Primary vs Secondary medical

[FOXYDEBBY]

I obtained travel insurance for my upcoming cruise but medical is secondary. I do not have out of network benefits on my health insurance (HMO). Will the travel insurance automatically pick it up if used or will they refuse to pay because there is no primary? I still have time to cancel if I must. TIA.

 

Debra

[GeezerCouple]

8 minutes ago, FOXYDEBBY said:

I obtained travel insurance for my upcoming cruise but medical is secondary. I do not have out of network benefits on my health insurance (HMO). Will the travel insurance automatically pick it up if used or will they refuse to pay because there is no primary? I still have time to cancel if I must. TIA.

 

Debra

 

Assuming that this is written as other "secondary" policies are written, that won't be a problem.

 

But NOTE:  It is ALWAYS safer to ASK the insurer or agent directly, and not "assume", when dealing with insurance.

 

What is likely to happen, if you have a medical claim, is that you'd need to submit documentation that out of network coverage isn't included, and then they'll start the processing.

But also make sure that your regular policy doesn't include out of network if it is an *emergency*.  If it does, then the travel insurance would pick up anything not included (such as deductibles or co-pays).

 

IF you had "primary", then you wouldn't need to submit anything.
In your case, it should be easy to submit copy of the policy terms.  Hopefully the travel insurer wouldn't then require that you actually submit a claim and then wait for the denial.

 

GC

[FOXYDEBBY]

1 minute ago, GeezerCouple said:

 

Assuming that this is written as other "secondary" policies are written, that won't be a problem.

 

But NOTE:  It is ALWAYS safer to ASK the insurer or agent directly, and not "assume", when dealing with insurance.

 

What is likely to happen, if you have a medical claim, is that you'd need to submit documentation that out of network coverage isn't included, and then they'll start the processing.

But also make sure that your regular policy doesn't include out of network if it is an *emergency*.  If it does, then the travel insurance would pick up anything not included (such as deductibles or co-pays).

 

IF you had "primary", then you wouldn't need to submit anything.
In your case, it should be easy to submit copy of the policy terms.  Hopefully the travel insurer wouldn't then require that you actually submit a claim and then wait for the denial.

 

GC

Thank you for your response. I am hoping I won't have to even find out. But you have given me a peace of mind. Thank you. Enjoy your new year!!!

[GeezerCouple]

1 minute ago, FOXYDEBBY said:

Thank you for your response. I am hoping I won't have to even find out. But you have given me a peace of mind. Thank you. Enjoy your new year!!!

 

And actually, to be more precise/accurate, you DO have health insurance.  It's just that it doesn't cover <whatever it doesn't cover>.

 

That's often a reason some people get travel insurance.  
Basic Medicare typically does not cover out of country medical care, and that's similar to your situation.

The main question probably is whether they'd insist that you file a claim, wait for it to be declined (assuming that's what happens), and *then* pay.  That's also pretty much the same thing as having the travel insurance pick up whatever wasn't covered.

 

Our travel insurance has twice covered a physician's visit to our hotel room.  I have no idea if our regular insurance would have covered that.  If they did, I'd be surprised if they'd cover the full amount.  (Translation:  Hotel physicians do charge for the convenience...)

 

GC

[klfrodo]

Just to make sure there is no misunderstanding, you will have submit claims to the HMO, then they will deny coverage, then you submit to the travel insurance plus send them a copy of the HMO denial letter.

Yes, it’s a pain, but it is the process.

[Ep010835]

Or you can ask your question on:

https://boards.cruisecritic.com/forum/2441-qa-cruise-insurance-w-steve-dasseos-of-the-tripinsurancestorecom/

 

The policy I purchase for each of our trips is from an insurer that will issue a primary coverage policy rather than secondary coverage for an upcharge of $25/pp. My thinking is that doing so will save a lot or wear and tear on me if ever needed.   

Edited December 30, 2018 by Ep010835

[FOXYDEBBY]

I understand. My DH wants me to cancel it but its so cheap for a plan it gives me peace of mind knowing I have it. Thank you. 

