Travel Insurance Coverage

[Jimsgirl]

I filed my claim 5 weeks ago, but in phone calls to Berkely Care, I found that no one had worked on my claim because, it had not been scanned into the computer, it has to be "in the computer before staffers even read it!

 

Still waiting for Medicare to send letter of denial ("we are very busy" , "we get thousands of such requests" ) Then that letter has to go to Supplemental Ins, when they reply with a denial (said denial is automatic), then both have to be sent to Berkely, - and I bet that company will then take weeks before all paper work is scanned and someone actually looks at the claim.

 

The sad truth is that only the medical evacuation from Belgium via Call international based in Salem NH worked as expected. They were excellent, no excuses or excess paper work, they kept in touch with my daughter in USA and their nurse who brought me home was an angel.

[Jimsgirl]

Sadly I find it impossible to believe in the integrity of Berkely Care purchased through Cunard .

 

I have filled out countless forms , supplied even more reports from doctors, provided even more "proof of cost of the original cruise from my agent" , nothing satisfies Berkely, no matter how many forms, reports or proof I supply in response to their incessant demands, no work is done on my claim, they simply make more demands for even more paperwork. Anything to avoid actually admitting they are guilty of stalling processing a claim they have known about since Oct 6th.(they were informed I was in a foreign hospital and my condition on that date by Call International )

 

I know they will never pay out unless I obtain lawyer and go the legal route.

 

The original purchase of insurance covered, everything that could happen,

I made sure of that before purchasing, but only the medical evacuation - provided by Cal. International was given, anything that was supposedly covered by Berkely Care , has failed to be provided.

 

Berkely Care staff are lazy, and incompentent,if you asked them to add 2+2 they would need , an electronic calculator to come up with the answer-that is assuming they can actually use a cursor.

 

I am tired of Berkely Care staff treating me as though I am committing a criminal act in filing a claim.

[6rugrats]

Jimsgirl - I understand your frustration. This is what I do for a living, but the reality is, you have to follow the procedures. Travel insurance, if it's not your primary medical coverage, won't process your claim without denials from Medicare & your Medicare supplement. They aren't "lazy", they just have procedures they must follow.

 

If a correctly filed claim was sent to Medicare on paper, it does take usually over a month, IME, to receive payment or denial. Hopefully, Medicare will electronically send the claim to your Medicare supplement carrier, as it's faster than a paper claim.

 

I had a similar problem with my MIL and insurance she purchased through Princess. She was taken off the ship, spent a week in the hospital, then accompanied home. Took me almost a year to get this settled, and I do this every day. You just have to keep good records and be a little patient.

 

Count yourself lucky. My DH, who wasn't even close to being old enough to be covered by Medicare, suffered a massive stroke and died last year. At least you are still here to complain.

Edited November 30, 2014 by 6rugrats

[tlatrice]

I'm so sorry I hadn't responded. Been slammed at work & home. But THANKS SO MUCH FOR THE WEALTH OF INFORMATION!:D. You guys are awesome!

 

My next trip is Freedom of the Seas western itinerary Thanksgiving 2015.

[iamtrustworthy]

Quote:

Originally Posted by Jimsgirl

I thank you for your explanation, but , I just do not understand Berkely Care logic.

 

EVERYONE in USA knows that Medicare covers Medical costs ONLY if the treatment is given in the USA in USA, ( and that even in USA it is MEDICAL COSTS ONLY, no other event -such as not being able to take a trip - or continue a trip , so Berkeley Care is fully aware that even my costs for the ship or hospital in foreign country will not be covered by Medicare since they took place OUTSIDE USA.

 

Supplemental will pay the 20% ONLY AFTER Medicare pays the 80% of that which they think is correct, so -NO MEDICARE PAYMENT -,NO SUPPLEMENTAL Payment.

 

So knowing this, the requirement for letters from Medicare or Supplemental is simply superfluity on their part, just another road block, to delay payment whilst they try to think of some reason not to pay as per contract.

 

Hi Jimsgirl,

 

I, too, am sorry to hear about what happened to you on the QM2. I hope your recovery has gone well.

 

Next, I'm sorry I didn't see your comments before today. I've been laid up since Nov 9th, Here's a tip for you and pretty much anyone over age 50 (I'm 57): Don't go roller skating!

 

The reason Berkeley Care is waiting for your Explanation of Benefits form is because they have Secondary medical (meaning they pay what you other insurance doesn't). Your Medicare Supplement plan will likely cover you partially.

