Why EOB from primary insurance carrier?

[twangster]

20 minutes ago, psberg said:

When I received the claim form from the insurer, it specifically said that they required an EOB from my primary insurer.  

 

They want to make sure you are not double dipping, submitting the claim to your primary health care insurance and subsequently filing a claim for the same expenses against your travel policy.  Some health care plans do provide coverage outside of the US, it depends.

 

 

Edited March 2 by twangster

[Biker19]

[BirdTravels]

1 hour ago, psberg said:

This is an old thread but is comparable to my situation.  I purchased travel insurance for my cruise which was specifically sold as primary coverage.  I ended up making a visit to the ship’s medical center (hacking cough).  When I received the claim form from the insurer, it specifically said that they required an EOB from my primary insurer.  Isn’t the purpose of buying travel insurance with primary coverage to avoid the hassle of filing a foreign claim (which has to be done by mail) with my primary?

 

What is the point of paying more for primary coverage if it is going to be treated as secondary coverage?  That should result in a lower premium, shouldn’t it?

The are avoiding fraud of double dipping. 

[pcur]

Because many travel insurance carriers consider themselves secondary IF you already have coverage that will cover you.  Many primary carriers do not cover their policy holders outside the country of residency.  The EOB is to confirm what was denied or paid by your home country's coverage.  Even if they denied everything, the travel insurance company then knows they pay primary.  It's usually clearly stated in terms and conditions of coverage.

 

I had a friend call me up about a year ago to ask about travel insurance.  (She knew I had worked in the health insurance industry at one time.) I told her the first thing you do is see what you already have: country of residency coverage, credit card benefits, etc. THEN, go buy travel insurance to cover the rest.

 

She found out her primary (government) coverage covered her outside the US. 

 

I don't need any medical coverage from travel insurance, for instance, because my Senior Advantage Plan pays outside the US.

[psberg]

This is a pretty simple solution, which consists of telling the travel insurer that I have two primaries and have elected to file with the travel insurer first and representing that I will not file a claim with my primary health insurer, which happens to be Medicare, unless the travel insurer shorts me on the claim.

 

Edited to add: This is a response to NorthStateCruiser.

Edited March 3 by psberg
Attribution

[iuki]

I once posted about that a few years ago.  When I spoke to Steve? With Insure Travel?  He told me to just say you don’t have other insurance.  I didn’t want to lie on the form if I had to file a claim.  Since then, I decided to just use my BC/BS insurance and RCI’s insurance and pay the difference for out-of-network prices and take my chances.  Most third party insurance will not cover after a certain age.  However, I have noticed a BIG price hike by RCI on certain ships and destinations.  In fact, outrageous costs.

[pcur]

On 3/2/2024 at 11:26 PM, psberg said:

This is a pretty simple solution, which consists of telling the travel insurer that I have two primaries and have elected to file with the travel insurer first and representing that I will not file a claim with my primary health insurer, which happens to be Medicare, unless the travel insurer shorts me on the claim.

 

Edited to add: This is a response to NorthStateCruiser.

In most insurance claims processing, the insured does not make this decision.  It doesn't matter which one you want to pay, it's usually the insurer following insurance laws from your US state of residency.  Plus, if they are set up to secondary, they ask for other insurance you have on the application.  Many travel insurance policies don't allow any deviation from their primary/secondary liability for payment.  You have to shop for a travel policy that does allow for them to be primary.

 

Standalone Medicare doesn't pay outside the US.  However, Senior Advantage/Medicare combined coverage can cover.  I live in CA and have Kaiser Sr Advantage with Medicare, and it pays for everything anywhere in the world, but copays and deductibles are applied.  The travel insurance, as secondary, would cover the copays and deductibles the primary (Kaiser in my case) doesn't pay.