Honesty is the Best insurance Policy

Spring 2005 CSANews Issue 54  |  Posted date : May 17, 2007.Back to list

May I first welcome many of you back to Canada from your splendid winter vacation. I must say that you missed a lot in your absence – tons of snow, freezing temperatures, icy roads and a generally dreary winter. Do not feel too sorry for those of us who stayed behind, however, as we managed to get in a little skiing, a little skating and some snowmobiling to pass the winter days.

We at Medipac are busy sorting out the final loose ends on literally thousands of health-care claims and preparing for our Early Bird launch. As we review these claim files, there still appear to be a few instances where misunderstandings occur on either the application or on the policy conditions. You should try to avoid any of these situations and I will give you a brief outline of what to do or what not to do.

The most obvious problem occurred on two cases where people thought they could jump the long line-ups in Canada by buying travel medical insurance and getting their treatment in the United States. Both involved heart bypass surgery and neither claim was paid. Why? Because they "fibbed" on their application. They were not really surprised by the declination of their claim but it did end up being very expensive for them. We pay for lots of heart bypasses, but only when you tell us the truth. The sad part is that heart bypass surgery is easily available in most provinces without having to endure the "phantom" long waiting list. The provincial governments, in most cases, have dramatically improved the waiting times for heart surgeries. We evacuated several people who returned to Canada to be with their families during their hospitalization and we have been very successful in getting them treated quickly, often on the day following their return.

Delaying medication or investigative tests recommended by your doctor can also create claim problems. All travel insurance policies use your doctor's notes to determine whether a claim is payable. If your doctor said you should change your medication, you should change it, now. Do not try to delay any treatment, test, or medication change due to your upcoming travel. It can be dangerous and it makes absolutely no difference to your insurance coverage. If your doctor recommends a medication change or a test, and you refuse it, a claim for the illness or disease which is being investigated or treated will be declined. There is no sense in paying for insurance if your most likely claim will be denied. The answer is to undergo the test, change your medication and basically just follow your doctor's recommendation. This may change your insurance class or affect your pre-existing condition clause, but those are the kinds of things Medipac can usually fix for you. Just call us! It may cost a little more, but you can then travel knowing you are fully covered. I can guarantee to you that the additional cost we may charge will be insignificant compared to the claim you may have to pay.

Another difficulty can arise when you have chosen a large deductible. Many people will routinely pay for any medical bills they have up to their deductible of, say, $5000. The trouble comes when they are suddenly hospitalized and they then call their emergency medical line. Many policies have a reoccurrence clause that says that if you have had any treatment, a reoccurrence of that condition will not be a payable claim. Several insurers will treat that first minor doctor visit as a first claim, even if it is under your deductible. They then decline to pay the huge hospital bill. This can happen even when you have a small deductible. That innocent $40 doctor bill can have ruinous effects on your finances when the $300,000 hospital bill comes in. This situation is simple to avoid – simply call your emergency medical line before getting ANY treatment. It does not matter who will be paying the bill. This will normally ensure that your coverage remains in full force and effect. If it will not, then the assistance company must tell you that.

Medipac is way ahead of our competition in this regard, as we have highly trained nurses answering our telephones. You have the benefit of a quick second opinion as to what your medical problem may be. What seems to be a minor concern to you could ring alarm bells to a trained medical person and they may recommend a different course of action – like calling 911.

There is no sense in paying for insurance if your claim will be denied

You must be very careful when buying a travel package from a tour operator or a travel agent. Usually the simple question is, "Do you want to take the travel insurance?" and you, of course, say "Yes." That's it! Be advised that if you have any kind of medical condition or are taking any medication, you usually do not have any medical insurance for that condition. This is ridiculous, I know, but many, many people find out this fact too late. You must be proactive to avoid this situation. Ask them questions; tell them about your medical condition; tell them what drugs you are taking; then ask the really key question, "Am I fully covered for any health problem I may encounter on my trip?" If they simply say "Yes," then you should ask them to put that in writing when they send you the tickets. You can also ask them to fax you a copy of the policy and you must then read every word. If you do not totally understand something, ask more questions.

One final caution: if you are dealing with an agent, you should fill out the application yourself. Many agents have a tendency to skip over parts of the application relating to medical problems because they think they know you. My bet is that they do not know you, as we all tend to keep our medical conditions to ourselves. Even a family member may not know all of your medical information. Fill out that application yourself and understand what it says. Tell the whole truth and nothing but the truth.

Medipac brings unique solutions to many of these concerns. We routinely call back about 50 per cent of our clients, after receiving their application and their cheques. We want to make sure you answered all of the questions and answered them properly. I know of no other company that does this in such a structured way. Some may call you if you forgot to sign the application, but that is about it. And we all know why they want your signature so badly. I was recently talking to a major travel insurer and asked them how many "callbacks" they did to ensure their applications were correct. The answer was as expected – hardly any. In many cases they simply do not seem to care, as they can solve any application problems at claim time, often by denying your claim.

We are currently ramping up our operations for Medipac's Early Bird travel insurance launch and I hope you will join us again for next year's travel season. We are now entering our 23rd year in the travel insurance business, and I believe we are doing things right. I also know that if we are not, you will be the first to tell us. This is, after all, your program. Buy your Early Bird and have a great summer.