Follow Along with me and we'll see how this claim works out

[iamtrustworthy]

On 5/3/2021 at 8:56 AM, Jersey42 said:

 

@iamtrustworthy Does GeoBlue Trekker require any pre certification before getting medical treatment?  I know they have (or used to have) a 60 day notification requirement after an incident.  

Geo Blue doesn't have any pre certification for medical procedures. The Emergency Medical Evacuation Benefit states "You must contact Us at the phone number indicated on Your identification card to begin this process."

 

That's because Geo Blue (and all my Trip cancellation plans) arranges and pays for the Medical Evacuation. And, the only way a company would know that someone needs an Emergency Medical Evacuation / Transport is if someone contacted them.

 

I recommend that our customers contact the insurance company when there's any not-minor medical condition because it's always a good idea to have the company be in contact with the attending physician(s).

 

Steve

[klfrodo]

For others who have gone through something like this,,,, are my expectations to high in that I would have thought that after I emailed my claim into BC/BS, they would have acknowledged receipt of the claim via e-mail? I sent the email on May 4th. Today is the 17th and I've not heard anything.

 

I would have expected something like "We have received you claim and assigned it to ______. For further inquirers, please refer to claim # ABCXYZ"

[iamtrustworthy]

20 hours ago, klfrodo said:

For others who have gone through something like this,,,, are my expectations to high in that I would have thought that after I emailed my claim into BC/BS, they would have acknowledged receipt of the claim via e-mail? I sent the email on May 4th. Today is the 17th and I've not heard anything.

 

I would have expected something like "We have received you claim and assigned it to ______. For further inquirers, please refer to claim # ABCXYZ"

Yes, they are too high. I sold health insurance for 16 years before what I do now and I have rarely seen health insurance companies acknowledge receiving a claim. I have had an ongoing medical claim with BC for nearly 2 years and BC has used the covid delay excuse for the past 15 months.

[klfrodo]

55 minutes ago, iamtrustworthy said:

Yes, they are too high. I sold health insurance for 16 years before what I do now and I have rarely seen health insurance companies acknowledge receiving a claim. I have had an ongoing medical claim with BC for nearly 2 years and BC has used the covid delay excuse for the past 15 months.

 🤣

Thanks Steve.

[klfrodo]

28 May

 

UPDATE

 

Received a check in the mail from BC/BS.

Out of a $3600 claim,  received a check for,,,, wait for it,,,,,,,,$70.05 😲

I hope that doesn't hurt their EOQ bottom line.

 

They only paid for the "surgery" portion of the claim. Basically the stitches. 

Submitted charges $682.51

Eligible charges $87.61

Paid $70.51

"Because you used a nonparticipating facility, the allowance has been reduced to the average network facility allowance. This increases your out of pocket responsibility."

 

Will hold on to the check until I hear from Healix-Spain and my correspondence with the Washington State Insurance Commissioner. Healix-Spain had until 31 May to respond to the WSIC inquiry. Holding the check so there's no double dipping or profiting off the injury claim.

 

Why not cash the check anyway you say????

This is a public forum and my entire process has been documented.  It's not like I attacked the Capital and then posted my picture all over FB bragging about it. 🤪😲😲

Edited May 30, 2021 by klfrodo

[klfrodo]

UPDATE

11 June 2021

 

Heard back from State Insurance Commissioner.  Just telling me that they have not heard back from Healix-Spain. They are reaching out again.

I'm not holding out much hope. Very happy that my wife is doing better, satisfied with the service and treatment she received from the medical professionals in Cancun, and happy we're dealing with such a small amount of money.

Lesson Learned

[reney313]

This is a great cautionary tale.  I'm always a little apprehensive on what is or isn't covered between my insurance and any that I purchase (or using through the cruise line or other travel company).  I'm not sure, or rather pretty positive, I wouldn't think to call the insurance company proactively in the scenario that you described.  Particularly when the resort doctor referred me/spouse to the hospital.  I guess I would expect if they did that, it would be covered.  Thanks for sharing and I hope for more resolution, although I agree, thankful it's not a much larger amount of money,

[klfrodo]

Update 17 June 2021

 

Received this message from the Washington State Insurance Commissioner

"Good afternoon, Unfortunately after all my efforts to contact this company in hopes to get some sort of courtesy response or resolution for you, I have been unable to reach anyone from Healix. This company is not registered with our Office or even the National Association of Insurance Commissioners, therefore I continued efforts on our part will go unanswered. You can certainly consult with an attorney about what options you may have with the courts. Again, my apologies that we could not do more to assist you. Let me know if you have any questions."