[Hlitner]

While I can understand the "wear and tear" issue, paying extra for Primary is tossing away money.  And keep in mind that if you have a lower deductible with your regular (not your travel policy) it still can become complicated.  For those that do not understand lets talk about Primary vs Secondary.  It simply has to do with who pays first...when there is a claim.  In theory you would first submit a claim to your Primary Insurer and then wait for claims settlement.  In a perfect world your Primary Insurer will work with any secondary providers (they usually ask for this info when you file a claim) and internally handle any necessary "claims coordination"  (also sometimes called "third party liability" within the insurance industry).  But many Primary payors (especially travel insurance companies) will simply pay their portion of the claim and send you an EOB (Explanation of Benefits).  At that point you can file other claims with secondary insurers (include a copy of that EOB) to try and get reimbursed for stuff not paid by the primary.   All this is somewhat of a hassle and also involves delays.  Most reputable insurers try to settle claims within 30 days, but do not hold your breath :).

 

Even with Medicare some travel insurance companies (who are secondary) will insist that you first file a claims with Medicare...even when they are well aware that Medicare will not cover the service.  One thing we really appreciated with our annual Geoblue plan is that when we had to file a major claims, GeoBlue just asked us to file a claim and they would take care of everything (acting as Primary) which they did!

 

We also suggest that frequent cruisers/travelers take a good look at annual travel and or medical policies versus buying something for each trip.  Annual plans will often give you a lot more benefit for your money.   Also beware of policies sold through cruise lines and cruise/travel agents which might have attractive cancelation provisions but give you wholly inadequate medical coverage.  Always remember that your potential liability for medical bills is unlimited while cancelation is limited to the trip cost (which you were going to pay anyway).

 

Hank

[Ep010835]

5 hours ago, Hlitner said:

While I can understand the "wear and tear" issue, paying extra for Primary is tossing away money.  

Then so be it. We're talking about $25/pp here. $50 in my case. My time (and yours I strongly suspect) is worth far more than that in not having another link in the chain that I have to deal with in the event of a claim.

I consider the primary supplement to be just a component part of the overall policy. Much like your GeoBlue policy. 

[Hlitner]

1 hour ago, Ep010835 said:

Then so be it. We're talking about $25/pp here. $50 in my case. My time (and yours I strongly suspect) is worth far more than that in not having another link in the chain that I have to deal with in the event of a claim.

I consider the primary supplement to be just a component part of the overall policy. Much like your GeoBlue policy. 

The irony is after a lifetime working in the Medical Insurance Industry (Government) and helping folks here on CC, I never had to deal with a major travel medical issue until this past April.  That was a pretty complex situation which ultimately involved lots of dealing with Geoblue (all good) and also with Chase (not so good).  The medical claim stuff was actually not too difficult because I had worked in that field for over thirty years so had a good idea what was expected.  As I have often advised, the key to medical claims is to get everything documented in maximum detail...which is best done at the time and at the source,  When I finally filed my medical claim with GeoBlue they paid everything (expect one taxi bill) in less than 3 weeks.  GeoBlue also paid for about $10,000 of medical evacuation.  But dealing with Chase, who provides $10,000 of trip cancelation and interruption insurance (as part of free card benefits on their higher end cards) turned out to be a major challenge.  Their claim procedure was complicated and took many weeks (with lots of two way communication between Chase and myself) but we finally got a check for the maximum amount. 

 

The process of dealing with medical, evacuation and interruption issues was sobering.  Even with all my professional experience, and understanding the language of the insurance industry and claims processing, it still took the patience of Job.  I came away from the experience wondering how the average traveler, with normal knowledge of insurance procedures, could deal with all the hassles and stress.  My file on the entire "case" is several inches thick.  There were a few times when I really wanted to pull out my hair (not much left) and scream!  And the thing that is often forgotten in posts on the subject is that with Medical situations (and this was ongoing for about 4 months) folks are already under a lot of stress and constantly distracted by the day to day related issues.    

 

So, God forbid you would ever have to deal with a real claim, it may be that your $50 has been well spent :).  Just keep in mind that because you pay a travel policy to be primary does not necessarily free you from any work as you still may need to submit the claim to more then one insurer.  Primary means "first"....not "only."  In a sense it governs the order of claims submissions, but does not always mean you do not need to deal with the secondary company (or companies).

 

Hank

[Ep010835]

14 minutes ago, Hlitner said:

So, God forbid you would ever have to deal with a real claim, it may be that your $50 has been well spent :).  Just keep in mind that because you pay a travel policy to be primary does not necessarily free you from any work as you still may need to submit the claim to more then one insurer.  Primary means "first"....not "only."  In a sense it governs the order of claims submissions, but does not always mean you do not need to deal with the secondary company (or companies).

