All too often, when travel insurance claims get denied, the first thing you hear is the lament: “but my doctor gave me a clean bill of health,” or “my doctor never told me my angina was unstable.” And though that may be true, the claim is still denied, and the aggrieved snowbird ends up stuck with a huge medical bill.
With more and more insurers offering medically underwritten policies to people in less-than-perfect health, the family physician can play a vital role in seeing their patients become better historians about their health. One way to do that is to spend a little more time explaining to patients why they need such-and-such a test, or why they are taking certain medications, and what their official medical record says about that first- or second-degree heart block, or what atrial fibrillation is in plain language, or if hemorrhoids are considered a gastrointestinal condition.
Travel insurance policies may stipulate that they will cover a pre-existing condition if it has been “stable and controlled” for a given number of days, or weeks, or months prior to the effective date of coverage.
But what does “stable and controlled” really mean?
Very often, insurance applicants are told by their family doctors that so long as they take their medication it’s okay for them to take off for their winter vacation in Arizona or Florida—as the doctor considers their patient stable, and since they’re “covered” by insurance, they may as well enjoy their vacation.
Except that the doctor’s interpretation of “stable” may not be the same as the insurer’s or the medical underwriter’s. Or their assessment may be that a second-degree heart block (a disturbance in the electrical conduction system of the heart) is asymptomatic, and since there is little they would do to treat the condition, why not let their patient get out of the cold weather and have a warm winter?
But if their patient is hospitalized for a medical emergency and their insurer finds that they did not report a heart condition on their application—even if their emergency had nothing to do with their heart—their claim can be denied for non-disclosure.
I advise every applicant for medically underwritten travel insurance to have a clear discussion of the contents of their medical record, in plain language, with their doctor, and explain that though they appreciate his or her concerns and care over the years—it is the insurer who will define what “stable and controlled” is.
A “clean bill of health” is a nice ideal. But it’s virtually meaningless in assessing a medical travel insurance claim.
Many doctors don’t know this. They don’t know how travel insurance works, and think that it’s only for emergencies, and it has exclusions and limitations. They need to learn. They should, because I’m willing to bet that every family physician in Canada has some snowbirds on their patient roster.