see a physician or have anything diagnosed until after the cruise. In other words, there is nothing to prove that he was ill on the ship.

 

Travel insurance policies usually have a caveat in them stating that they will cover you if you are X number of miles from home. Since you were home, travel insurance might not apply. It is called "travel" insurance.

 

File the claim and give it a shot, but I doubt that the travel insurance company will permit itself to be used as secondary "medi-gap" insurance.

 

PS: If your DH doesn't want a Medicare Advantage plan, you can get a decent secondary plan through AARP.

[Spurschick]

Firstly I wish to pass my best wishes to your husband and yourself. I hope he recovers quickly.

 

We claimed once for illness onboard doctor for DD on a cruise. We had to file the claim with our US medical insurance first and show what was not covered by them before the travel insurance would pay out. Even if they say they will review your claim you may follow similar procedures.

 

Good luck

[exchiefPFD]

dia+, my wife had an injury on a shore excursion a few years ago. First of all-- Medicare will not cover anything that happens out of the US. Some private ins will, United Healthcare, our secondary ins did cover some expenses, The travel ins purchased thru Royal covered everything else, right down to bandages I purchased at home. I would Never, ever sail with out it.

[Ken076]

From your post it appears that even though your DH fell ill on the ship, he did not see a physician or have anything diagnosed until after the cruise. In other words, there is nothing to prove that he was ill on the ship.

 

Travel insurance policies usually have a caveat in them stating that they will cover you if you are X number of miles from home. Since you were home, travel insurance might not apply. It is called "travel" insurance.

 

File the claim and give it a shot, but I doubt that the travel insurance company will permit itself to be used as secondary "medi-gap" insurance.

 

PS: If your DH doesn't want a Medicare Advantage plan, you can get a decent secondary plan through AARP.

 

The OP's specific Policy looks to cover them "door-to-door" - the OP played it VERY close by stopping at the ER in their own State but before reaching their house, and so may well be covered - it would be interesting to know what stone walls the insurer throw-up! The OP's policy provides secondary coverage and as such, if they pay they should pay what Medicare doesn't pay, up to the Policy's limit (adjusting everything for UCR, of course). Since the treatment was provided in the US, the Medicare coverage should then be in effect and the OP is only looking for reimbursement for charges beyond the Medicare coverage.

 

This is another thing to check when comparing policies/coverages; some policies cover only any emergency treatment occuring during the cruise, while others cover all continuing/associated treatment for 6 months to even 12 months afer occurence.

 

ken

Edited April 26, 2014 by Ken076

[IWORK2CRUISE]

My SIL passed 5 days before our cruise last week and we had to cancel. The insurance company is requesting with the paper work a copy of the death certificate. Does anyone know if this is a normal request? I hate bothering family with this at this time.

 

Sorry for your loss.

The request for the death cert. is perfectly normal. They need to prove loss.