What to do when cruise insurance isn’t a “shore” thing

eAlisa / Shutterstock.com
eAlisa / Shutterstock.com
Like other cruise lines, Oceania’s optional but “highly recommended” insurance promises discerning passengers help “in the face of the unexpected.” But that’s not what happened when George Domino and his wife cruised from Stockholm to London last year and he suddenly developed a urinary tract infection.

The good news: Domino made a full recovery. The bad news: His wallet didn’t.

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Even though his insurance covered some of his medical expenses — although not as muchas he’d been led to believe — he was still on the hook for his missed shore excursions.

I’ve reviewed the back-and-forth between Oceania’s insurance company, AON Affinity Berkely Travel, and the red tape seems a bit much—even to someone like myself who deals with claims on almost a daily basis.

Instead of paying his claim promptly, the insurance company insisted that he first file a Medicare claim, even though it doesn’t cover foreign travel. Then it didn’t cover his entire medical bill — instead, he had to split the difference between another insurance policy.

“My contacts with Berkely were extremely unpleasant and the senior claims examiner that I spoke with was rude, extremely intolerant, and bureaucratic in the worst way,” says Domino.

In the end, AON Affinity Berkely Travel only covered $335 out of a $675 medical bill, left him with a $1,175 loss for the missed excursions.

“They do not cover the missed tours despite the fact that there is wording in their policy that would lead one to believe they do,” he says.

It’s true, the promotional language on the policy makes it seem as if you’re totally covered, but the fine print reveals you are not.

So, where does that leave us?

“I think Oceania or their travel insurance company should refund us for the missed tours,” says Domino. “I would request your assistance in this matter.”

I’d like to help, and our resolutions team has been back and forth with Domino on this particular case, and they agree that this is an unfortunate situation. Beyond fixing the bill, the solution is twofold. Oceania should boldly declare that shore excursions aren’t covered under its own policy, and it should recommend a policy that does cover shore excursions instead of pushing its own limited policies.

It also needs to do something about the claims process, which is tedious and insulting. Why file a Medicaid claim when you know it will be rejected? What kind of game are the underwriters playing with the likes of Domino?

Frankly, taking this case is going to be like tilting at an enormous windmill. Oceania, which absolutely hates being in the media, will probably offer a hurtful response (“Why are you picking on us? That’s how everyone does it.”), AON Affinity Berkely Travel will likely just say the shore excursion wasn’t a covered reason, end of story.

But I’m willing to try. Why? Because I think this just isn’t fair. Oceania may get away with making big promises about its policies, and AON Affinity Berkely Travel may be legally correct — but that doesn’t make any of this right.

Will Domino get his money back? We shall see.

Should I mediate George Domino's case?

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43 thoughts on “What to do when cruise insurance isn’t a “shore” thing

  1. I hate companies that needlessly waste time. Hopefully they can be prosecuted for requiring people to pointlessly file claims to the federal government.

    1. Medicare does not cover you out of the country, but many Medicare supplements do, so when Medicare denies the claim and it is sent to the secondary, they pay it. AARP has a policy that does this, so the travel insurance company saves.

  2. Always purchase third party trip insurance. Insurance offered by a cruise line/tour company etc. is designed to protect the company and not the traveler. Learned that lesson years ago!

    1. Careful…

      Stonebridge Casualty Insurance Company — the underwriter for Oceania’s travel protection plan — is also the underwriter for CSA’s (“third party”) Travel Insurance.

      The contract language for Post-Departure Trip Interruption is virtually identical in both cases. The main difference is that one policy refers to “your Covered Cruise” while the other refers to “your Covered Trip.”

      https www(dot)csainsuranceservices(dot)com/pdf/100cs_cert.pdf

      oceaniacruises(dot)com/documents/insurance/OC-Travel-Protection-Program.pdf

      With either product, I suspect the insurer could argue that cancelling shore excursions does not constitute a “Trip Interruption” if the passenger doesn’t completely disembark the cruise.

      I noticed that TravelGuard policies specifically cite that “medically imposed restrictions as certified by a Physician” are included in it’s trip interruption benefits. But you won’t generally find that inclusion in third party policies however (e.g. CSA, Travelex, Allianz, et. al.).