 

Hank

Very wise words, sir. When one takes the time to read all of words, the "fine print", in these policies (at least those I've taken the time to read), the phrase "Usual and Customary" or "Usual, Reasonable and Customary" are ever present. So even with the travel policy as Primary, there is the URC element to deal with. Always seems to me that the need for Secondary is lurking around every bend.

 

For those of us on Medicare, even with the better supplements, a lifetime limit of $50K sure isn't much but I've always been of the opinion that it will be enough to cover what remains after the URC is applied to primary. 

 

Then there's the credit card insurance. I've never, never relied on any of this coverage (since it's always secondary anyway) and have always figured it's out there as kind of newspaper at the bottom of the bird cage. Just enough to maybe cover anything that's left over after exhausting everything else.

 

If all of this has beaten up a lifelong insurance professional like yourself, what chance to we amateurs have! 

[Philob]

Just as a reminder, most medical providers outside of the US will require payment when service is provided and sometimes before.  This includes the medical center on the ship.  The ship medical center will just add it's bill to your ship account.  They will not file a claim or submit the bill to your insurance company, that's your responsibility.

 

Be prepared and bring a high limit credit card or two, just in case.   

 

 

 

 

 

 

Edited January 1, 2019 by Philob

[Ep010835]

41 minutes ago, Philob said:

Just as a reminder, most medical providers outside of the US will require payment when service is provided and sometimes before.  This includes the medical center on the ship.  The ship medical center will just add it's bill to your ship account.  They will not file a claim or submit the bill to your insurance company, that's your responsibility.

 

Be prepared and bring a high limit credit card or two, just in case.   

 

Great advice!

[GeezerCouple]

57 minutes ago, Philob said:

Just as a reminder, most medical providers outside of the US will require payment when service is provided and sometimes before.  This includes the medical center on the ship.  The ship medical center will just add it's bill to your ship account.  They will not file a claim or submit the bill to your insurance company, that's your responsibility.

 

Be prepared and bring a high limit credit card or two, just in case.   

 

 

Likewise, if one needs to change plans to return home unexpectedly, that could involve much higher cost "last minute" airline tickets.  So make sure you'd be able to cover that charge for everyone also, with you charge card limit.

 

GC

[Walfam]

On 12/31/2018 at 9:42 PM, Philob said:

Just as a reminder, most medical providers outside of the US will require payment when service is provided and sometimes before.  This includes the medical center on the ship.  The ship medical center will just add it's bill to your ship account.  They will not file a claim or submit the bill to your insurance company, that's your responsibility.

 

Be prepared and bring a high limit credit card or two, just in case.   

 

 

 

 

 

 

That was our experience when I went to ship infirmary twice on a cruise.  We had to pay the $800+ bill before disembarking, then go through the process of filing for reimbursement first with our main group health insurance, and waiting for it to be denied so that we could then file with the trip insurance.  

[Ep010835]

8 hours ago, Walfam said:

That was our experience when I went to ship infirmary twice on a cruise.  We had to pay the $800+ bill before disembarking, then go through the process of filing for reimbursement first with our main group health insurance, and waiting for it to be denied so that we could then file with the trip insurance.  

 

Exactly the reason I happily spend an additional $25/pp to upgrade the normally secondary medical coverage to primary for each trip policy I purchase. I look upon this additional $50 (for the two of us) as avoiding unnecessary and avoidable "wear and tear".........on me! 

[SG65CB]

Something I read a  long time ago: It seems easier to make the travel insurance the primary insurance. Especially since your own medical insurance might not cover out-of-country costs and if they do you will have a deductible and co-payments.

 

The travel insurance medical coverage does not have deductible or co-pays. 

 

However - if your travel insurance is primary and you max it out and then revert to your own medical insurance, deductibles become applicable and payable by you. 

 

On the other hand if your own insurance is primary then your travel insurance will cover your deductible and co-pay for your medical insurance. 

[GeezerCouple]

26 minutes ago, SG65CB said:

Something I read a  long time ago: It seems easier to make the travel insurance the primary insurance. Especially since your own medical insurance might not cover out-of-country costs and if they do you will have a deductible and co-payments.

 

The travel insurance medical coverage does not have deductible or co-pays. 

 

However - if your travel insurance is primary and you max it out and then revert to your own medical insurance, deductibles become applicable and payable by you. 

