A pre-existing conditions scam?

I’ve never been a big fan of travel insurance — or of any insurance, for that matter. You either have to pay a high deductible to use it (health insurance) or you have to die (life insurance) or it’s no good at all. That certainly seems to be the case with many forms of travel insurance these days.

How do insurance companies get away with denying scores of travel claims? Well, one increasingly popular way is to invoke the pre-existing conditions clause, according to some of the recent ombudsman cases I’ve received.

A pre-existing condition is usually defined as any injury that happened prior to and including the effective date of the insurance and any recent illness for which treatment by a licensed physician has been sought.

Here’s the problem: No one ever reads the fine print on insurance policies. Instead, they rely on a phone agent or travel advisor to tell them what’s in it. And since insurance policies can be very complex, and since travelers don’t always feel the need to disclose their medical histories to their travel agents, something invariably gets lost in the translation. Or just plain lost.

Even for those travelers who are diligent enough to take the time to read the fine print, many policies are confusing about what does and doesn’t constitute a pre-existing condition. For example, some policies allow for what’s called a “controlled condition” — something for which you don’t need to change your medication or treatment during a given period of time. Others allow you to purchase a waiver of the pre-exisiting clause, but with strings attached.

Result? Many travelers think they’re covered when, in fact, they aren’t.

It might be a stretch to call the confusion surrounding pre-existing conditions a scam. But I have no doubt that certain insurance companies are leveraging that confusion to their advantage — and to the detriment of their customers. (My success rate at overturning insurance denials is pretty low. It’s actually so dreadful that I’m embarrassed to cite numbers.)

My advice is to read all the fine print carefully and to ask any questions of your insurance company before buying your policy and booking your trip. Remember, it isn’t just your own health that’s an issue. It’s also your travel companions and other family members whose health may determine whether you travel or not. Be sure everyone is covered.

Finally, don’t cancel your trip and submit a claim unless you’ve checked with your travel insurance company first, to make sure the claim will be honored.

There’s nothing more frustrating that canceling a trip that you could have taken, just because you thought your insurance would cover you.



  • Tommie Imbernino

    Insurance is crucial for travelers who are on a cruise, tour or anything nonrefundable and they do come through. I have never had anyone that had to cancel or needed medical care not getting what they paid for. This is why all people should use a travel agent. A god travel agent will explain to the person if there are any restrictions, but also if you pay for the insurance within booking your trip there are no preexisting conditions, but also I have two companies I use that do not impose preexisting. Yes, they don’t want you to see a doctor, be diagnosed for something severe, take out the insurance and then try and get your money back.

    I guess that is why so many people still use travel agents because on line is just that. They are part of your computer. They are lower paid and the turn over is great, so one agent on line can tell you anything you want to hear – and then try and find them again. Also even with the person that bought the airline ticket with the wrong spelling. Oh I sound like a broken record, but again an live agent could have handled that without any stress.

  • Joe Ihnat

    I had a great experience with travel insurance. I am a great believer of booking flights as early as possible in order to get the best price and possibly the best seats. I always travel First Class if possible and booked flights for my wife and I to travel from Cleveland, Ohio to Acapulco, Mexico to spend time with my 85 yearold mother. These tickets were booked in May with flights in January of 2006. In October my mother was diagnosed with breast cancer and her doctor would not allow her to travel to Acapulco in January due to a breast removal operation in November.

    I contacted my flight insurance company (AccessAmerica I believe the name was) and they got right to work with the paperwork I needed to cancel our flights and obtain a refund. It worked perfectly. It took about two months to get the refund and I was very pleased with the outcome with book the tickets and my mother’s operation. All went well. I was treated extremely nice and recommend them highly to anyone that will listen.

    I know that some people have problems with flights, car rental, hotel bookings, and the list goes on. I believe firmly that if the customer is nice to anyone that they talk to seeking help the response will be positive. We all have bad days. We all have problems. We can catch more flies with honey then vinegar. Yes, there may be times that nothing works. Then we should politely hang up and call the next day to see if the person we talk with can handle our problems.

    Chris, I might have been lucky but I have flown many times over my 64 years on this earth. I take each journey as a fun time and have always felt that half the trip is the travel. Why not smile, keep a positive attitude, and hopefully all will go well.

    Hope you agree.

  • Tab Stone

    It’s not just the pre-existing condition waivers that get you in the fine print. I was looking for insurance for a 2 week dive trip a year from now at insuremytrip.com. I based the comparison on a trip of about 2 weeks and $3900 a person since I wasn’t sure about the second week cost. The numbers I got a month ago were a bit cheaper, but the differential is about the same.

    AIG Travel Guard Expanded $280
    If the Insured must cancel or interrupt his/her Trip due to Injury or Sickness of an Immediate Family Member, it must be because the condition is life-threatening, and because the Immediate Family Member requires the Insured’s care.

    Travel guard at $250

    If the Insured must cancel or interrupt his/her Trip due to Injury or Sickness of an Immediate Family Member, it must be because their condition is life-threatening, and because the Immediate Family Member requires the Insured’s care.

    My Travel Guard

    $326
    If the Insured must cancel or interrupt his/her Trip due to Injury or Sickness of an Immediate Family Member, it must be because their condition is life-threatening, or because the Immediate Family Member requires the Insured’s care.