 

So,,, it's looking like after 74 days since the injury, my claim has run its course.

I should have had another option but my wife wanted to use her CC for this trip instead of my CSR card. CSR would have been another option but 0 part of this trip was put on that card.

 

So,,,, at the end of the day, my wife is doing better, we're out the $3500 for her medical, so,,, what did we learn:

1. Next trip out of country, get "real" travel medical insurance and make sure it's "Primary".

2. Use the Chase Sapphire Reserve card.

3. Slow down and help the wife manage all potential obstacles and barriers.

 

Thanks for taking this travel insurance journey with me. Hopefully it may help you in the future.

[klfrodo]

Imagine my surprise.

 

Received a check from BC/BS of Alabama for an additional $2400.47

I guess the previous $70 was for the ER visit and this was for the Outpatient Surgery.

 

Obviously not made whole on the entire out of pocket costs but better than the slap in the face I thought I was taking.

[teacherman]

I live in Michigan and have BC/BS Medicare Advantage Plan as part of my retirement system.  I have been informed by them that they will cover me everywhere in the world except on a cruise ship.  I do not know what your plan offers, but I followed your "story" and was somewhat surprised that BC/BS was not offering you anything.  I was not surprised when they sent you the big check, as that is what I would expect.  Of course, I would have to cover my deductibles and co-pays, just as I would in the USA.  Had you covered yours?

[klfrodo]

1 hour ago, teacherman said:

I live in Michigan and have BC/BS Medicare Advantage Plan as part of my retirement system.  I have been informed by them that they will cover me everywhere in the world except on a cruise ship.  I do not know what your plan offers, but I followed your "story" and was somewhat surprised that BC/BS was not offering you anything.  I was not surprised when they sent you the big check, as that is what I would expect.  Of course, I would have to cover my deductibles and co-pays, just as I would in the USA.  Had you covered yours?

At the end of the day, BC/BS reimbursed about 66% of my total out of pocket expenses for this medical situation. Deductible was a non issue because I was not using a Preferred Provider

I have no idea what the fine print in your Advantage plan covers. My BC/BS plan is thru an employee plan and includes an International Rider. I am retired but receive coverage until I'm 65. The patient in this case was my wife who has Medicare Part A&B with BC/BS has a secondary.

On top of the medical, what my BC/BS will currently cover also only includes an ambulance ride to the nearest medical facility. Had I needed it, the plan would not have covered an evacuation back to the States, nor would it have covered repatriation of her remains had that been required.

 

For $70 total, I could have purchased a 3rd party plan that would have been Primary, covered $100K medical, $250K in evacuation, and 100% repatriation of remains. I would have received my entire $3600 out of pocket expense.

 

In this instance, I paid $1200 out of pocket after waiting 4 months to be reimbursed.

[SAKay]

@klfrodo  Can you tell me what policy that is  “ For $70 total, I could have purchased a 3rd party policy that would have been primary, covered $100K medical, $250K in evacuation, and $100K in repatriation of remains. “ or tell me who to contact. I think that is what we need for our next cruise. Thank you very much !! 

[klfrodo]

2 hours ago, SAKay said:

@klfrodo  Can you tell me what policy that is  “ For $70 total, I could have purchased a 3rd party policy that would have been primary, covered $100K medical, $250K in evacuation, and $100K in repatriation of remains. “ or tell me who to contact. I think that is what we need for our next cruise. Thank you very much !! 

www.tripinsurancestore.com

 

I select the TravelSafe Washington plan. 

I don't purchase a full blown comprehensive travel insurance plan. I only "insure" $500 per person trip cost. This still gives me the full medical and evacuation coverage while "self insuring" the cancellation, trip delay, trip interruption portions of the policy.

[SAKay]

Thanks very much !