Question
What is the name of your state? Oregon
In March 2002 my husband and I went on a Caribbean cruise. We purchased the very expensive travel guard insurance that was supposed to pay if luggage was lost, cruise was canceled or if we got sick the health coverage part would kick in. We purchased the insurance 5 months before we went on the cruise and it was paid in full at time of purchase. Since we would be out of the country we figured this would be the best way to go since we were unsure if our own HMO would pay if something went wrong.
Ask luck would have it, my husband choked on a peice of food and it would not dislodge. The Doctors on the ship could not get it out and he needed to be taken off the ship and rushed to a puerto rico hospital. We had to pay for evac ambulance and doctor bills by cash which was not a problem. They would not take him any other way. The travel guard insurance was contacted and they arranged for the hospital bills and surgery bills to be paid before we left the hospital. They told us they had everything covered and glad they could be of assistance.
We thought we were very fortunate to have this insurance. UNTIL now. On 12-19-02 we recieved a call from our HMO, stating they will be reimbursing the travel guard insurance 75% of the costs they paid and we are responsible for the other 25% as our standard deductable. We also received a late notice from the Puerto Rico hospital that we have an outstanding bill of $521 for surgery room time. We had heard nothing from the travel guard insurance company since March 2002 when the cruise ended. We thought they paid all the expenses since we paid their very expensive $995 preimum for the 7 day cruise.
If we have to pay 25% and our HMO is paying the other 75%, plus we already paid cash for the amublance and Dr bills, now we have to pay for the surgery room time. Just what good was it for us paying for the travel guard insurance in the first place? They will get every dime they spent plus the $995 preimum charge.
I have tried to read through their mombo-jumbo they call a policy and in no section can I figured out where it says, they will have to be reimbursed for any medical expenses they pay for. It just goes in to detail what they will and will not pay for. What happened to my husband was clearly covered. As it was accidental, not pre-exsisting and was not a self inflicted wound.
The policy states that the limits for medical and hospilzation was $50,000. His bill was way below that. Again, I could not find a clause that says this must be reimbusrsed if any portion of the medical is used.
Does this sound right? I have a call in to the Travel Guard insurance company, but as of yet they have not returned my phone calls.
The hospial bill for the surgery room is now 9 months behind and we just got the very first bill from them 4 days ago. I would like to get it paid as soon as possible, but I do feel that the insurance company is resposible since this is why we purchased insurance in the first place. I surely do not want this way past due bill to go on our credit report as being 9 months late, when this is the first we ever heard of it.
Is this standard practice to purchase insurance only to have them get reimbursed from your HMO if something goes wrong? Does something sound weird in all this or am I just expecting way to much from the insurance companies? In retrospect I should have just saved the $995 and spent it on the 25% deductable. I guess this is whats called insurance poor!
Any advise would be appreciated.
Answer
Verrrynice,
Apparently the policy covers quite a bit more than just medical expense.
Also, there are apparently two plans to choose from, one is "primary" and the other "secondary". You medical plan may have been "secondary" although you do say you purchased the more expensive plan. You should have an agent, or someone knowledgeable, review the situation in detail. You can also file a complaint with the Oregon Dept. of Insurance.
Answer
While I am not an expert in the travel insurance field a "coordination of benefits" and "primary / secondary" provision that prevents the insured from collecting twice makes sense. For one insurer to be subrogated by another also makes sense.
BUT what would is NOT right is if you should be asked to pay your HMO's deductible out of pocket. Let the 2 companies fight it out.
If you don't get satisfacti, contact your state insurance department -- I would if I were you.