After she was seriously hurt on vacation, Molly Brooks made a giant, but not uncommon, travel insurance mistake. She left the rural Mexican hospital where she received pricey emergency services and flew home without any documentation of treatment. Her only evidence of hospitalization was a non-itemized $6,000 credit card receipt. As could be expected, this lack of documentation presented an insurmountable problem when she filed her travel insurance claim.
A year later, her injuries have healed, but Brooks is still fighting a battle with her travel insurance company. Now she wants the Elliott Advocacy team to help get her $6,000 travel insurance claim approved. But can we? (reprint)
Brook’s plight is a frustrating one, to be sure. But there is a critical lesson here. If you want your travel insurance claim approved, don’t make the mistake of neglecting to document your expenses. Otherwise, you might face a travel insurance problem that not even the Elliott Advocacy team can fix.
Severely hurt during vacation
Last January, Brooks and some friends traveled to Mexico for an extended vacation. Toward the end of the trip, Brooks tripped on a chain that was lying concealed in a driveway.
“The fall severely injured me,” Brooks recalled. “An ambulance took me to a small local hospital in La Penita de Jaltemba Bay, Nayarit, Mexico.”
At the hospital, the nurses and doctors sent Brooks for X-rays and a blood transfusion. As the nurses tended to her, the treating physician consulted with a supervising doctor in Guadalajara via phone.
Sometime later, Brooks received a frightening diagnosis — she needed emergency surgery. She had severely fractured her humerus in many places and it needed immediate repair.
But before the medical staff could schedule the procedure, the hospital needed proof that Brooks could pay for it.
Will my travel insurance company have a problem with this receipt?
In a lot of pain and shock at the turn of events, Brooks made some phone calls. First, she called her credit card company to get approval for the jumbo charge. The next call was to Allianz, her travel insurance provider.
“I talked to an Allianz representative before I used my credit card,” Brooks reported. “The agent assured me that the Visa receipt would be sufficient to file my travel insurance claim.”
Relieved that she had the protection of the medical coverage of her travel insurance policy, Brooks tried to relax. She settled back into her hospital bed and attempted to calm her nerves and prepare for the surgery.
A terrifying experience: I don’t want surgery here!
Unfortunately for Brooks, her vacation soon went from bad to worse — much worse.
The hospital staff prepped Brooks for surgery and wheeled her into the operating room. But then something went wrong.
They weren’t all in scrubs or gloved up. I got more scared. The primary doctor tried but was unable to find a vein for a spinal block. He kept telling me (yelling) to ‘Hold still!’
I became terrified and asked them to stop. I was probably yelling, too. The medical team immediately took out all the needles, backed away, and disappeared. The nurses took me back to my room. I was one of only two patients in the entire hospital. (Brooks describing the attempted surgery to repair the injuries she suffered after a fall on her vacation)
Groggy from the medication administered in preparation for the surgery, Brooks asked to speak to the doctor. She wanted to leave the hospital immediately and go home.
The doctor told Brooks that she could not go anywhere in her condition and he abruptly left.
At night, no nurses roamed the halls. As far as she could tell, Brooks says, they were alone in the facility. Her only comfort was her friend, Nancy, at her side.
The hospital: You’re not leaving until you pay for your treatment
In the morning, the two friends informed the hospital staff that they would be leaving. Brooks wanted to get back to the United States immediately to have the emergency treatment she desperately needed.
“When we tried to leave, a horrible argument and scene began with locks and guns!” Brooks says.
The hospital staff tried to run Brooks’ credit card to pay the bill, but her bank rejected it. Police officers arrived and told her that she could not leave until she paid for her treatment in full.
Two men physically restrained Molly [Brooks] from leaving. Then they pulled down a metal sliding door and locked her in. I left to get help! (Nancy, Brooks’ friend and vacation companion recalling the events at the hospital)
Nancy soon returned with a Spanish speaking acquaintance and he determined the problem. Brooks’ credit card was rejected because the employee attempted to run a charge for 100,000 pesos. The credit card company interpreted it as a $100,000 charge and rejected it. When the staff adjusted the figure to $6,000, the charge went through and the police officers allowed Brooks to leave.
Unfortunately, but understandably, Brooks did not wait around to try to get her medical file. That was a mistake since she would need it later to support her travel insurance claim. But she just wanted to go home and try to put the ordeal behind her.
“I was in a lot of pain,” Brooks recalled. “We went straight to the airport and flew home. I was pretty insane with fear.”
If you’re hurt on vacation, you’ll need documentation for your travel insurance claim
When Brooks arrived home, she went straight to the hospital. As it turns out, the injuries she had suffered on her vacation were even more severe than the initial diagnosis.
“My fall broke my arm in eight pieces!” Brooks recalled.
As she began to convalesce, Brooks’ thoughts turned to her travel insurance claim. She filled out the paperwork and forwarded her one piece of documentation to Allianz – the paper credit card receipt.
Then she waited for the reimbursement for her medical expenses from her Mexican ordeal.
And Brooks waited.
Some months later, an Allianz representative broke the news: There was a big problem with her travel insurance claim. A non-itemized credit card receipt was not sufficient documentation to prove that she’d been hurt on vacation. Nor did it verify that she had received necessary treatment for her injuries.
Brooks explained to the Allianz agent that the hospital had given her no treatment records. She also pointed out that the Allianz phone representative had made a mistake by telling her that a receipt would be sufficient to file her travel insurance claim. This agent recommended that Brooks send the hospital a request for her records.
So Brooks sent off that request to the hospital but received no response. Then she asked for help from her acquaintance in Mexico — the man who had come to her rescue on the day of her escape. That friend went to the hospital and asked for the medical records Brooks needed. But the hospital staff turned him down.
