Travel Insurer Knows Which Question To Ask Doctor In Order To Deny Claim

(frankieleon)

When you’re buying a non-refundable plane ticket, it can be very tempting to fork over the few extra dollars to pay for travel insurance so that you’ll be able to get your money back in the case of an emergency like a medical crisis. But as easy as it is to click on that box and sign up for the plan, the insurance companies don’t always make it easy when it comes time to file a claim. Take the example in today’s L.A. Times of a California woman who had to cancel her plans to visit Washington, D.C., in December after she began experiencing shortness of breath and her doctor advised her not to fly. Luckily, she’d paid $29.33 for a travel insurance policy so she’d be able to get her $451 airfare refunded.
Not exactly.
See, this particular travel insurance policy has an exception for cancellations due to pre-existing medical conditions, and the insurer eventually determined that the passenger’s cancellation fell under this category.
Fair enough, but how did Allianz, the insurance company, reach this conclusion?
The passenger had suffered a heart attack ten years ago and had been diagnosed with high blood pressure before that. However, both conditions were being controlled with medication. Her cardiologist tells the Times that he provided Allianz with a statement explaining that her shortness of breath could be attributable to heart or kidney trouble. He also included a list of all her visits to his office for more than a year.
Allianz asked him to circle any visits during which he treated the woman for this diagnosis of possible heart or kidney trouble. As this issue was something new that he hadn’t treated her for previously, he didn’t circle any of the dates.
And so he received yet another form from Allianz, asking, “Was the patient symptomatic of or receiving treatment for the primary or underlying conditions” in the four months before booking her trip?
Unable to provide any further explanation, the doctor had no choice but to check off “yes” on this form, and that’s all that was needed for the insurer to deny the passenger’s claim.
“Obviously she’s receiving treatment for her underlying condition,” her doctor tells the Times. “She’s been receiving treatment for her underlying condition since I started seeing her in 2003.”
But he still feels that he was put into a corner, unable to provide any context or explain that just because he’d treated her for the possible root cause of her shortness of breath doesn’t mean it’s a pre-existing condition.
“It’s a new symptom,” says the doc. “It’s not an existing condition.”
A second cardiologist agrees, saying the woman’s doctor was given no choice on this second form. “Anyone simply taking medicine would be considered to be receiving treatment for an underlying condition,” he explains.
Allianz tells the times it wasn’t trying to corner the cardiologist into providing the answer it needed to deny the claim.
“We were just trying to get to the bottom of why she canceled her trip,” says a rep for the company.
The rep did state that Allianz would reach out to the doctor again, though that hadn’t happened as of yesterday.
Meanwhile, the California Dept. of Insurance tells the Times that it wants to take a look at the particulars of this case.