How reasonable is it to call / get 'prior approval' during a Medical Emergency?

[ljones]

"Expenses incurred by you for Physician-ordered emergency medical evacuation, including medically appropriate transportation and necessary medical care en route, to the nearest suitable Hospital, when you are critically ill or injured and no suitable local care is available, subject to prior approval by us or our authorized agent"  

 

 

[jclinard]

I've asked that question several times, especially as I travel alone.  If I'm incapacitated, how is anybody to know to call them to get prior approval?

[klfrodo]

How reasonable is it?

 

About as reasonable as your current healthcare provider has to call your insurance company to get pre-authorization for you to receive the medical procedure or diagnostic examination they feel you need?

About as reasonable as your current prescription med company requiring you to change your medications prescribed to you by your healthcare professional because they want you to reduce their costs.

 

I don't think it's reasonable at all. However, thems the rules we have to play by.

 

BTW, Thanks Optum. NOT!

Edited April 1, 2023 by klfrodo

[ljones]

For too long I made assumptions on what each insurance heading meant.  Bad idea.  I used the comparison tool another CC member suggested to compare costs.  But, $$ comparisons clearly do not tell the 'whole story'...

 

It is important to read the restrictions in a policy.  I did notice that Gernerali had the wording I quoted from one of their policies.  Reading a Travel Guard option, I found this: "In the event the Insured’s Injury or Sickness prevents prior authorization of the Emergency Evacuation, Travel Guard must be notified as soon as reasonably possible."  

 

Other policies do not specify "Prior" - but do indicate that the "the program medical advisor determine that transportation to a Hospital or medical facility is Medically Necessary" - that is not as clear as it should be so default naturally goes to the Corporation!

 

Clearly the '10 day look' is something that definitely needs that time and attention.  

 

And - Something wrong when the "rules" can be written in such a way to benefit only one side...We offer this much "coverage" - but most likely you will never be able to collect any of it...Gotcha!

Edited April 2, 2023 by ljones
misspelling

[ljones]

jclinard - A question for you.  In your signature, you have: Do not use AIG Travel Guard.  Why?  They are one I am considering due to cost & "coverage".  Were you denied a covered issue?  What was their reasoning and did you have the documentation necessary?  I always feel insurance companies have a 'gotcha' that we don't realize in advance.

 

 

[jclinard]

You don't have to take my word for Travel Guard.  You can just look up their cases with the Better Business Bureau.  Just google Better Business Bureau AIG Travel Guard to read their reviews and cases.

 

That will provide plenty of information on the "gotchas" and "not covered" from a variety of people, not just me.  

 

I will urge you to only take recommendations from people who have tried to collect on a policy.  It's foolish to take recommendations from people who only have experience with how fast they deposited the premiums.  You should also request a copy in the policy in advance and read it.  

 

I'll give you the high points of my denial.  I had a trip to Copenhagen.  Denmark then imposed travel restrictions during COVID times, meaning I would not be allowed into the country.  I was told I had to cancel the flight before I could make a claim.  I did so, then my claim was denied.  That meant I no longer had recourse to cancel the flights for different reasons (such as flight time delays).  It didn't seem to be fun enough for them to deny my claim.  They wanted to make sure I was totally screwed first.

[ljones]

Appreciate your reply.  Were you told in writing or over the phone about cancelling your flights? 

 

I am looking at some of the complaints on BBB - but that would not generally be the best place to review a company as it is ALL about complaints...thus far, most seem to be the length of time it took to resolve a claim - but some show a response from the complainant or AIG that the investigation had been competed (without a further response from the original sender - so those outcomes unknown).

 

Some show the following or another that the investigation was completed and the complainant can send a different default letter that the issue has NOT been resolved.

 

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]

Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 

 

BUT valuable information is clear:

 

DO NOT CALL the insurance 'call center', 

Put everything in writing & keep copies of it all.

Learned while on a cruise which was diverted during covid - do not use a 'booking site' if you expect help with an issue involving your flights, your cruise, etc.  

 

 

Edited April 4, 2023 by ljones

[jclinard]

All of my interactions with AIG Travel Guard were online.  

 

I still feel like a prime sucker for buying their insurance, following their instructions, and then ending up with both a denial and no alternative methods to obtain a refund.

[mort&fran]

It’s been some time since we last presented a claim to them, however my wife and I had only minimal issues with the claims we have presented to TravelGuard. But I try to read everything before I buy anything, so I knew what I would have to do. (The biggest issue we had was that after my heart attack in the southern Atlantic, TravelGuard had to speak with the local doctor after my wife and I were transported to Buenos Aires, to confirm that I really should not fly home before having the surgery (and recuperation) in BA. TravelGuard agreed to immediately pay for the surgery – if the hospital would guarantee what the final cost would be. The hospital obviously couldn’t so we had to charge it and TravelGuard reimbursed us.)

 

TripMate (Generali) is another matter. We submitted a claim in June 2022; in September 2022 we received checks for less than what we had submitted, so I sent additional information. In November 2022 we received more money, but still less than the bills we had submitted. So five times between December 2022 and March 2023 I tried to get someone at TripMate to explain the shortfall. Thus far, all we have received is a letter that effectively tells us that they paid us the correct amount. (Viking also tried to get the information, but could not, so they gave us travel credits.)

[Mehroswitha]

Different people in different situations can have very different experiences dealing with the same company.

 

Several years ago we had a large and rather complicated claim with Travel Guard and could not have been more satisfied with the way it was handled.

 

An important part of the reason for our positive experience, I believe, is that we contacted TG as soon as we realized we were having a medical emergency while abroad.

 

We worked with a single TG rep from start to finish and were able to get all necessary medical forms filled out, signed by the doctors, and faxed back to TG even before leaving the emergency room.

 

TG not only covered our early return home (as one would expect) but they booked the patient in business class and made all the arrangements including booking flights and transportation to the airport.

 

Because out TG  medical coverage was primary rather than secondary, they covered all the medical expenses rather than our needing to first file with our "regular" insurer. (Some TG policies include primary medical coverage, others do not. At least that was the case last time I checked.) Like Mort&Fran, we paid the hospital bill using a credit card and received reimbursement from TG very promptly-- in less than two weeks, as I remember it. 

 

I can't dispute the negative experiences some others have had, and wouldn't want to. But we've been using Travel Guard for years as a result of this experience of ours. Your mileage, as they say, may vary!

[ljones]

It sounds as though you both had excellent experiences with Travel Guard...I also preferred their wording regarding notification during an "emergency or urgent" situation.  But I have learned, after years of just getting a policy & not reading it, that that is not the way to go.  I also wonder if it is not easier to get reimbursed for a medical issue as you have a Dr to verify expenses.  Harder to provide documentation on the contents in your suitcase or meet cancellation limitations...But compared to medical - much less of a worry.