TRAVEL MEDICAL INSURANCE.
YOU DEFINITELY PAY THE PREMIUM BUT ARE YOU DEFINITELY COVERED?
Like thousands of Canadians, my wife Rita and I drive south from Osoyoos in BC around mid October to our small home in Yuma Arizona. As prudent individuals, we always secure insurance for Outside of Province emergency medical treatment for the six months of intended absence. We did so this year with Group Medical Services (GMS). In February we flew from Yuma Arizona to Bangkok Thailand for a 3-week break. The following is a summary of what happened after we had been in Bangkok for about 10 days. I hasten to add that I am going into a little more detail than is really necessary only to indicate the seriousness of the situation and our need for as much moral support as possible.
- Rita had a heart attack around 7pm March 6th in the hotel.
- She was taken by ambulance to emergency in Samitivej Hospital - accompanied by a doctor (standard procedure in Thailand). She was diagnosed and stabilized for the night with a routine procedure planned for early the next morning.
- 2 Stents were inserted March 7th around 7.30am with no apparent complications and she was transferred to ICU.
- Around 9am her blood pressure plummeted and an emergency procedure was carried out in ICU. I was told later (and I repeat in layman’s terms) that one of her arteries had fractured and blood was seeping into her heart sack, which needed to be drained immediately. In the haste to do so her liver was punctured and needed repair later. Also, her stomach began bleeding and her blood sugar rose to a very high level (I believe 600 was the number) both for no apparent reason. In view of the multiple complications, several doctors were in attendance and the emergency procedure lasted about 1 hour.
- After being stabilized she was taken back to the operating room for corrective procedures and 3 hours later taken back to ICU. The surgeon explained all that had happened. Rita’s was the 1% chance of something going wrong they mentioned when first describing the normally routine procedure and ultimately proved to be the second most complicated heart surgery, where the patient survived, in the cardiologist’s 25-year career. We were later told that she is now a case study of the heart surgeon.
- She remained in ICU for 9 days and discharged from hospital March 17th.
- The cardiologist examined Rita as an outpatient 3 days later and cleared her to fly back to BC in business class accompanied by a nurse from door to door.
- We remained in the hotel whilst GMS and the airline reviewed Rita’s condition. Medical clearance to fly back to BC March 30th was finally received on March 28th.
We had the obvious heartache and worry of a traumatic medical emergency outside our province of residence but the satisfaction of knowing that we had paid for adequate insurance to cover such an eventuality. I envisaged the insurance company would be our lifesaver; not only from a financial standpoint, but also our friend in need whilst we were in a far-away non-English speaking country.
How wrong I was! Our true friend was the hospital that didn’t wait for beaurocratic form-filling and clearance procedures to be completed; they just went ahead and immediately did what was necessary to save Rita’s life.
The cardiologist informed me that from day one the Group Medical Services (GMS) doctors were phoning him 3 times daily to monitor Rita’s progress. How nice and considerate of them I thought, but at the same time wondered why they hadn’t called me. Was it because they were constantly assessing the cost of the hospitalization before they would commit to paying? I will probably never know the truth but it sure looked that way at the time and one doesn’t need that kind of negative thought at a time like that.
When GMS did contact me after a few days, the main messages were:
1) They would not guarantee payment to the hospital until they had received information from our BC family doctor and they had verified that Rita had not lied on the application.
2) They would not repatriate my car from Yuma unless Rita had to be repatriated and hospitalized in Canada.
3) They would only pay up to C$1,000 for expenses incurred by me as a result of the medical emergency – extended hotel stay and taxis etc..
4) They would only pay up to C$1,000 for an economy ticket for me even though Rita would fly business class.
I did not consider the above messages and the way they were conveyed to be those of a much-needed friend.
GMS finally confirmed on March 21st that they would pay this claim. This was 15 days after Rita’s admission to hospital – 9 of which were spent in Intensive Care. Imagine worrying about the life and death situation and whether or not we would need to come up with an as yet unknown amount of money!
Later conversations with GMS all had the same tone – here’s what the policy terms are and we’ll not consider paying anything extra – period; give us your credit card number to pay the difference between the policy benefit and the actual cost.
OK, the policy is the governing document and I guess I’m as guilty as most people – we read what we want to read and feel comfortable when we see something like for example “Policy Maximum of $2,000,000”.
It seems reasonable to assume that $2,000,000 will cover anything that could possibly go wrong!
