Travel insurance claim denied, denied, denied — oh, never mind!

By | December 29th, 2009

Here’s a truly strange case, brought to you by the H1N1 virus and our friends at Access America.

You might say Marian Levin’s claim was denied on a technicality. An important technicality that I’ll get to in a moment. But it’s how her problem was resolved that’s even more interesting: Her travel insurance company turned down her claim and a subsequent appeal but then mailed her a check anyway.

All of which goes to show that if you don’t like the first (or second, or third) answer from a travel insurance company, just keep asking.

Levin explains what happened to her:

I bought trip insurance for a US Airways flight to Denver as my husband and I were going to visit our daughter and grandchildren.

We were scheduled to fly on October 22, 2009. On the afternoon of October 21st, my daughter called saying her six-year-old son had just been diagnosed with H1N1 and wanted to tell us so we could cancel our flight as she didn’t feel we should be around her son and she wasn’t feeling too well either. My husband and I agreed and called both the airlines and US Airways.

All the paperwork was received by Access America, including the physician’s report. Yesterday I was called by Access America telling me the claim was being denied as the physician was the patient’s father. I have looked through the booklet of coverage and cannot find where this is excluded.

My grandson’s father is an emergency room doctor and I asked her that if a relative were treated in an ER would that be an exclusion as well.

Is there any way you can help me out on this?

I’ve never heard of such an exclusion, and since Levin had received a rejection by phone, I thought it might be worth appealing Access America’s denial in writing. (Insurance insiders tell me that more than 90 percent of appeals are successful.) So that’s what she did.

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Here’s what happened next:

I wrote to Jeff Hyman, a vice president of travel operations, and Jon Ansell.

A few days later I received a phone call from Justin Nichols, who was adamant about “the rules” about a physician treating any relative. I told him that in this instance the doctor who treated the patient was an ER doctor as asked what would have happened if the patient had been brought to the ER and this particular doctor was the only physician available? Justin told me the insurance company would not have paid.

I told him that “rules” sometimes have to bow to common sense and he told me that if I could get the patient’s regular doctor to say that the patient’s mother had called about the child’s symptoms (which were H1N1) the claim would be reconsidered.

I spoke to the pediatrician’s nurse and she said she’d see what she could do, but it would be at least a week as the doctor was away.

Today I received three letters from Access America. Two requested more information and the third was a check for $600.

Isn’t it nice when the right hand knows what the left hand is doing?

Yes, it is.

If Access America’s policy had an exclusion for doctors who happen to be relatives, Levin probably wouldn’t have had much of a case.

The insurance company did the right thing, although it may not yet be aware of it.

Update (11:45 a.m.): It is now. From a company representative:

I thought you might be interested in our definition of “Doctor” as stated in our travel insurance policies: Someone who is legally entitled to practice medicine, and is licensed if required. This can’t be you, a traveling companion, any member of either of your immediate families, or any member of the sick or injured person’s immediate family.

Despite this, I’m glad we were able to make a consideration for this customer.

(Photo: I’m not there/Flickr Creative Commons)

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