Time and again, travelers who have had their out-of-country health insurance claims denied complain that they applied for coverage “in good faith” and expected full and complete coverage after paying their premiums and heading out for a carefree vacation.
If only it were that simple.
First, let’s make it clear that according to most reliable surveys—the most recent being one by Canada’s provincial and territorial insurance regulators—the number of travel insurance claims denied is minuscule when compared to the millions of trips actually taken.
But, statistics aside, if it’s your claim that’s denied leaving you with the burden of a large foreign hospital or medical bill, it doesn’t matter how many millions of others have been approved and paid.
So what must you do to shield yourself from the possibility of having your claim for an out-of-country medical claim denied?
Read all That? Get Real.
We could say, read your policy from top to bottom and use your legal or medical dictionary to navigate the obscure terminology—too much of which is still present in travel insurance policies.
But we know that’s not going to happen. Who has the patience or the time to read 32 or 46 or however many pages of numbingly boring type? Only lawyers.
However, you need to understand the fundamentals, so this is what you must read and question if you’re not sure how the language applies to you.
Accuracy, Not Opinion, Counts.
Make sure you answer all of the medical eligibility questions accurately—as they are asked. Don’t make judgments about what you consider unimportant or irrelevant. If you are taking any medication, have seen a doctor for symptoms that concern you, have undergone any tests or are waiting for the results of tests, have been referred to a specialist for further care or investigation that must be reported.
Disgruntled claimants often fail to report having undergone certain tests because they didn’t show any abnormalities, or fail to take prescribed medications because they think they don’t need them, so they leave the question box blank: only to find their claims denied for non-disclosure. It happens too often.
Answer the questions as they are asked. Don’t try to manipulate questions so as to allow you “more convenient” answers.
Check Out Exclusions. Carefully.
Look carefully at the Exclusions section of your policy: have you in the three years prior to the effective date of coverage been investigated, treated, been prescribed medication or had a change in your medication for 1) a heart or artery disease, 2) long or respiratory condition, 3) etc.? Answer honestly, and if you’re not sure how long ago you had that catheterization, ask your doctor.
Also be aware, that exclusionary periods can change according to your age group or your medical status. For example, if you had a cardiac angioplasty more than 10 or 12 years ago, you are very likely to be put into a higher risk category because medical statistics show that the older the angioplasty/stent, the more likely it might break down and need a replacement. Or if you are over 60 or 65, your exclusionary periods may go back further, or require more questions.
Watch out for exclusions. They are not put into policies to trick you, but to separate out higher risk applicants from those who don’t pose a risk.
Trust Your Doctor. But the Policy Rules.
Also make sure you understand what terms such as “pre-existing condition” or “stable” or “treatment” mean—according to the wording of the policy, not your own pocket dictionary, or your family doctor’s interpretation. You will usually find “definitions” prominently explained in your policy, as you will “exclusions”. These are the rules you will be expected to play by.
And though your doctor may give you “a clean bill of health” to travel; be aware that you will still have to meet all of the eligibility and medical requirements as they are listed in the travel insurance policy and the application, before you are truly covered.
One last caution: if you generate a claim and your insurer gives the hospital treating you notification that you are covered, understand that the notification is not a guarantee of payment. That will only come after the insurer has investigated your medical records, perhaps going back years, to make sure that your application for coverage was completed accurately and you are truly eligible for the coverage you purchased.
Again, this is not trickery. A travel insurance policy is a contract between you and the insurer based on the accuracy and honesty of what both parties propose. It’s a two-way street.
Apply in “good faith.” But verify as well.
Are you ready to transition from the vetting phase to purchasing? Click here to browse our travel insurance policies.