An injury prevented me from taking my trip, but what is preventing Trip Mate from paying my claim?

By | April 22nd, 2017

Robert Hood and his wife were looking forward to their trip to Madagascar when a sudden injury made it necessary to forego the adventure. Luckily, Hood had purchased a comprehensive travel insurance policy from World Nomads to protect his $9,000 deposit on the trip. So why is he still waiting for reimbursement six months later? That’s what we aim to find out.

Question: My wife and I had planned a trip to Madagascar in September. I purchased trip insurance through World Nomads.

Then I suffered a back injury that required surgery in August. My surgeon said I would not be medically cleared for the trip as it was too soon after surgery. As soon as I knew I couldn’t make the trip, I filed a claim with World Nomads and the claim is still being processed by Trip Mate (the underwriter of the policy).

I have provided every shred of information they have requested and kept in contact with their customer service department. It is now almost six months since I submitted the documents and I feel I am being stonewalled. Can you help find out what is going on with my claim? — Robert Hood, Fallston, Md.

Answer: Certainly, Bob, I would love to help you. After all, you purchased a travel insurance policy to provide you with the peace of mind that your hefty trip deposits would be protected. You should not be spending your convalescence worrying about when, and if, you will be reimbursed.

I reviewed your paperwork and noticed that the underwriter of your policy, Trip Mate, had notified you on more than one occasion that your doctor had not provided them with any documentation. This medical documentation is an essential part of your claim and it is impossible to receive an approval stamp without it.

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You checked with your doctor and he told you that no one from World Nomads or Trip Mate had requested any information about you.

So I contacted Trip Mate and asked what was holding up your claim. An executive at Trip Mate informed me that no one from your physician’s office had responded to their multiple requests for the needed documents.

Upon further investigation, it seems that these requests were going to the medical records department of your doctor’s office. Because you had not provided a signed authorization form these requests had gone unanswered by the staff there.

It appears that no personnel from the medical records office thought to proactively contact you and ask you to approve the forwarding of your medical information to Trip Mate. And so, for months, your claim continued to remain stagnant.

Once we were involved things finally started to move along.

After you signed the release form, Trip Mate was then informed that your doctor’s office required a small fee before they would provide your information. We wondered about this request, but Trip Mate explained that this type of fee is frequently required by medical facilities.

After the payment was processed the necessary paperwork was finally sent to Trip Mate for its review.

A few weeks later, your claim was approved and you were informed that a reimbursement check would be sent to you by Federal Express. You were pleased with this outcome.

There are several lessons to be learned from your case. First, when making a claim with your travel insurance company, it is imperative to be clear about the required documentation. You felt confident that you had provided all the needed paperwork and that Trip Mate was delaying your claim. However, upon closer examination, it was the disconnect between you, your doctor and his medical records department that was holding up your claim.

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And, of course, your story is a strong reminder of the purpose and benefits of trip insurance. Luckily, you had the forethought to purchase a policy that protected your investment. But we receive many requests from consumers who did not purchase trip insurance and then are faced with a medical emergency or other calamity. They ask us to help them apply the benefits that are available for insured policy holders — but we can’t — and their investment is typically lost.

It is unfortunate that there were some roadblocks with the processing of your claim. However, we are pleased that you are now fully recovered, ready to travel again and have been reimbursed for your missed trip to Madagascar.

  • Rebecca

    I don’t understand why its implied Trip Mate is the party at fault. They did nothing wrong. They notified the OP exactly what the problem was. Apparently when the OP finally contacted the physician at the request of the advocates, the doctor or his staff first said they hadn’t received anything, then later admitted they’d received multiple requests and ignored them without notifying the OP. The claim was quickly processed and paid once the OP was directed to the doctor’s records department to sign a release.

    Of the three parties involved, the doctor’s office is most at fault for ignoring requests without notifying him and (even worse) lying about ever receiving them. The OP was told multiple times the physician wasn’t responding to their requests, and he shares a lesser amount of blame for not contacting the doctor’s administrative staff to provide the information; common sense would dictate, after multiple emails telling him this information is missing, to contact the physician directly and ask who sends records and what they would need from him. Trip Mate doesn’t shoulder any blame. They promptly responded and followed up several times; the information they requested is completely reasonable and necessary. They’re not asking anyone to jump through hoops. They paid the claim in a timely fashion once they had the requested information.

  • finance_tony

    Glad you posted it – now I wonder if TripMate will have a tally in its column when the semi-annual “worst companies” gets published on the site. Hate to see TripMate in the headline.

    Also, a kudos to the OP who did (most) everything right – especially purchasing trip insurance and not trying to get a sympathy refund!

  • Annie M

    The insurance company usually sends the forms to the consumer that they need completed by the Dr. Didn’t she get those and take them to the dr. herself?
    That would have also have had the release form for her to sign and give to the Dr.

    Did she receive these and do nothing about them?

  • Harvey-6-3.5

    I have to agree with Rebecca here. The first time Tripmate notified OP about the medical records, ok, maybe there is a disconnect, but after the second time, the OP should have directly arranged for the medical records to be transmitted. My kids are older now, but when I registered them for camps, I always had to have forms filled out by the Doctor. Sometimes they’d directly fax them to the camp and sometimes I would have to pick them up and fax/deliver them myself. But I had keep track because the Doctor’s office certainly didn’t, and clearly didn’t in the case of this OP. This is not Tripmate’s fault and I hope they don’t get dinged for it.

