Taking out health insurance for your next trip abroad: don’t fall victim to the fine print
A Saskatchewan man’s nightmarish journey to the United States is a cautionary tale for those traveling outside of Canada.
If you’re traveling soon, experts say, now’s the time to get travel health insurance and, they stress, read the fine print before you buy.
When Louis Lamothe, 72, of Halbrite, Sask., suffered a stroke while on vacation in Arizona, his family received another dose of bad news: Their insurance claim had been denied, and they’d also be on the hook for the $56,000 flight home . like other hundreds of thousands of dollars in medical bills to come.
Lamothe, who is currently recovering at Regina General Hospital, has not disclosed a change in his cholesterol medication. The 10-milligram pill he was taking was increased to 20 milligrams in July, three months before he left for the US.
Blue Cross rejected Lamothe’s claim for his hospital stay or flight home because they were unaware of the 10-milligram dose increase. The family says they don’t know why he didn’t disclose the change in dosage, but say it wasn’t intentional.
Will McAleer, executive director of the Travel Health Insurance Association of Canada, says it’s important to disclose underlying medical conditions before your trip.
“The insurers have a hard time when they look at a person to determine if a claim is affordable or not because they have to contact their GP to get a report that would have shown a dose change,” he said, referring into the possible reasons why it took Blue Cross 16 days to inform the family that their claim had been rejected.
Even a reduction in medication can affect coverage, McAleer says.
“The family has the right to appeal the claim decision,” McAleer said. “Some of the questions you should be asking would be if I had been made aware of the dosage change at the time of application, would you still have given me the policy or denied it,” he said.
“Even if the denial comes through, you can appeal the decision, but you do have a responsibility to provide the information before you travel.”
The insurance company declined an interview.
But in an emailed statement on Tuesday, Blue Cross said privacy requirements prevent them from providing details about the claim and their decision, but that all decisions go through a multi-stage formal review involving both internal and external experts.
“Less than one percent of personal travel claims are rejected due to false statement or omission of an application. When claims are rejected, help is always offered to facilitate repatriation arrangements to ease administrative burdens in a time of need, and planning costs refunded,” the statement read.
“Know Your Journey”
“Know your journey” is one of the tips McAleer recommends.
“Are you going on a trip and just sitting by the pool? Or are you going to be more adventurous and try bungee jumping or skydiving and other risky activities. And then check if your insurance covers those things.” .”
Some policies cover such activities, he says, but the customer may need to buy a little extra protection.
McAleer says the number of tragic incidents was quite low before the pandemic and “the number is still low.”
In his travel insurance association’s most recent claims survey, conducted before the pandemic, 94.3 percent of claims filed were paid by insurers.
“Since the pandemic, more people are taking out travel insurance, but make sure you do your homework, even if it’s not a big expense in the overall travel budget.”
Tijana Potkonjak, an attorney at Toronto law firm Devry Smith Frank LLP, called Lamothe’s situation “sad but not unique” when it comes to insurance law.
“You don’t see them in court much, as most of them settle out of court, with the insurer paying a percentage of what’s due under the contract — medical bills in this case — without admitting they owed that money in court. first place,” she said.
Potkonjak said both the insurer and the insured are part of a contract in good faith and the insured has a duty to share any relevant information or “material”.
The 10-milligram dose increase, she said, would qualify as a “material” change, but other subjective factors would play a role in the final decision.
“There would be a subjective and objective test that the court will use to determine whether this person knew this change was relevant,” she said.
“They will take into account his age of 72 and Lamothe’s sophistication, knowledge and background. Older people, in my practice, often don’t get travel insurance when they get sick and file a claim.”
The Afternoon Edition – Sask7:21What you need to know when purchasing travel insurance.
A Saskatchewan man and his family lost thousands of dollars after his overseas health insurance was revoked by his provider after suffering a stroke while in the United States. His family says the insurance was withdrawn because his cholesterol medication dose was changed from 10 milligrams to 20. Garth Matterie spoke to Will McAleer of the Travel Health Insurance Association of Canada about what people should know when buying insurance before traveling.
Potkonjak says it’s difficult for some people to keep track of their frequently changing medications and then inform the insurance company: “There’s a common law rule that a person shouldn’t disclose what they’re not asked to.”
But, she added, some questions are worded broadly.
“If there’s ambiguity in the contract, it’s interpreted in favor of people buying the insurance or getting covered,” she said.
Diagnostic tests include blood tests, MRIs, ultrasounds, scans, and the like.
“We are seeing more and more such cases lately,” Potkonjak said. “It could be because of the surge in travelers after the pandemic,” she said.
“The average person doesn’t know or overlook these things in the fine print of the policy. Larger letters and extensive phone calls to explain the policy can better help people.”
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