 

On the other hand if your own insurance is primary then your travel insurance will cover your deductible and co-pay for your medical insurance. 

 

It's tricky.  You need to understand your own policies quite well.

 

If someone has a regular insurance company with something like an "out of country" *lifetime* maximum (e.g., $50k), then it might be better to use the travel insurance and keep that max for some time that you don't have the travel insurance in the future.

 

All of these are things one needs to consider.

 

GC

[Ep010835]

50 minutes ago, GeezerCouple said:

If someone has a regular insurance company with something like an "out of country" *lifetime* maximum (e.g., $50k), then it might be better to use the travel insurance and keep that max for some time that you don't have the travel insurance in the future.

 

Excellent thought. Never occruued to keep the $50K “in the bank” so to speak. 

And if memory serves, not all Medicare supplements provide that $50K. 

This is yet another argument for buying $100K or more in medical coverage. 

Better to have and not need than to need and not have. 

Edited January 5, 2019 by Ep010835

[GeezerCouple]

25 minutes ago, Ep010835 said:

 

Excellent thought. Never occruued to keep the $50K “in the bank” so to speak. 

And if memory serves, not all Medicare supplements provide that $50K. 

This is yet another argument for buying $100K or more in medical coverage. 

Better to have and not need than to need and not have. 

 

Yup!  It seems like there is no end to "what needs to be learned"!

 

That's why we use a travel insurance broker (TripInsuranceStore).

 

Not only have they saved us money (and also saved us from purchasing a policy where a claim would have been denied, due to fine print that we hadn't yet learned, very early on!), but we keep learning more and more, from them and, importantly, here on CruiseCritic.

 

It's a terrific forum!

 

GC

[Ep010835]

3 minutes ago, GeezerCouple said:

 

Yup!  It seems like there is no end to "what needs to be learned"!

 

That's why we use a travel insurance broker (TripInsuranceStore).

 

Not only have they saved us money (and also saved us from purchasing a policy where a claim would have been denied, due to fine print that we hadn't yet learned, very early on!), but we keep learning more and more, from them and, importantly, here on CruiseCritic.

 

It's a terrific forum!

 

GC

 

I called them just today to amend two policies. On one we accepted an upgrade (paid) from S7 to S3 on a cruise next month. Had 21 days to make them aware of the change and pay the additional premium in order to keep my pre-existing coverage in place. Could have waited but the down side of missing the deadline was something I didn’t want to chance. 

The second one was an October Mediterranean cruise where I added pre-paid hotel rooms in Barcelona and Rome. 

[pcur]

As Hitner says, you need to pace yourself and be calm when you file a claim for travel medical expenses to your primary carrier.  I, also, have worked in the health insurance industry, as well as coordinated "you name it, I did it" for 3 elders in our family.  

 

However, even the best documented claim can be an initial disaster if you get a lazy claims processor.

 

We had 13 bottles of insulin frozen on the Rhapsody of the Seas last March 2018, thus ruining it. The ship's doctor got us a partial supply from his in the medical center, and had 3 more delivered the next day when we docked in Cozumel (at our cabin door at 8:00am), and Customer Service reimbursed us for the rest of them.

 

BUT, we weren't going back to CA.  We were going for an extended visit with our son in MI.  No Kaiser pharmacies there.  So, we went to Costco's pharmacy, got the Kaiser prescription faxed to them, and paid over $1,100 for the remaining insulin.

 

I am dogging this whole nightmare with all kinds of paper work, reciepts, printouts with emails to the Kaiser doctor, even PICTURES of the frozen insulin.  But, a lazy claims adjuster denied our request for reimbursement because we didn't use a Kaiser pharmacy, completely missing the EMERGENCY involved with an insulin user having his insulin FROZEN.  So, I patiently called, discussed, resubmitted, got denied again, resubmitted, talked again, and finally got the full refund.

 

Rule of thumb:  NEVER, EVER get pissy with the person you're asking to pay the bill.

[Ep010835]

9 hours ago, pcur said:

Rule of thumb:  NEVER, EVER get pissy with the person you're asking to pay the bill.

 

So very true in many, many areas of life.

 

I tend to think of this as Situational Power. He or she may not have much of it elsewhere but when they are on the opposite end of the counter/phone with you and are empowered to make a decision that is important to you..........they certainly "have the power".