However, this maximum is made up of the components listed above. Ticket home for me C$1,000; Extra expenses C$1,000 and repatriation of car C$2,000. First of all, am I missing something here or is GMS actually putting more emphasis on getting my car back home than myself! Doesn’t matter because they declined to pay the benefit anyway! Secondly and I still may be missing something but when these pathetic maximums (along with a few other relatively minor benefits) are deducted from the $2,000,000 policy maximum, there is an enormous amount left over to pay the actual medical bills. I would imagine one could have just about every organ in their body replaced for the available resultant dollars.
The only apparent reason for a Policy Maximum of such an unrealistic amount is to enhance the policy’s attraction to the ignorant buyer.
$1,000 to fly me home: The lowest fare they quoted me was over $2,000. You could say $1,000 would fly me home from anywhere in the States. Yes true, but this is “Out of Province” insurance - NOT “USA” insurance. To be realistic and for the relatively small number of dollars involved, I think the covered member repatriation maximum should cover a flight from anywhere in the world.
$1,000 extra expenses: Perhaps adequate if you have a home in the south but if on vacation in a hotel it is not.
$2,000 car repatriation: It is absolutely ludicrous to make this benefit dependent upon the hospitalization of the patient.
When GMS and I were discussing getting us back home, they even suggested that I fly back to Yuma to pick-up our car and drive it back to BC while they flew Rita directly to BC! Can you imagine anybody not being angry and surprised at such a stupid and uncompassionate suggestion? How could they think I would even consider letting my wife fly home with a complete stranger, albeit medically qualified, and then arrive home to an empty house waiting for me to drive 1,600 miles from Yuma.
Another aggravating point is that they employ the services of a Travel Agent. Cut a long story short, here is a summary of the saga per emails when I queried the arrangements:
GMS “As explained in previous e-mails, the benefit for your return is to a maximum of $1,000CAD. The full cost of an economy ticket is $2296, so we will require your credit card information at your earliest convenience to pay for the difference”.
GMS “I am just writing to advise you that when checking with our travel agent this morning regarding the business class seat, they advised me that a seat became available and the cost is: 4427.90 CAD. (including taxes and the travel agent’s fee)”. Please advise us if you would like to book this seat - your credit card would then be charged for 3427.90 CAD.
AH “Per our telephone conversation, here’s the itinerary I told you about. I do not want you to jeopardize my flight home with Rita but please present to your travel agent the question “Why am I being asked for C$4,427.90 when I can book the same flight for C$3,593.69”? Please review and advise by email ASAP”.
GMS “Full Business Seat J Class seat is $4357.90CAD plus agent fee (approx. $100CAD). 2nd Level Business Seat D Class seat is $3614.90CAD plus agent fee (approx. $100CAD). I have confirmed with the travel agent, and have put you in 2nd Level Business Class, which is the same as the Full Business Class we booked for Rita. We will also confirm again in morning in the actual seating arrangements. (system not allowing the travel agent to confirm at this time). I don’t have any further detail or reason why there is a difference in price when it’s the same class of seat. But the difference right now in which you will be responsible for is approx. $2614.90CAD.
Maybe I’m slow but can you understand the price part of the last email from GMS? Anyway I did save approx. C$800. Was it just me being ripped off or is the Travel Agent ripping off GMS and all it’s clients? These are questions that really need to be answered. To add to the disappointment, I had sent GMS an itinerary several days prior the above saga. The cost of a business class ticket at that time was only C$1,858.81 with Air Canada. If the GMS team had their act together, they would have discovered this but they started down the wrong road to get medical clearance from Cathay Pacific and it proved expensive – we probably overspent collectively by approx. C$6,800.
One morning at 1.30 am GMS called me with information. At 4.30 am they called again contradicting the previous info and confirmed we would be traveling back to BC on March 30th by Cathay Pacific. Apparently they or their Travel Agent had “lost” a business class seat with Cathay so they then attempted to obtain speedy medical clearance to fly with Air Canada. This was not possible so they had to somehow resurrect the Cathay ticket.
All the arrangements were now made and the three of us, Rita and I and the Thai nurse, went to Bangkok airport and presented our travel documentation. Another hiccup! Cathay asked me for Rita’s Certificate to fly from the doctor. I didn’t have one of course as GMS and the airline had sorted out this between them or so I thought. I was at a loss for words, but fortunately the nurse was able to have a certificate faxed to the airport – after a very stressful half an hour of discussions with airline officials.
