Medical Emergency of family member and Trip Cancellation Insurance

[songbirdofva]

Made arrangements for a cruise. During the first couple of days of the arrangement spoke with the agent and stated that I wanted insurance coverage they were offering. I have documentation that shows the insurance included on the travel agency's confirmation at the first deposit.

 

The agency didn't post the billing of the insurance to my credit card until about 40 days later.

 

Two days prior to the cruise there was a medical emergency where one of our parents (who was not one of the travelers on the cruise) was taken seriously ill with heart failure and required hospitalization.

 

We followed all directions for cancelling and lost all our money for both our tickets and the other set of tickets we purchased for our additional travel companions. We requested our claim forms and started gathering the appropriate documentation. The doctor has completed the physician's form, but there are statements on the form which state 'is this condition a complication of an underlying condition' where the doctor answered 'yes' and related it to cancer treatments.

 

Insurance coverage appears to cover the trip cancellation due to the requirement to hospitalize, but the issue of timely billing on the agency's side puts that of some concern as well as the treatment of the family member for cancer with drugs which brought on the heart failure.

 

While we haven't submitted the claim as yet, there is a concern that the insurance company will deny based on a 'pre-existing condition'. Looking for some help in how to provide the appropriate responses on the claim so that we are assured of getting an approval and return of over $7,000.

 

Thanks!

[patseacruiser]

Here is where the travel agent needed to advise you that pre-existing conditions are not covered unless the insurance is paid for with 10-14 days of initial deposit depending upon what company they are using. Just saying you want insurance and not paying for it until final payment are two different animals. If you wait to pay at final payment no pre-existing conditions are waived. Seems you either agreed to that or need a new travel agent.

[songbirdofva]

Here is where the travel agent needed to advise you that pre-existing conditions are not covered unless the insurance is paid for with 10-14 days of initial deposit depending upon what company they are using. Just saying you want insurance and not paying for it until final payment are two different animals. If you wait to pay at final payment no pre-existing conditions are waived. Seems you either agreed to that or need a new travel agent.

 

Answer is probably need a new agent. The agent was told, she even had a second staff member call to confirm. The billing statement was updated to show that as part of the cruise price and deposit made. The fact that the agency didn't post the insurance billing then and there...no clue. I'm addressing that issue with them right now. Since I have written documentation to the agreement within the timeline required.

[cruiseco]

 

While we haven't submitted the claim as yet, there is a concern that the insurance company will deny based on a 'pre-existing condition'. Looking for some help in how to provide the appropriate responses on the claim so that we are assured of getting an approval and return of over $7,000.

 

Thanks!

 

 

 

 

There's nothing you can do do improve your odds of getting the claim approved. The plan document spells out exactly what is and what isn't a pre-existing condition and when payment has to be made to the insurer to get any waiver of that exclusion. Payment was either received by the insurer in that time frame or it wasn't. Nothing you can do about that after the fact.

 

Two things can happen here -- #1 the situation doesn't fall under the plan's definition of a pre-existing condition and your claim will be paid. Many plans do not apply that exclusion to non-traveling family members. Without knowing the plan you purchased I have no way of knowing if this is the case with you.

 

Or, #2 your claim will be denied because of the pre-existing condition exclusion in which case (if I'm reading your post correctly) your travel agent may be responsible for covering your loss.

[sirwired]

When you received your policy documents in the mail, the declarations page should have had the effective date of the policy printed on it.

 

If the effective date of the policy is the cc billing date instead of your booking date, and if your claim is denied due to being outside a pre-ex waiver period, you will need to get your travel agent to pay up. Reputable agencies should have Errors & Omissions insurance for precisely this reason.

 

A few more notes:

- Not all policies have a pre-ex waiver available, no matter when pay you for the insurance.

- Policies with pre-ex exclusions commonly have time-limited "look back" periods. If the cancer was under control and no treatment changes were made within the look back period, you should be fine.

- Not all policies with pre-ex exclusions include non-traveling family members in the exclusion, so it may not matter at all.

 

You really need to spend some quality time with your policy to determine what your situation is.