  3. Chris,

    I hate to be blunt, but did you actually read the policy, or just farm it for juicy quotes for the story? Part D is Travel Accident coverage, NOT medical coverage (Part B). It’s the part of the policy that will pay out some life or loss-of-limb insurance if you are run over by a car or something on your trip. It makes total sense that that section of the policy would exclude sickness.

    As far as filing with Medicare (or other insurance you might have) first… that’s a pretty standard part of lots of trip insurance plans. Notably, they don’t require you to appeal a rejection. Medicare receives the claim, puts a “rejected” stamp on it, and sends it back to you. It does delay your claim a couple weeks while you wait for that denial letter, but the total payment in the end is the same.

    You said that Berkeley “only covered $335 out of a $675 medical bill”… how much did his “other insurance” cover? How far was he from being made whole?

    Next, did he make the shore excursion arrangements through Oceania, or did he select 3rd-party excursions, and were they pre-booked? If they were pre-booked through Oceania, I can’t imagine why they aren’t covered… it’s pretty unambiguous that pre-booked excursions should be covered. If they weren’t pre-booked, I thought most lines (though I’ve never sailed Oceania) will allow you to cancel excursions at the last minute on-board if you have a documented illness, which avoids the insurance claim entirely. If they were booked through a 3rd-party, I would not have expected Oceania’s insurance to cover them, as no premium was paid on them.

    1. I think the OP should have been covered under the Post-Departure Trip Interruption in Part A. (Part B addresses medical and evacuation expenses, not reimbursement of non-refundable payments).

      But I think the insurer could easily argue that even part A doesn’t apply.

      Part A would clearly apply if the OP got a physician’s written opinion that he could not continue the cruise, and if he then disembarked and got transportation either to a hospital or to the ship’s final destination.

      But if he remained on the ship and simply cancelled his shore excursions, (or if the ship’s physician didn’t provide the requisite written opinion, or if the insurer deemed that there was a pre-existing condition), then the insurer could argue that they owe no trip interruption benefits whatsoever.

      Post-Departure Trip Interruption
      We will pay a Post-Departure Trip Interruption Benefit, up to the amount in the Schedule, if due to your, an Immediate Family Member’s, Traveling Companion’s, or Business Partner’s, Sickness, Injury or death or Other Covered Events as defined: 1) your arrival on your Covered Cruise is delayed; or 2) you are unable to continue on your Covered Cruise after you have departed on your Covered Cruise. For item 1) above, the Sickness or Injury must: a) commence while your coverage is in effect under the plan; b) for item 2) above, commence while you are on your Covered Cruise and your coverage is in effect under the plan; and c) for both items 1) and 2) above, require the examination and treatment by a Physician at the time the Covered Cruise is interrupted or delayed; and d) in the written opinion of the treating Physician, be so disabling as to delay your arrival on your Covered Cruise or to prevent you from continuing your Covered Cruise.

      Post-Departure Trip Interruption Benefits
      We will reimburse you, less any refund paid or payable, for unused land or water travel arrangements, and/or the following:
      1. the additional transportation expenses by the most direct route from the point you interrupted your Covered Cruise:
      a) to the next scheduled destination where you can catch up to your Covered Cruise; or (b) to the final destination of your Covered Cruise;
      2. the additional transportation expenses incurred by you by the most direct route to reach your original Covered Cruise destination if you are delayed and leave after the Scheduled Departure Date. However, the benefit payable under (1) and (2) above will not exceed the cost of a one-way economy air fare (or first class, if the original tickets
      were first class) by the most direct route less any refunds paid or payable for your unused original tickets.
      3. reasonable additional accommodation and transportation expenses (up to $100 per day) incurred to remain near a covered traveling Immediate Family Member or Traveling Companion who is hospitalized during your Cruise.

  4. I read the promotional material, where I thought I’d be able to find sympathy. I can’t stand it when coverage is misrepresented and given a rosy hue when the fine print contradicts it. But the page you linked to says:

    which can help you in the face of unexpected medical expenses, trip and
    baggage delays, or lost, stolen or damaged luggage and personal effects
    while traveling. Additionally, reimbursement is provided for penalties
    that may be assessed due to cruise cancellations for covered reasons.

