“But my doctor gave me a clean bill of health.” I hear that more than any other defense from people who have just had their travel health insurance claim denied because of pre-existing conditions.
Patients seem to think that because their family doctor said it was okay for them to travel, their insurer would be bound by the doctor’s opinion. Well, that’s wrong. And sometimes I wonder whose side the doctor is on.
Whether it’s a sense of their own infallibility, or because they are busy, or because they simply don’t think it important, doctors too often don’t make the effort to understand even the basics of their patients’ travel insurance and all too casually tell them to “go ahead and have a good trip” without realizing that they may be putting them at risk.
The unresolved abdominal pain that results in an emergency gall bladder removal later on; the uncompleted series of tests that might have detected a malignancy if completed; the heart murmur that was not discussed with the patient because it didn’t seem definitive enough to warrant upsetting a forthcoming trip—all are scenarios for potential claim denials costing travellers hundreds of thousands of dollars in declined benefits.
All travel insurance has limitations. It is supplemental coverage. It is not a substitute for one’s primary domestic insurance. It either does not cover pre-existing conditions or it covers them only to a limited extent, usually with the insurer’s knowledge and approval. Denial on the basis of a pre-existing condition does not require a formal diagnosis, just a reasonable link between a condition or symptoms that existed and a related subsequent medical emergency.
Related: What Is Not Covered?
When doctors tell you not to worry, that you should just have a good time, when your medical record doesn’t warrant that confidence, they are letting you down. They may know you have travel insurance but they should not mistake its purpose, which is to protect against sudden, unexpected illness. It is not designed to cover unstable chronic conditions, symptoms under treatment, or ongoing examinations and diagnoses not yet completed, no matter how benign the doctor may consider them. This is the time for full disclosure, because what you don’t know about your medical record can stonewall you later on. And claiming you didn’t know about something in your record is no good. It’s your record. It’s your responsibility to know what’s in it.
If a doctor can’t take the trouble to learn the basics about travel insurance—and it’s not that complicated—or can’t afford the time to help you fill out a medical application for underwritten insurance, he should at least warn you to be sure you understand its benefits and limitations. And he should make it clear that if you encounter a medical problem and the insurer suspects something pre-existing, the insurer will requisition your medical records and determine validity of the claim on that basis, not on a letter the doctor writes later about you being perfectly healthy when he last saw you.