The most frequent cause of travel insurance claim denial is the presence of a pre-existing condition; which is ironic because almost every travel insurance policy issued says it will cover pre-existing conditions (albeit with some limitations). The trick is to understand those limitations.
If travel insurers were to deal only with people in perfect health, who take no medications, and only go to the doctor once a year to show off a perfect stress test, their market would be too small to bother with.
And so they need to hedge their bets and offer policies that allow coverage of conditions that are stable and under control, possibly with medication and intermittent monitoring by doctors, but don’t present too great a risk of erupting into full blown conditions that are going to require expensive diagnostics or hospitalization. That’s why you are asked certain medical questions when you apply, or why you must complete medical questionnaires if you’re over a certain age limit, or you have a spotty medical history.
If you’re in that “less-than-perfect health” category, as most of us are, you need to read and understand the insurer’s definition of “pre-existing condition.” If you read nothing else, you must read that.
Here are some tips to understand “pre-existing condition.”
There are certain serious conditions that insurers will not cover, such as terminal illnesses , certain cancers, and HIV/AIDS, but they will be clearly listed in the eligibility section which tells if you are insurable. If you’re not, don’t bother reading any further and move on to another insurer. Not all impose the same eligibility criteria. Some are more lenient than others.
If you pass the eligibility criteria, any set of symptoms that you experienced or conditions that were under treatment within a specified period prior to your trip will be considered “pre-existing.” Some policies will specify 90 days, some 180, some 365: make sure you know.
Most insurers will cover those conditions if they were “stable and controlled” during that specified period
period. But what is considered stable and controlled is determined by your policy, not your doctor’s opinion. And “stable and controlled” usually means the symptoms or conditions did not intensify, did not require a change of medication, treatment by a doctor, referral for testing or investigation, or consultation with a specialist. And they don’t have to be specifically diagnosed or given a firm clinical name by your doctor. So long as the symptoms or conditions existed and required some kind of medical intervention, they will be considered unstable pre-existing conditions.
Many claimants insist that their doctor never told them they had pre-existing conditions, or that they were unstable, or that they knew what was in their medical record in defending a denied claim. That’s no longer good enough. If you have a major claim in a foreign hospital, your insurer’s assistance company will requisition your domestic medical records and go over them with a fine tooth comb. This is not a name of gotcha. They’re not trying to trap you. But they are trying to verify that they are not paying for risks that were hidden from them when you applied for insurance.
Take advantage of offers of coverage even if you are in imperfect health. Insurer’s want you to. You make up a huge share of the market. But be aware of the conditions of such coverage. And to protect yourself, make sure you know what those limitations are. Travel insurance is not a substitute for your domestic medicare: it’s a supplement to it.