    Medical expenses, trip and baggage delays, stolen luggage, and penalty fees on cruise cancellation. I don’t believe the insurance coverage is misrepresented there at all.

    It continues to list specific dollar amounts. If there was any doubt about shore excursions coverages in the above paragraph, that doubt is obliterated by the rest of the promotional literature.

    Mind you, it does not sound like a good deal at all. It’s a lousy deal in my opinion. But sorry to say, I don’t think the bounds of the coverage was in any way misleading.

    1. You quoted the wrong portion of that page. The very next paragraph says:

      TRIP CANCELLATION & INTERRUPTION

      Reimburses pre-paid non-refundable cancellation or interruption
      charges (up to a maximum of $50,000 per insured) for losses caused by a
      covered medical condition of either the insured guest, an immediate
      family member, or a traveling companion.

      And this must have been a “covered medical condition” if they reimbursed medical expenses.

      1. Yeah, I’m lost on that section. Unless the shore excursions weren’t pre-paid, I can’t figure out why they wouldn’t fall in there.

        1. I think they may have taken shore excursions from a third party, or did not actually CANCEL the shore excursions while onboard, which could have caused its own problems. I’d love more info. BUT yet again – NEVER take the cruise line’s “insurance” as it is NOT as comprehensive as 3rd party would have been.

  5. The policy is clear: “We will not pay for loss caused by or resulting from Sickness of any kind.”. It might be clear but you took it out of context. Didn’t you just write a column on half-truths and how you dislike them? This appears to be a glaring example of leaving information out of a post to build your case.

    1. I presume your post is pure sarcasm. I mean, if it’s ‘clear’ they don’t pay for sickness of any kind, then why did they pay for sickness? Unless their policy is so confusing even the insurance company can’t comprehend it.
      So maybe the policy intent is:
      “We don’t pay for sickness, unless you file a claim for Medicare that will surely be rejected, thus wasting everyone’s time, but then we do pay for sickness but not all of your bills for sickness because, remember we don’t pay for sickness. Until we do. Partially. After wasting your time.”

      1. I assume that you did not read the full post prior to Chris removing a sentence. You might have saved yourself some time. Read his post below.

  6. I voted no for a few reasons… 1. This seems to be a legal dispute at this point. The policy was either misrepresented or isn’t being enforced correctly. Take your pick. That’s a lawyer not a journalist problem. 2. Insurance is a regulated product. This is a case where the better solution is to take it to the OPs state office that regulates insurance and let them handle it.

  7. They probably told him to file the medicare claim in the hopes it would take too long and then their policy would be void.

    Scam!

    1. Actually, no – they all ask for that in these cases, to show no other coverage was paid out. But that is why you should choose a 3rd party PRIMARY coverage insurance, not a vendor’s SECONDARY coverage insurer. 🙂

  8. Have been using Travel Guard for some years now, for every trip where there is something to loose. Premium has always been reasonable, pre-existing conditions are covered if purchased promptly, it pays first without having to file with primary medical insurance, and claims service is easy to deal with.

  9. So the OP did the right thing: he bought insurance for his trip. Unfortunately, the policy was not very good and didn’t cover much of what he needed it to cover. But it does seem that it paid what it said it would, which is better than nothing. Another reason to shop around for travel insurance to be sure you get coverage that will really work for you.

  10. I agree that the “sales” language can be misleading when they are trying to sell the policy. However, if they posted more detailed policy certificate language, it would be hard to convey the benefits. There needs to be an in-between.

    Other tips would be to: 1) Buy insurance from a 3rd party provider, which would provide coverage for medical, the lost portions of the trip, and more. 2) Buy a plan with Primary Medical coverage, which pays first without seeking coverage form other policies.

  11. I expect secondary insurances require one file for Medicare first even if they know it will not be covered. The ‘red tape’ part of it may be that that denial has to occur before going to a secondary insurer. Not an expert, but check it out.

  12. Why would a company take your advice on the proposed remedies? This way, they get the insurance premium and the excursion payment. Your way they get only the insurance premium! And so what if they annoy one, two or a hundred.people. there are plenty more where they came from.

