Travel Medical Insurance Claim Denied

[Sled]

Hey Guys,

We need some help from the collective brain trust of CP here. My mother in law has a complicated medical history but has been snow birding down to the US for the last 5 years or so. This last trip she suffered an unrelated heart attack and was hospitalized for a couple of weeks. As soon as she was healthy enough to leave her insurance company pulled her coverage and we put her on a plane to fly back to Calgary the day she was released. She then spent 3 more weeks in the hospital here.

They have now received a letter from the insurance company that their claim will not be paid as she "Lied" about some aspect of her application. There is nothing they would have lied about on the application as they were so paranoid that something like this would happen that she probably told them to much information.

Her doctors claim up here that there is no way she could have predicted what happened and that there is no reason the claim should be denied.

Has anyone else ever had something like this happen to them? Is this just standard procedure for these insurance companies? I'm also looking for any recommendations for a Lawyer in Calgary that specializes in this type of claim.

They are facing a pretty big bill for something they thought they were completely covered for.

[Johnny199r]

Need more info regarding what it is she is alleged to have "lied" about.

[Sled]

Originally Posted by Johnny199r

Need more info regarding what it is she is alleged to have "lied" about.

I have not seen the letter yet myself but her doctors have seen her application and letter of denial and have written letters for her that she did not lie.

edit - They are claiming she lied about having a problem with her heart. That there was a test she did that tested for heart problems that was completed 4.5 years ago. Her Doctor said it was for preventative measures as she does have several other health issues. Her Doctor said there was nothing wrong or out of the ordinary in the test results. There was nothing there that indicated she would have a heart attack almost 5 years later.

[PaperBagger'14]

I have nothing to contribute to this thread other than I'm glad to hear she's alright, I wish you the best of luck in dealing with the insurance company and you have a wicked avatar.

Try asking around CP,(I believe trout man is a lawyer), these lawyers might not specialize in that field but it's a small enough community they know someone who will. Good luck again!

[troutman]

I think Vlad would have some wisdom to share about this. Standard procedure for insurance companies to deny claims. Pressure from a lawyer could result in a settlement. Theses cases rarely go all the way to trial.

[DoubleF]

FWIW, I had a friend this happened to years back. Travel insurance tried to refuse a claim. They fought it for weeks (maybe months) and in the end insurance covered it.

I wish your family the best, good luck on all things and stick to your guns and get your claim.

[wretched34]

Not a lawyer, or an insurance claim agent, but have worked in HR for years, and have seen my fair share of queries like this regarding benefits, especially out of country medical.
Out of country is finicky at best, as you've noticed medical bills, especially from the states are very costly, and insurance companies always look for loopholes to get out of paying.
The biggest loophole is definitely "pre existing condition". this is likely where the denial came in, as they have evidence that she has been assessed for heart issues in the past, and likely at her doctors advice put that she did not have any heart issues on the application. It sounds like this is true, but again, insurance companies will deny at every opportunity, and make the insured put in the time and money to prove otherwise.
Having her Doctors on her side is definitely a good start, and hopefully with enough push back from her, and them, the insurance company will reassess. Otherwise it will need to turn legal.
Sorry I can't be of much help as far as actually pushing the claim through, and probably didn't shed much light on the situation, but I like the look of my own text.

Glad she is home and well now though!
Best of luck, hope you can get what is due, I hate insurance companies.

[Phanuthier]

I don't think I have anything worthwhile to help, but as a related story, one of my friends dad is getting ####ed by insurance companies as well for his cancer treatment for something similar to this. There are lots of stories like this in the USA...

Best of luck, insurance companies down here are scum bags.

[Temporary_User]

Originally Posted by Phanuthier

Best of luck, insurance companies down here are scum bags.

Insurance companies everywhere are scumbags. I would assume OPs mom bought insurance from a Canadian company before heading down or had travel insurance built into her employers insurance plan.

[Russic]

My wife's doctor heard what she thought might be a murmur, so she sent her for some tests. Turns out it was nothing. Simply by having those tests done she was denied life insurance. She was successful in getting mortgage insurance, but if she happens to die of a heart-related matter we've been told to expect that they won't pay.

Insurance is pretty great.

[Weitz]

Worst part of American Hospitals is they keep sending you invoices even though you have paid, just to see if you will pay again.

[undercoverbrother]

Originally Posted by troutman

I think Vlad would have some wisdom to share about this. Standard procedure for insurance companies to deny claims. Pressure from a lawyer could result in a settlement. Theses cases rarely go all the way to trial.

Standard procedure for lawyers to bad mouth insurance companies and chase ambulances. I can't think of too many cases of lawyers really speeding up things.

Sled, one word of recommendation, is she should escalate her dealings with the company. Often, the initial point of contact isn't empowered to make decisions/exceptions.

In short, your MIL needs to speak to the Organ Grinder and not the Monkey.

[vtec260]

Originally Posted by Weitz

Worst part of American Hospitals is they keep sending you invoices even though you have paid, just to see if you will pay again.

My Dad had a heart attack close to 20 years ago in US and had to use helicopter and was admitted to Johns Hopkins hospital for treatment. He survived, but didn't have any travel insurance. Bill was over $100G. He told them that he couldn't pay, but will try to pay monthly the best he could. After about six months, he stopped getting the bill as he was paying small amount monthly.

[Slava]

Originally Posted by Russic

My wife's doctor heard what she thought might be a murmur, so she sent her for some tests. Turns out it was nothing. Simply by having those tests done she was denied life insurance. She was successful in getting mortgage insurance, but if she happens to die of a heart-related matter we've been told to expect that they won't pay.

Insurance is pretty great.

I just thought that I would post and say that I could almost surely get a standard offer for your wife in this case. I sent you a PM to that effect as well.

I have no idea who you applied through or things like that, but I can tell you that as an independent broker we have access to a number of different companies for these reasons (some have varying standards), and frankly, some of us will go to bat to get things placed and make sure that the policy is written (as best as we can!)

I have a client with a hole in her heart who is otherwise healthy and I got her standard coverage for a full standalone life policy. It sometimes takes some effort on the part of the advisor, and there are no guarantees, but its a lot better than the mortgage coverage with the exclusion!