Another travel insurance mistake: expecting Medicare to cover international treatment
Frustrated by the roadblocks she was hitting, Brooks decided to try something else. She filed an insurance claim with Medicare, her primary medical insurance. That plan soon proved as fruitless as every other.
Unfortunately, many consumers make the mistake of assuming they don’t need travel insurance because of their Medicare coverage. To be clear: Basic Medicare does not cover you if you get sick or hurt on an international vacation.
As past cases we’ve covered here show, if you rely on basic Medicare for your medical coverage abroad, you’re making a potentially disastrous error. If you become sick or get hurt on your vacation, you’ll likely be on the hook for the entire medical bill. (Note: There are Medicare supplements that provide medical insurance coverage abroad. But these come at an additional cost.)
And soon, not surprisingly, Brooks received the denial of her claim from Medicare.
We’re very sorry, but payment cannot be made for your hospitalization [in Mexico].
Medicare law prohibits payment for items and services furnished outside of the United States except in certain limited circumstances.
With another path blocked to having her vacation’s medical bill paid, Brooks turned to the Elliott Advocacy team for help.
Is there any way to fix this travel insurance problem?
When Brooks’ complaint reached my desk, it had been a full year since she had been hurt during her vacation in Mexico. But she wasn’t getting any closer to fixing her travel insurance problem. In fact, she hadn’t heard from Allianz for six months. At that time, the representative had told her that the claim was on hold until she could provide proper documentation of her injuries and treatment.
By this time, Brooks was well aware of the mistake she had made by not gathering any documentation for her travel insurance claim before leaving Mexico. But she hoped that there was some way to satisfy the insurance company’s requirements without the hospital records.
I was doubtful.
As I explained to Brooks, the insurance industry is highly regulated. There is virtually no room for flexibility as to what will be covered by a policy and how it will be covered. So, it’s critical for travelers to thoroughly read through all of the terms and conditions of their policies. This will cut back on the possibility of making a mistake that can put a permanent roadblock between you and a successful travel insurance claim.
But I felt terrible for Brooks and I went searching for anything that might support her claim. Her vacation companion, Nancy, offered to file an affidavit concerning the day Brooks was hurt and the three days at the hospital. Brooks also had proof of her treatment as soon as she arrived home in the United States. Lastly, even though it wasn’t detailed proof, she did have that receipt for the hospital in Mexico for $6,000.
A lack of proper documentation is the number one travel insurance mistake
I’ve never encountered a case such as this one, so I decided to ask our executive contact at Allianz about it. Even in the most challenging past cases, the Allianz team has been helpful.
And although I was doubtful, I hoped there might still be a positive ending to Brooks’ case, as well.
The Allianz executive team reviewed all the details of Brooks’ harrowing vacation tale. It turns out, Brooks’ situation is not uncommon at all. A lack of proper documentation is the number one travel insurance mistake.
The good news: Your travel insurance problems are over
I’m happy to report that Brooks’ year-long struggle to have her travel insurance claim paid is finally over.
Our executive contact explains his team’s decision about this unusual case:
Per your request, I did check with our Claims Department on the status of Ms. Brooks’ claim.
As you noted, we have been waiting for Ms. Brooks to provide us with a receipt from her hospital in Mexico so that we could finalize her claim. It’s very important that consumers obtain a copy of their itemized bill when they are discharged from a healthcare facility in order to avoid delays in processing their travel insurance claim. A lack of proper documentation is the number one reason that travel insurance claims are delayed.
Given the unique circumstance Ms. Brooks experienced, we are going to finalize her claim and she should receive her payment shortly. (Allianz to Michelle Couch-Friedman, Elliott Advocacy)
With that, Brooks can put this entire unpleasant vacation fiasco behind her. And we can put one more happy consumer into the Elliott Advocacy success files. It’s a great day! 😊
How to avoid travel insurance problems and mistakes
- Carefully consider your need for travel insurance
The number one travel insurance mistake our team fields every day is travelers who neglect to buy insurance at all. Invariably these consumers have discovered too late that travel insurance is for unexpected calamities — not because of an anticipated need. All travelers should make sure to consider protecting their vacations abroad with travel insurance. And remember, your primary medical insurance probably does not cover you if you get sick of hurt on an international vacation. Travel insurance can fill the void.
- Keep organized documentation of all expenses
This includes invoices for medical treatments, additional flights, hotels, food, etc. If you believe your insurance policy will cover the reimbursement, then you’d better get a receipt. Insurance companies do not reimburse without itemized receipts. If, as in Brooks’ case, you can’t get a formal copy of an invoice or treatment explanation, use your smartphone and take as many scans as you can before leaving.
- Make sure you purchase the right coverage for your circumstances
It’s crucial to get to know your insurance policy before you need to use it. Most plans have a 10-14 day lookover period. That’s the time in which you should thoroughly review all aspects of the lengthy document and confirm that you’ve purchased precisely what you need. *You can use a site like InsureMyTrip to compare a variety of travel insurance companies and policies.
- Understand what your policy covers
Many travelers file claims for items and events that their policies do not cover. In fact, during the coronavirus pandemic, our team has received a multitude of complaints from consumers with rejected insurance claims. Unfortunately, most travel insurance policies do not cover coronavirus-related cancellations. Filing claims for things that your policy does not cover is a waste of time and effort. Before you file an insurance claim, make sure that your policy covers you for that circumstance.
- File a complaint with your state’s insurance board
If all else fails and you believe your travel insurance company made a mistake by denying or delaying your claim, file a complaint with your state’s insurance board. That agency will investigate and give you the final word on your claim. (Michelle Couch-Friedman, Elliott Advocacy)