Comments on: Travel insurance claim denied, denied, denied — oh, never mind!

By: Rita

Rita — Thu, 29 Apr 2010 05:08:30 +0000

I always buy travel insurance. Mostly because my 82 year mother whom I care for can get sick at anytime and I am a Diabetic. Also the both of us are on a fixed income. Well my mother surprizingly died 2 weeks before our trip to DC for my sons wedding. I applied for reinbursement to Access America and sent them her death certificate and they denied me in one letter and said in another that I would get our money back.
Then they sent me another letter asking for the doctor to fill out a form telling them how long she’d had the disease. I called them and told them this is rediculous ( Dead is Dead! ) and the death cert. notes what she died of which was Ischemic Colitis which is like a heart attack of the colon and her colon was dieing. They could easily look this up in a medical dictionary to find out what it was. It’s not a prexisting condition you die from this unless you are young, health and can have surgery for a colostemey. She was 82 and the disease for that is called ( Old Age ). I still haven’t gotten our money back.

By: monalisa

monalisa — Mon, 04 Jan 2010 21:45:28 +0000

Benefits of Travel Insurance

http://insurance-infoland.blogspot.com/2009/03/benefits-of-travel-insurance.html

By: kwoww

kwoww — Mon, 04 Jan 2010 19:11:52 +0000

This is a very common exclusion with insurance. Although I will be the first to warn against using Access America, I must say in their defense, you can’t help it if people don’t read their policies. The brochure you get from your agent is only a breif overview of your benefits and exclusions. You get the actual policy once you are insured, and it is very extensive. This is why most companies give you a “free look” period (usually about 10 days) which gives you the option to withdraw without penalty once you’ve examined your actual policy. It is certainly possible that this person was only reading the brochure.
I would hate for a story like this to give Trip Insurance a bad name. It seems every time Chris writes about someone getting hassled by their insurance company, Access America is the culprit.

By: Colin

Colin — Sat, 02 Jan 2010 04:41:32 +0000

I wonder of the exclusion applies to Nurse Practitioners as well? Many urgent care clinics are exclusively staffed by NP’s, and if the case is too serious, the patient is sent to an ER. I know, my wife is an NP who primarily does urgent care. They are licensed, but are not doctors.

Does anyone know?

By: Joshua Z.

Joshua Z. — Thu, 31 Dec 2009 21:15:40 +0000

I’ve used Access America for flight insurance on a trip I took a few years ago to Costa Rica and Panama. I mainly chose them as they had a “cancel for any reason” plan where I could cancel the flight and get 75% of the money back. I ultimately had to cancel the flights as the trip dates changed and we could not change the flights. However, once I canceled the itinerary, it took several months and a letter to them to get them to pay us. They could not confirm that the itinerary was canceled. I ultimately sent them a letter with screenshots of the page saying the itinerary didn’t exist, the seatmaps showing that my selected seats were now empty, and even the new itinerary for my trip, which I would not insure. They finally paid us, but I still don’t believe it was worth all the hassle.

By: Jason

Jason — Thu, 31 Dec 2009 05:30:55 +0000

The funny thing is, its so easy to get around this ‘exclusion’. I am a physician. I have LOTS of physician friends. It would be extremely easy to get an MD friend of mine to fill out a form or write a note.

So the moral of the story is to know the policy exclusions, and then make sure you know how to properly avoid falling into the insurer’s pitfalls.

We do the same for calling in scripts to the pharmacy. My buddy and I will call in for each other’s families, and not our own, just to keep it a bit more kosher.

By: Jasper

Jasper — Tue, 29 Dec 2009 21:37:52 +0000

Another example of the insurance industry not doing their job: Insuring.

I propose we merge the insurance industry with the gambling industry and apply the same rules.

By: SirWired

SirWired — Tue, 29 Dec 2009 21:21:35 +0000

Dennis,

As covered in the updates, the policy explicitly includes an exclusion for treatment or diagnosis by family members. This is a sensible exclusion that is there for obvious reasons.

Les,

Insurance is a state-by-state product. Any complaints would go to the appropriate state insurance office. Some are better than others.

By: Les

Les — Tue, 29 Dec 2009 18:36:16 +0000

@Chris:

Is there a regulatory agency designated to oversee travel insurance? I’m aware of various state insurance commissions which regulate property and casualty coverage but I’m unclear on travel insurers.

By: dennis kavanagh

dennis kavanagh — Tue, 29 Dec 2009 17:52:46 +0000

Most states have “bad faith” statues against insurance companies for not treating their customers fairly. If a claim is turned down at the 1st level, be sure to assert “bad faith” at the 2nd level. That will get the ins. co. attention. Dennis K. in Calif.

By: Carver

Carver — Tue, 29 Dec 2009 17:43:08 +0000

I’m going to side with Access America on this one. The policy appears to have been disclosed, perhaps in the fine print. But as a practial matter this is the sort of exclusion that is likely to affect a tiny minority of the policy holders. And the exclusion makes sense. If someone is sc, its probably not a big deal to get a regular doctor to sign off on the note. But I can understand Access America being concerned about family members basically getting a free pass because you have a doctor in the family.

By: SirWired

SirWired — Tue, 29 Dec 2009 15:46:26 +0000

While I can’t speak to what the AA policy was at the time the OP purchsed, here is a snipped from the “Definitions” section of a current AA policy:

“Doctor: 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.”

So, if that definition was in the initial policy, the denial was legit, and the override a common-sense courtesy.

By: Mike

Mike — Tue, 29 Dec 2009 15:30:10 +0000

I’m sorry, but if the note or paperwork is coming from a licensed physician, then any claim or paperwork should be deemed valid. If the physician is found to be lying then the company has recourse with various boards or courts.

By: Joe Farrell

Joe Farrell — Tue, 29 Dec 2009 15:20:26 +0000

And Martin, such an exclusion needs to be disclosed clearly. PRIOR to making a claim. In fact, if the policy is vague because it fails to disclose an exclusion to coverage later invoked, the policy is interpreted by the courts as if the exclusion does not exist – and the insurers know it as well. If it is the practice of the carrier to deny all claims except those which are appealed [which seems to be the case if 90% of the appeals are paid] then I would have some serious issues with the claims practices of that insurer.

By: Cynthia

Cynthia — Tue, 29 Dec 2009 15:18:39 +0000

Even if it is a “very common exclusion in all kinds of insurance” it needs to be stated in writing in the policy documents in a way that makes the policyholder aware that it exists. If it cannot be found in writing in the policy documents then it does not exist.