mhrbpower

While in Florida I suffered severe knee pain and was seen by a Orthopedic surgeon who after doing x-rays informed me that I had a problem with my IT band and set up physiotherapy. All this was done with Travel Guards telephone approval. They advised me to go ahead with physiotherapy and would pay up to $400. After about 4 weeks I was still in severed pain and well over the $400 they told me I was allowed.
I then tracked down a Physical therapist who was able to give me relief.

TG say I had received treatment for hip pain prior to leaving Canada, which was not true, I had a x-ray with regards to arthritis but no treatment.

What I do not understand the Orthopedic doctor told me it was my IT band and that was what I got the physio they recommended with no relief.

How can I have my claim rejected when the people who made decision to say it was a pre existing condition but did not examine me and reject the doctors diagnosis who did examine me.

Do I have any recourse.
M Power

Christina

I think it may be medical lingo. The word "treatment" for hip pain could just mean you saw dootor about it and got some diagnostic tests, not that you received PT. IN that sense, you were treated for it.

Frankly, I don't get your complaint as your medical problems don't seem to have anything to do with travel, per se.

Christina

By the way, don't you have regular medical insurance? Why wouldn't they cover this? I thought Travel Guard would only insure Americans and that you must be an American on vacation in Florida, but perhaps that isn't the case.

mhrbpower

TG was bought as emergency medial coverage. As a Canadian my health ins does not cover out of country medical care. I also was never treated or had any doctor mentioned problem with IT band. The Florida doc did x-ray to rule out any other problem but had said before the x-ray that it was my IT band

mhrbpower

sorry not emergency medial coverage but medical coverage

MmePerdu

I imagine the distinction they're making between "medical treatment' vs "emergency treatment" is whether you could return home for treatment under your own steam. If you broke your leg it would constitute an emergency. Your knee, painful but still ambulatory, routine, not an emergency.

mhrbpower

no you buy this type of ins so you are able to have care while out of the country. We were there for 3months. You call ins and they approve you getting medical help even to providing medical personnel.

MmePerdu

Two possibilities come to mind:

1. Have you bought & used this same insurance before? If not, maybe it isn't what you thought it was. Or

2. When the claim was submitted by the provider they failed to use the correct code for what was originally approved. This happened to me recently and when I called to find out why the test that I knew was covered had been denied, was told that the provider must resubmit the claim using the code for the correct & covered test.

socaltraveler

They authorized $400 for physical therapy, which you went over. Correct me if I am wrong but you then found another physical therapist, sans approval and now want reimbursement? Without seeing the contract, I imagine you will not be reimbursed. Insurance is a tricky game. Hope you find some relief when you return home.

IMDonehere

Contact Travel Guard again and tell them that they are incorrect and that you are going a file a "bad faith" complaint with the Canadian Authorities.

For complaints or inquiries about life and health insurance products including life, disability, employee health benefits, travel and insurance investment products such as annuities and segregated funds life and health products and services issued by life insurance companies, you may contact the OmbudService for Life and & Health Insurance (OLHI).

Tel: (416) 777-9002
Fr: (514) 282-2088
Toll free: 1-888-295-8112
Fr: 1-866-582-2008
Website: www.olhi.ca

Michael

Hasn't ACA eliminated pre-existing conditions as a reason to deny payment?

lcuy

This has nothing to do with ACA. This Canadian had travel insurance.

lcuy

Oops, hit submit too early. Pre-existing conditions cannot be used to deny medical insurance .

IMDonehere

Oops, hit submit too early. Pre-existing conditions cannot be used to deny medical insurance
______________________
Travel Insurance is not health insurance, it is considered Accidental Death and Dismemberment (pleasant name, huh) and in the arcane world of insurance, it has nothing to do with medical coverage.

Additionally, the coverage was purchased in Canada. I do not know Canadian law, but I believe it subject to provincial regulation.

NeoPatrick

I'm a little confused here. Admittedly I don't know a lot about travel insurance, but it's surprising to think they would pay for general medical procedures for continuing or existing health problems.

sunbum1944

Also call TG and tell them you would like to file an appeal and ask how to go about doing that.

MmePerdu

This could be educational for all of us if mhrbpower wouldn't mind posting exactly which policy we're discussing. I'd like very much to take a look at the specifics. Please?

schmerl

>>
The OP bought this as MEDICAL insurance since she is not covered by her own insurance when she is not in Canada. Travel guard sells insurance that covers medical claims while away.

IMDonehere

Travel Guard only issues travel insurance and not health coverage.

Excluding pre-existing conditions is common in travel insurance. Many include pre-existing if you get the coverage within two weeks of paying for a reservation, others offer it but it is expensive.

MmePerdu

The confusion is apparently the difference between "travel" insurance & "medical" insurance to use while traveling. The OP seems to describe the latter. I wish we could see a TG description of the coverage to know what we're actually discussing.