  • Lilian Leung

    I also had problem getting reimbursement from Access America directly due to their definition of “Pre-existing condition”. I bought my plane ticket through Hotwire along with insurance through Access America on Jun 4. Got email confirming my policy with effective date being Jun 5. Dad got cardiac arrest on Jun 5 at 10:30pm. Needed to cancel my trip to arrange for Dad’s funeral. Thought it definitely would be covered since it was an unexpected event that happened after I purchased the insurance. Not so, got denial from Access America stating that “Pre-existing condition is defined as any injury that happened prior to and including the effective date of the insurance and any recent illness for which treatment by a licensed physician has been sought.” So since Jun 5 being the effective date, my case was NOT covered. I asked for an explanation of why “Pre-existing condition” could mean something that happened AFTER one bought the insurance (the main reason why one wants to buy insurance to protect oneself), I got absolutely no reply. I just don’t think they can justify that. So if I were you, make sure that the “Pre-existing condition” clause is waived before buying the insurance. I and all my friends will never buy insurance from Access America again. On a happier note, Hotwire did reimburse me for my loss since they obviously did not agree with Access America’s action.

  • http://www.tripinsurancestore.com/blog Steve Dasseos

    Hi Elliot,
    What you are referring to is “Medically Stable”. I agree with you that it’s not as cut & dried to have a Pre-Existing Condition coveed just because the insured buys the travel insurance policy by the deadline.

    In my opinion, the key to understanding Pre-Existing Condition coverage is to understand “Medically Stable”.

    Medically Stable includes the idea that nothing is foreseen or expected to “be a turn for the worse”. In other words, if you’re given a week to live (yet medically able to travel) and you want to buy travel insurance for a cruise next month, you can’t cover the Pre-Existing Condition. It’s like wanting to buy Fire Insurance when your house is on fire.

  • Rebecca A Wietecha

    Pre-Existing condition!! I’m 41 have had asthma my whole life. It is very well controlled, I travel alot usually 4 months each year, I got really sick in Asia last year was hospitalised in Bali with pneumonia. I was denied when i made a small claim aprox. AU$ 500 for my stay in hospital & costs to change tickets, on the grounds i have asthma, even though i have had insurance with this co. for 7 years & never made a claim before……Pre-Existing….BS!!! They may not know difference, but i sure do asthma is not pneumonia…they will screw you one way or another if you make a claim.

  • john

    access america is a scam
    we wanted to cancel a trip because of job loss
    and they said u have to be working in company for 3 years if the claim has to be approved ,
    this is bs its complete scam

  • Carl

    I booked travel to Chile a rather expensive junket the total was close to 7K. My mother-in-law was hospitalized the day we left with what turned out to be WEST NILE DISEASE and she ultimately died a month later. My claim was handled in a very professional manner and I was courteously treated at all times. I did have all required documentation which was fairly voluminous and is a requirement with any insurance company. I documented documents everything was collated and faxed and submitted and I waited barely a month and received my claim in the mail. Important to remember to not only document but research a potential vendor and do this from a variety of sources and not only through the web where you mostly turn up complaints but in business databases so that you truly know who you are doing business with. As it turns out Access America is owned by Mondial which is owned by one of your larger global insurance companies Allianz. I will be using Access America again this winter.

  • Steve

    Agree on the bad postings about AcessAmerica. They are a total scam. A waste of money and not worth it. I have bought it many times for trip cancellation insurance and the one time I tried to make a claim- DENIED! A total pain. They make you jump through paperwork hoops then you have to constantly check the web site for claim status as they will not contact you. So, you’ll eventually find your claim is denied. I found it to be a scam and will never buy it again. Good luck if you do. AccessAmerica = Bad News

  • Tutti

    Its a shame that I have to read about these sort of posts AFTER, and not before, I opted to purchase insurance from Access America. I just received a letter stating that my “insurance plan does not provide coverage for Existing medical conditions.”

    To be clear, Delta, the airline that I purchased my ticket from, tarnishes its reputation by associating themselves through their partnership with a company that engages in this sort of scam.

  • Julie

    Access America is also refusing to pay a claim. I purchased my airline tickets and insurance on November 3. My father was diagnosed with cancer on November 23. And even with paperwork from his oncologist – they are claiming that this is a pre-existing medical condition.

    I encourage all of you to take action. Perhaps collectively we can make sure that this sort of scam does not happen to more people.

    Access America is based out of Richmond, Virginia.
    I’ve contacted the Better Business Bureau, the Insurance Bureau of Virginia, the Attorney General of Virginia, and consumer report websites.

  • Emilyrudy

    Acess America biggest SCAM ever.

    Told me they will not refund me my 800 dollar flight cost. because get this…. a clogged ear is a pre existing condition for a brain tumor. I had  brain surgery, and because my first appointment with the ENT was 120 days before my flight departure it voids my policy. So now, not onLy am I laid up on disability, 2 disappointed children, I lose 800 dollars on a limited income. Who could possibly fly with 2 children to disney after brain surgery. ***DO NOT DEAL WITH ACCESS AMERICA****

  • jj

    My mom is being denied coverage because she was diagnosed with Breast Cancer on Sept. 12.  She purchased her tickets Aug. 30 with insurance on that date.  They have “lost” forms she has sent to them and they continually ask her to fill out more forms.  It’s a scam.  A giant scam.