We boarded the aircraft and were seated in the wrong seats of course! We had all been given seats in different locations so the fight attendant sat us all together – much to the annoyance of the guy that had Rita’s new seat on his boarding pass. Cathay very kindly sat him in First Class, so he was then happy.
We landed in Vancouver, after flying for approx. 13 hours, and another anticipated screw-up became a reality. When arrangements were being made to get us home, GMS planned a “limo” from Vancouver airport to our home in Osoyoos – a drive of approx 5 hours. I did tell them about the long drive but they obviously didn’t listen as when we arrived in Vancouver, the limo driver went white when we told him our destination. He had been told 5 minutes to local hotel. He called his boss and got the OK to drive us to Osoyoos. I asked him to drop off the Thai nurse at her hotel in Vancouver but she insisted on traveling with us to Osoyoos and then returning with the limo. She would get back to Vancouver around midnight and then fly back to Thailand the next day. Poor girl, she would be totally exhausted. Another good planning exercise by GMS don’t you think!
I couldn’t believe how so many things could go wrong – but by now expected it and thanked God we had survived this traumatic ordeal and were almost home.
So what are my conclusions?
READ EVERY SINGLE WORD in your Travel Policy and make sure it will suffice for all your intended and even possible travel plans. For example, you may decide to take a side trip to see the kids in Australia when you are wintering in the southern USA. Remember the C$1,000 maximum rehabilitation benefit should something happen all those miles away! Unexpected relatively high expenses may not be a problem to some people it could prove both embarrassing and difficult for others to find the necessary funds at the drop of a hat.
CONSIDER OTHER OPTIONS if your insurance broker offers you a policy with GROUP MEDICAL SERVICES. This will be my attitude until they have provided me with logical reasons for the many screw-ups and changed both their policy provisions and also their attitude in claims administration. The latter by the way is done by a third-party named WTP – this is another faceless matter of fact company with absolutely no compassion at all that simply blames the GMS underwriters for any bad news they are obliged on to their claimants.
GMS. Get your act together. Amend your policies to at least give some benefit of the doubt to your clients – they really do need only good news at the time of a serious illness. Worst thing that could happen is you screw up by paying unnecessarily on the odd occasion but satisfy the majority of your clients. I firmly believe that most of your clients will not knowingly tell a lie on the application, but many are getting on in years and may forget some minor medication or procedure that may ultimately give you a reason not to pay, which is obvious of paramount importance to your company. Forget this shameful attitude of whatever you can uncover to avoid paying – it’s totally unacceptable.
SUGGESTION FROM A LAYMAN. Life insurance policies contain an “Incontestability” clause whereby the insurance company has two years to verify the answers given by the applicant on the application. After that time period, they cannot say the applicant lied and refuse to pay the claim. Why can’t a Travel Policy have a similar clause?
I believe the following scenario would be preferable to the current industry standard.
Client applies for travel insurance to be effective next day (as can be done now) as he is traveling out of province. He would be told that this is not possible with XYZ company. He must go with another company if he cannot postpone his travel for say 14 days. Why? XYZ company needs 14 days to verify that he has not lied on the application. Once they have verified he has told the truth they will provide an IMMEDIATE GUARANTEE to any medical facility in the event of a claim. The other companies’ current practice precludes them from doing this as they only begin to verify answers in the event of a claim and this can take weeks.
Would this work? I have no idea, but I do know that something must be done quickly to ensure that IF YOU HAVE HEALTH INSURANCE, THERE MUST BE ABSOLUTELY NO DOUBT ABOUT PAYING A CLAIM IF YOU HAVE PAID THE PREMIUM AND ANSWERED THE QUESTIONS TRUTHFULLY.
I don't know if there are any medical facilities in the world that would let someone die for lack of funds - but personally I'm not prepared to be the first one to find such a facility!
As a matter of interest, Rita’s total hospital bill was roughly C$50,000. The USA trained heart surgeon estimated the cost of a similar procedure in the USA to be between 450,000 and 500,000 US dollars. One would think that if an insurance company saved that amount of money, they could waive the maximums and pay any additional costs expended that exceeded the policy maximums. I was told this would not happen.
Why should YOU care? Book a trip outside your province of residence, become seriously ill and make a claim. If you survive the illness compounded by the financial uncertainty of the claim, you could then join me in my efforts to bring Travel Medical Insurance policies into the 21st century - where people's welfare is slowly becoming more important than the production of automobiles.
If this doesn't appeal to you, please believe me when I say, without reservation, that at the very least THIS ISSUE MUST BE REVIEWED BY A COMPETENT AUTHORITY - AND SOON!
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