Is travel insurance necessary? The answer to this question is an emphatic yes when traveling outside of the U.S. To give you the “why” here is a true situation that proves trip insurance can save your life and your financial security.
It was a Tuesday morning and I had just sat down to my desk to review the new appeals that had been assigned to me the previous day. I was working in the Grievance and Appeals department of a large health insurance carrier. I was sifting through the typical appeals that came across my desk such as “non-emergent” emergency room visits and medication denials when I ran across a letter from an insured’s wife that was out of the ordinary. I sat and read the letter in empathy for this couple. The letter described a couple in their 50’s who were U.S. citizens that had travelled to their birthplace, Turkey, for a two month visit. Three weeks into the couple’s trip to their homeland the husband suffered a massive myocardial infarction. He was taken to a hospital in Istanbul from the Turkish coast. The hospital was able to stabilize the husband however he needed extensive restorative heart surgery that needed to be performed back in the U.S. After three weeks in a Turkish hospital undergoing palliative and stabilizing treatment he was as ready as he was going to be to make the medical evacuation back to the U.S. The physicians were uncertain if he would survive the long trip home and being on an airplane. The couple had to personally hire a physician and purchase life-saving supplies and secure a plane that could handle the husband’s required medical bed and all of the medical equipment. As I was reading this detailed letter I knew this was going to be a substantial claim and couldn’t help putting myself into their shoes. I went on to read the end of the letter. Luckily the husband made it back to the States without any major complications and received the life-saving surgery he needed at Christ Hospital. The appeal letter ended with a plea from the couple for the health insurance carrier to cover their medical expenses incurred while in Turkey. So I began going through the Turkish medical bills that were submitted with the appeal letter. They all had been denied through first pass claim processing. I reviewed medical notes and calculated the bills and was astounded at my final calculation. The husband incurred over $1.5 million in medical bills and medical evacuation while in Turkey. I laid down my pen and began reviewing their health insurance contract to determine why none of the bills had been paid or even partially paid. The couple had a PPO plan so even though the Turkish hospital and medical transport was out-of-network the couple should’ve realized some type of claim payments. So, I researched a bit further and found the following, “No claims will be covered that are incurred outside of the U.S. while on vacation or holiday.” This exclusion was the reason why the husband’s Turkish claims were not being paid. I investigated further into his claims that were incurred when he returned to the U.S. and thankfully they had been paid in full with no initial denials. I sat at my desk a few minutes thinking how I could help this couple. Not only did their trip to their place of birth ended abruptly due to a severe medical condition; according to their contract they were facing almost $2 million in medical bills. I searched further and could not find a loophole in the contract to allow me to pay the claims partially or in full. I went to my Medical Director’s office with the letter and bills; he was good at finding a way to help our customers. I sat in silence while he reviewed the letter and medical bills. When finished he set the paperwork down on his desk and looked at me and said, “There’s nothing we can do. We have to deny the appeal according to the contract.” I replied, “There is nothing we can do…nothing?” My Medical Director advised me to send out the denial letter with a copy of their contract with the reason for the denials and included an option for the couple to have a second level appeal hearing. I went back to my desk and drafted the letter. I do not know the final outcome of this case because it went to an outside medical consultant for review.
That evening I wondered how often this type of claim denial occurred and couldn’t get the couple off my mind. The entire situation was tragic. This example is the answer to the question, is travel insurance necessary? EK Agency and Seven Corners offers several Travel Insurance plans to cover you in the event such as the true story just told. Here is an example of just one plan offered by EK Agency and Seven Corners; Liaison Majestic covers the following:
- Travelers that are away from their residence for 364 days or less
- Includes political evacuation
- Provides up to $1 million in medical benefits
- Emergency Evacuation, Repatriation, and 24-Hour Assistance Services
- Pre-existing Condition waiver for U.S. citizens
- Covered benefits include Political Evacuation and Terrorism
If you are planning to travel outside of the U.S. whether it is a once in a lifetime trip or your travel overseas often trip insurance is necessary. The denial the couple received in the example above is in fact an exclusion stated in most commercial health plan contracts; travel insurance covers this gap or exposure for you. If you are planning a trip and are asking yourself “Is travel insurance necessary?” please contact an EK Agency representative to discuss the travel plan that best fits you and/or your family. It could possibly save your life and financial well-being.