  • michael anthony

    I don’t think anything implies Trip Mate did anything wrong. The headline is just asking what’s preventing them from paying the claim. It’s the crux of the matter.

    This isn’t the doctors fault either as they are not involved in the handling and disbursement of medical records. It’s the office staff and the management of that department. (Unless you’re a one doctor office, there is usually another staff member/aide and a receptionist. Those would be the ones handling the records). And due to the volume of requests, mostly from insurance, these are not communicated to the doctor, unless it’s something truly unusual.

    Many offices have patients sign a document that its ok to release records to insurance companies for services,etc, so they can be paid. Depending on the wording, this may not follow under that type of consent. They are very particular, usually limited to your current insurers.

    Large or small, I would bring it to the attention of the manager of that department, or the doctor, if it’s a small one man show. I would relay the experience and ask if a policy could be put in place that if a records request has been received, and they don’t have signed release from you on file for that company, that someone contact the patient. Then ask the ask the patient to come in and sign. I’ve never seen requests for release sent to patient directly, as the signature should be witnessed. It could create a nightmare should there be a malpractice suit. The company requesting info already has the doctor info, thus they just send to doctor.

    Neither caveat; Most doctors charge fees for sending records. Usually do much per page. Medical records can be large I’d small, but if you add in diagnostic pictures, etc, the package can be bulky. Smart insurance companies send a check with the letter of request. (They either call beforehand to get fees, or, theyll limit what they will pay).

  • michael anthony

    These weren’t forms that needed to be complete, but records related to his illness and treatment. Medical records requests almost always stay between the doctors office and insurer, due to fraud issues.

  • Chris_In_NC

    Here’s the unanswered question. Why was the OP unable to get a clear and concise answer from Trip Mate that the claim was incomplete because medical records were never received? If I had $9000 on the line, I’d be a lot more proactive.

    I can’t speak for how Trip Mate works, but when we had to file an insurance related claim requiring medical documentation, I took the required forms directly to the physician office and arranged to have it picked up, and I submitted it to the insurance company directly. Yes, I was charged a fee by the office to receive these records, but at least in NC, the amount that may be charged is regulated by the law.

    In medical offices that are part of a group or system, the medical records is handled exclusively by HIM (health information management) or a centralized medical records office. If the office receives a release of information, or medical records request, it gets forwarded to the appropriate department. Unless there is a release signed by the patient authorizing the release of records to a 3rd party, the request will be ignored. Since these departments can be large and bureaucratic, the only sure way to get these forms completed is to be your own advocate and “help the process” through

    No one is really “at fault” per se, but I still question why it took the assistance of a consumer advocate to find out that medical records were missing.

  • AAGK

    Tripmate def. not the problem. So long as OP knew he never signed a medical release, which seems to be the entire time, he is solely at fault for his delay. The medical records dept doesn’t interface and legally required to ignore any records requests without a release in place. The OP should’ve proactively taken care of this and not blamed everyone else.

  • AAGK

    The OP did nothing right. The only thing he had to do was sign a release. Instead he sent irrelevant info and wasted people’s time. The Dr would be in serious trouble if he even confirmed the OP was a patient. This is common sense.

  • AAGK

    I don’t even think if tripmate sent the OP a release it could be honored as it has to be produced by the Dr.

  • AAGK

    I’m not sure a release provided by tripmate would suffice. He would need to complete one issued by the Dr, which you are right as it would still require him to go to the office and take care this. Then the Dr and tripmate can interface.

  • Lindabator

    NO – the client has to sign the release so the Doctor can SEND the info

  • Lindabator

    but the RELEASE form is the OPs responsibility – and they never signed it, so the Doctor could NOT release the info to the insurer

  • Lindabator

    they give the release to the doctor – or send in – but since he never signed, the doctor’s office never released the info – OPs fault, here

  • Lindabator

    there is a simple for the insurance company gives the client — since he failed to sign, the doctor’s office would not release any info

  • Lindabator

    they DID inform him they made several attempts to collect the info, and the doctor’s office did not send – he failed to find out why

  • AAGK

    Agreed. But I think the doctor has to provide the release bc then he doesn’t know it’s legit. Either way, that’s step one. I think the more interesting part with all of these claims is they explain why doctors are going the no insurance route. They don’t even want to deal with med insurance companies, let alone deal with vacation claims, unless they have large staffs. If surgeon heals you, that’s amazing and his job. They just don’t have time for all this extra stuff so the OP needed to be more active.

  • AAGK

    Weird subject for me bc my stepdad’s prostate cancer surgeon saved his life and a normal life when every other dr told him he would die and not to bother about 1 years ago. This Dr is like a god to my family. Shout out Memoirial Sloane Kettering.

  • jmiller45

    the release form has to be generated from the doctor’s office. I work in Labor & Delivery and when one of our patients has had to go to another hospital the request for their prenatal record comes from that hospital. The OP would have had to sign the release form from the doctor’s office.

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