Pre Existing Condition..Travel Guard. ??.Anyone Understand This?

[jaja]

This is from the their plan..

 

 

Pre-Existing Conditions WaiverNot AvailablePre-Existing Condition Period180 Days

 

Pre-Existing Condition Period

 

PRE-EXISTING MEDICAL CONDITION EXCLUSION:

The Insurer will not pay for any loss or expense incurred as the result of an Injury, Sickness or other condition of an Insured, Traveling Companion, Business Partner, or Family Member which, within the 180 day period immediately preceding and including the Insured’s coverage effective date: (a) first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; (b) for which care or treatment was given or recommended by a Physician; © required taking prescription drugs or medicines, unless the condition for which the drugs or medicines are taken remains controlled without any change in the required prescription drugs or medicines.

 

I am confused...

Doesn't this seem a little "loose"--who decides what a reasonable person is??

 

Not to mention..that I can't understand the rest of it either :eek:

Does this mean I can't get sick and see a doctor 190 days prior to cruise..(part b)

[cherylandtk]

It means that anything you see a doctor for (or 'reasonably' should have) in the 180 days before you buy the policy is not covered under the policy. So, if you have an ongoing condition and want it to be included in your cancellation or medical coverage you need a different policy with a Pre Existing Condition Waiver.

 

It does not mean you cannot get sick and see a doctor for something. It just means that if you want trip coverage or cancellation because of that something you need to buy the insurance BEFORE you get/catch/be diagnosed with the something.

[jaja]

It means that anything you see a doctor for (or 'reasonably' should have) in the 180 days before you buy the policy is not covered under the policy. So, if you have an ongoing condition and want it to be included in your cancellation or medical coverage you need a different policy with a Pre Existing Condition Waiver.

 

It does not mean you cannot get sick and see a doctor for something. It just means that if you want trip coverage or cancellation because of that something you need to buy the insurance BEFORE you get/catch/be diagnosed with the something.

 

Thank you SO much for a clear explanation !

 

(I wish you were writing their explanations;))

[cruiseco]

The "reasonable person" part is to prevent some from doing something like this:

 

A cruiser has absolutely no plan on buying a travel insurance policy. A month before sailing he starts coughing up blood and thinks "if I buy a policy today and go see the doctor tomorrow that won't be a pre-existing condition since the doctor won't diagnose the problem until after I'm covered."

 

This clause closes that loophole. Travel Guard would consider the condition to exist as of when the coughing started -- when a "reasonable" person would seek treatment.

[Kellie Poodle]

Don't expect much from Travel Guard. They have a patent on weaseling out on the provisions in their contracts. I'm a victim.

[klfrodo]

Don't expect much from Travel Guard. They have a patent on weaseling out on the provisions in their contracts. I'm a victim.

 

And I completely disagree. I've filed twice with Travel Guard and had my checks in a couple of weeks. I'm sure that if I was in the minority, most state insurance commissioners would no longer allow Travel Guard to be sold in their state.

[cruiseco]

And I completely disagree. I've filed twice with Travel Guard and had my checks in a couple of weeks. I'm sure that if I was in the minority, most state insurance commissioners would no longer allow Travel Guard to be sold in their state.

 

Plus, these types of decisions aren't made by Travel Guard or Travelex either.

 

For example, this is from Travelex's wording:

 

"All medical transportation services must be authorized and arranged by Travelex's designated provider. In the event of an unauthorized Medical Evacuation, reimbursement may be limited or coverage may be invalidated."

 

Travelex has neither the expertise nor the desire to do what's necessary to arrange an emergency evacuation so they contract that service out to a third-party and wash their hands of it. They essentially purchase for you a short-term membership with one of the worldwide providers of this type of service.

 

Some of the insurers use One Call, some use Mondial Assistance, some use Allianz, some use EuropAssist and so forth. And they change all the time -- for example up until a while ago CSA used One call and now they're using EuropAssist.

 

This also explains the last line quoted above. The insurer (Travelex in this case) has already pre-paid the service provider to handle any emergency evac the client might require (the small portion of your premium that's your membership fee paid to the service provider). It's kind of like AAA and their towing service -- each member pays a small amount and AAA knows that in an average year they'll collect more in fees than they'll actually pay out to the tow companies. So if you decide to arrange your own evac you're risking not getting reimbursed by Travelex. Their attitude is that they already pre-paid your membership fee to have this handled so why should they pay a huge chunk of money out again because you didn't follow the rules?

 

So, the ironic part is that if Kellie Poodle should ever need to call for an emergency evac in the future the same darn person might answer the phone (and be making the decisions) as last time even though she's switched insurers.

[paul929207]

They are saying that if you wait until you know about a problem to purchase their insurance, they will not cover you for the stuff you knew about. To cover pre-existing conditions, you must usually purchase the travel insurance within 14 days of booking.

 

So for example, if after you book, a parent has a heart attack. You then buy the insurance. Two days before the cruise the parent dies from heart problems. The insurance company would not pay for the canceled cruise. Had you bought the insurance when you booked they would have.

[Kellie Poodle]

And I completely disagree. I've filed twice with Travel Guard and had my checks in a couple of weeks. I'm sure that if I was in the minority, most state insurance commissioners would no longer allow Travel Guard to be sold in their state.

 

 

They did everything in their power to weasel out of a medical evacuation. We had primary coverage for one million dollars medical evacuation and they wouldn't do it.

 

I got checks from them, too, but when it came down to what would really cost them money, they failed.

[Kellie Poodle]

 

So, the ironic part is that if Kellie Poodle should ever need to call for an emergency evac in the future the same darn person might answer the phone (and be making the decisions) as last time even though she's switched insurers.

 

 

I beg to differ with you. The persons I had contact with were employees of the insurance company, in our case Travel Guard. Had they agreed to the very necessary medical evacuation for which we had one-million in coverage, then I could see us being transferred to a third party. That never happened. Travel Guard acted in bad faith by failing to provide the contracted service and thwarting any avenues to achieve such service.

 

If this service had been pre-paid, as you suggest, Travel Guard would have provided it under the contract. They had the right to approve the evacuation and that decision was made by a paramedic even though he'd been told by others more familiar with the case that the patient was not receiving proper care and should be evacuated. They wanted to save money, not save a life.

 

Travel Guard even refused to hold a translated phone conference between the patient's personal physician at home and the treating physician, even though this provision is in the contract. The personal physician at home called them and requested it. They denied it. Their reason was that the treating physician had to request the conference. Of course they made certain that the treating physician never knew that.

 

You can deal with whomever you want. I was stuck in Sicily with a husband in a hospital of third world quality, providing him dangerous care depending upon a very expensive insurance policy with agents who were more concerned with their bottom line than his health.

 

Unless you were there you can't have any appreciation of how difficult it was for me to have to worry abut my husband's health and treatment by doctors who didn't speak English and had never seen an insulin pump (they made the patient remove his) while fighting with an insurance company to get the benefits we had contracted for.

 

Believe what you want, but I was there.

[6rugrats]

That never happened. Travel Guard acted in bad faith by failing to provide the contracted service and thwarting any avenues to achieve such service.

Travel Guard even refused to hold a translated phone conference between the patient's personal physician at home and the treating physician, even though this provision is in the contract. The personal physician at home called them and requested it. They denied it. Their reason was that the treating physician had to request the conference. Of course they made certain that the treating physician never knew that.

 

I don't know what type of policy or coverage you had so impossible to comment if you received what you paid for. However, if you feel TG did not comply with the terms of your policy, you certainly should file a complaint with your State's Department of Insurance.

[klfrodo]

To imply that Sicily is third world country loses all credibility with me.