  13. I vote yes on this one, the main policy overview directly states that they will cover the the non-refundable fees, and they have no reason to not pay the full medical bill. If the overview didn’t say they would be covered, and the fine print confirmed it, I would say no, but when they say it’s covered in bold, and then say its denied in the fine print, they are contradicting themselves and I think they should cover the excursions as stated. I’m not sure of the legal interpretation, but if a company says you will get X covered, and in the fine print says, we don’t cover X, it appears to be fraudulent. As far as making the OP go through Medicare, I think the insurance company is either trying to defraud Medicare, or trying to wear the OP out. Take them on Chris!!

  14. My health care provider covers us while we are living in Paris for several months. I have not been ill in all my trips overseas and elsewhere but wonder how it will be if we do take ill. I imagine we
    pay the bill and will be reimbursed. For years we have bought special insurance for travel (expensive) and now this is a great thing to know we are covered.

  15. I always recommend Travel Guard for insurance over cruise line or other companies ESPECIALLY Berkely who has been and continues to be notorious for poor service. We have had several first hand experiences with TG and they are great bunch of people to work with. Responsive, capable, and thorough. And not ONCE with overseas claims did they make us file for denial from Medicare first! Oceania needs to be called on this. (Maybe they need to find a new insurance provider!). Good luck with Berkely you’ll need it.

    1. That’s because they are a primary coverage insurer — and cruise/tour vendors offer a limited “insurance” which is really made to cover medical cancellations.

  16. I want to sign and contract, and then it should do what I think because I was too lazy to actually read it.

    There are a ton of companies offering worthless products, but I don’t blame them if I buy one.

    1. Agreed, but advertising should be considered a contract as well and I’ve heard of cases where they’ve been held to it.

      1. You’re absolutely correct. It is possible that an advertisement was a fraudulent inducement to purpose a product.

  17. “Why file a Medicaid claim when you know it will be rejected?”

    __________________

    Because the entire plan is built around knowing that some people will give up at that hurdle. And some of those who do file the Medicare claim will give up at the next hurdle, and so on.

    1. Or because the OP bought secondary instead primary medical insurance (and saved money doing it). By definition, secondary medical insurance only covers what your primary insurance does not.

      1. Immaterial in this case. Medicare doesn’t cover foreign travel. That requirement could have been waived in this case. Only reason not to waive it is to make things harder on the insured.

        1. NOT immaterial – they have to have the rejection in writing when they are secondary, to justify paying out a full amount. And it would not matter if it was Medicare, personal insurance, homeowner’s, etc.

  18. How were the excursions purchased? If through the cruise line you usually can cancel for any reason. I’ve not gone with this company but the one’s I’ve been on if there was a wait list I was able to cancel up until 24 hours ahead of time. The people at the desks were always pleasant and overall the process seemed very fair. But if purchased on their own through a 3rd party – why would that be covered?

    The medical seems to be a partial truth. The OP cannot make money on their bills – if the primary paid X and the insurance paid Y and together it equal the total, then why any fuss? If it didn’t pay the difference then it should be clear, but just saying it only paid part of it is likely extremely misleading to the reader.

    Glad the OP is okay, being sick is never fun, being sick on vacation really isn’t fun, adding in being sick on vacation and being out of the country, ugh.

    1. Or when he got sick, he never bothered to cancel? Would really like some more information on the shore excursions from the client.

  19. Advertising: Make grand claims to entice customers (Hide Truth in Fine Print).
    Promises: Lead people on, be vague, but be sure to avoid putting “Promises” in writing
    Payout: We took your money EXPEDICIOUSLY, we’ll pay out next to never.

    Moral: Read the fine print. Those attached insurance deals sound great via the highlights right up until reading and hitting the fine print.

    Good luck. I hope the OP wins.

  20. Medicare (for those who are disabled or 65+ years old) is a different program from Medicaid, which is for low income people. Might want to straighten the terminology in the story out… in one instance, you refer to Medicare, in another to Medicaid.

  21. This is so frustrating. I’m one of these people that always tries to read all the nitty gritty of insurance coverage, but it can seriously be overwhelming with the density of text and ambiguity as well as technicality of language. I think this is one of those cases where it would be so helpful to have a federal standard for spelling out insurance contracts. I read as carefully as I can, and I’m still never 100% sure if I’m covered.

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