 

Here's a more detailed explanation of Medicare & Supplements:

 

Medicare Does Not Cover You Outside the United States

 

You can get Travel Insurance that fills in the gaps in your Medicare / Medigap Policies C, D, E, F, G, H, I & J

 

The Original Medicare Plan does not cover health care when you travel outside the United States, except for some emergency situations in Mexico and Canada. Go here to learn about your options for getting coverage.

 

In rare cases, Medicare can pay for inpatient hospital services that you get in Canada or Mexico. Medicare can pay only if:

 

- You are in the United States when a medical emergency occurs and the Canadian or Mexican hospital is closer than the nearest U.S. hospital that can treat the emergency.

- You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.

- You live in the United States and the Canadian or Mexican hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

 

Important Information About Medigap Policies C, D, E, F, G, H, I & J

 

Your Medigap (Medicare Supplement) plan may provide worldwide coverage benefits for health care needs when you travel outside the United States. Medigap policies C, D, E, F, G, H, I & J provide Foreign Travel Emergency health care coverage when you travel outside the United States. Under these plans, Medigap policies pay for 80% of the cost of emergency care during the first 60 days of each trip after you pay the $250 deductible. Foreign Travel Emergency coverage with Medigap policies have a lifetime limit of $50,000.

 

You should check with your Medicare Supplement plan prior to traveling outside of the United States regarding your worldwide coverage benefits. Your Medicare Supplement plan will either tell you:

- “We pay whatever Medicare won’t pay, subject to deductibles & copays.” or

- “If Medicare’s not obligated to pay, we won’t pay either.”

 

Here are the Basics of What is Medicare and What it Covers:

 

Here’s the Official US Government Medicare website’s Q and A:

http://questions.medicare.gov/cgi-bi...er/std_alp.php

 

Medicare is the health insurance program for people over the age of 65. People under the age of 65 can qualify for the Medicare program with certain disabilities, and any age with End-Stage Renal Disease (ESRD – permanent kidney failure requiring dialysis or a kidney transplant).

 

Medicare has four parts

 

- Part A (Hospital Insurance) - Helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, and some limited home health care.

- Part B (Medical Insurance) – Helps cover medically necessary services such as your doctor’s services, outpatient care, and other approved medical services not covered under Part A.

- Part C (Medicare Advantage Plans) – Medicare Advantage Plans are a replacement of your original Medicare Part A & Part B. Medicare pays private health insurance companies to “Manage” your health care. Many of the Advantage plans come in the form of a HMO or PPO. These programs are required to provide the same coverage that the original Medicare Part A & Part B provide. Some plans even have coverage for Part D which you will read about next.

- Part D (Medicare prescription drug coverage) – Helps cover prescription drug costs. If you are in the original Medicare program you may purchase a Part D plan from private insurers to help reduce your cost further. If you are enrolled in Medicare Part C, depending on which type of plan you have, may or may not allow you to purchase Part D. Check with your agent or call Medicare to verify your options.

 

What is a Medicare supplement policy?

 

A Medicare supplement policy is a health insurance plan sold by a private insurance company to fill the gaps in coverage from the original Medicare Part A & Part B. Sometimes called a Medigap policy. These plans will help you pay your share of the costs (coinsurance, co-payments, or deductibles) associated with Medicare-covered services. *You will need to qualify for Medicare Part A and Part B from above.

 

There are different Medicare supplement policies

 

Insurance companies can sell you only a “standardized” Medicare supplement policy. These policies are identified by letters (Plans A through L). Plans F and J also come in a high-deductible version. By law each type of Medicare supplement policy offers the same basic benefits, no matter which insurance company sells it. For example Plan D with company 1 has the exact same coverage as Plan D with company 2. The only difference between Medigap policies sold by different insurance companies is the cost.

 

What doesn’t a Medicare supplement policy cover?

 

They don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing. Please see www.medicare.gov for information on approved services.

 

Any new Medicare supplement policy issued today is guaranteed renewable

 

This means the insurance company can not cancel your policy as long as you pay the premium.

 

Prescription Drug Coverage

 

Although some Medicare supplement policies sold in the past covered prescription drugs, no new Medicare supplement policies are allowed to include prescription drug coverage as of 2005. If you want prescription drug coverage, you may want to join a Medicare Prescription Drug Plan (Part D) offered by private companies approved by Medicare.

 

When is the Best Time to buy a Medicare Supplement Policy?

 

Open Enrollment is the period that lasts for 6 months and begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. During this period, an insurance company can’t use medical underwriting. They can’t refuse to sell you any Medicare supplement policy it sells. They generally can’t make you wait for coverage to start. Finally, they can’t charge you more for a Medicare supplement policy because of you health problems.

 

I hope this helps you,

 

Steve

Edited December 28, 2014 by iamtrustworthy
spelling corrected