Case dismissed: “The insurance will not cover our tickets” By Christopher Elliott | November 3, 2011 FacebookTwitterGoogle+Pinterest Beware of the pre-existing medical conditions clause in your travel insurance policy! Oh alright, maybe that’s a little dramatic. But could you at least pay attention to it? I mention this because of Ingrid Murray, whose claim against Access America recently crossed my desk and then made its way into the “dismissed” file. She’d planned a trip to Italy this fall with a companion, who fell ill just before they were about to leave. Good thing she’s taken out a travel insurance policy. She explains, At the end of June, [my companion] went to a specialist for her hip. The doctor said she needed surgery and to cancel this trip. I submitted my claim, but Access is stating due to some pain she had been having in her hip prior to the trip that this is considered a pre-existing condition and the insurance will not cover our tickets. She appealed the decision to an Access America executive, but was denied again. Next, she appealed to Orbitz, which had sold her the policy. It said she could get flight credit, as long as she paid a $250 change fee (standard answer). She asked her airline, Air Canada, for help, and it referred her back to Orbitz. So she asked me to investigate. I would like to know if you think there is another way to come at this. I don’t know how Access can say it is a pre-existing condition, this is a BIG loophole in their insurance which gives them an ‘out’ in almost any situation. I agree, the pre-existing medical conditions clause is troublesome. And there’s a way to avoid it by purchasing a more expensive “cancel for any reason” policy — but that’s beside the point. As always, the devil is in the details. If Murray’s companion developed a medical condition after purchasing insurance, then I thought Access America should reconsider its decision. So I contacted the company on her behalf. Here’s what it said: We are very sorry that Ms. Murray felt that she needed to cancel her trip due to the illness of a traveling companion. We understand how frustrating it can be to have to cancel a trip you’ve been looking forward to and we sympathize with Ms. Murray’s situation. According to Ms. Murray’s traveling companion’s orthopedic surgeon, her traveling companion had been in pain for the last two years and had “gotten progressively worse over the last six months.” The doctor indicated that symptoms began approximately 2/1/11. As Ms. Murray’s travel insurance policy was purchased on 5/11/11, the onset of her traveling companion’s symptoms fall within the exclusionary period of 120 days prior to and including the date the insurance was purchased. The medical records show that the condition would be considered an existing medical condition and any claim related to that condition would be excluded from coverage. In Ms. Murray’s travel insurance policy, an existing medical condition is defined as an illness or injury that you, a traveling companion or family member were seeking or receiving treatment for or had symptoms of, on the day you purchased your plan, or at any time in the 120 days before you purchased it. We’re very sorry that we were unable to cover Ms. Murray in this circumstance, but we wish her well in her future travels. That’s too bad. I’ve written about pre-existing medical conditions on numerous occasions, and while I agree with Murray that they can be used as a blanket excuse for denying a claim, her particular case had gone through numerous levels of appeal. There’s nothing more that could be done. Could Orbitz, the online agency that sold her the policy, have done a better job of explaining the limits of her policy? Maybe. But this trip, unfortunately, won’t be covered by her travel insurance. FacebookTwitterGoogle+Pinterest Christopher ElliottChristopher Elliott is an author, journalist and consumer advocate. You can read more about him on his personal website or contact him at email@example.com. Got a question or comment? You can post it on our help forum.More Posts - Website - Twitter - Facebook - LinkedIn - Google Plus Phil You really have to be a legal begeal to understand an insurance policy of any type, and travel insurance is one of them. Most people don’t even read what is covered and what is not even before purchasing it. Policies need to be read and if there is a clause you don’t understand get the insurance company to explain it first before purchase sirwired I feel for her. Really, I do. But the pre-existing condition clauses are: A) Standard. Most policies have them. B) Clear. Contrary to popular belief, trip insurance policies are written in clear, easy-to-understand English. I’m not kidding. Pull one up sometime and read it. BTW, there is another way to avoid pre-ex exclusions. If you buy trip insurance on your own (vs. from your agent or travel provider), most of the major providers (TravelGuard, CSA, TravelEx, TravelSafe, AccessAmerica etc.) will waive pre-ex exclusions if you buy your policy within a certain amount of time after placing your deposit. If you do this, you can avoid pre-ex problems at far less premium (and with much better coverage) than an Any Reason rider. Chris in NC Without access to the complete medical records, it is impossible to say whether this claim should be processed or denied. While insurance companies have abused the pre-existing clause, I’m not against it per se. What I do have a problem is how providers like Orbitz, Expedia, etc. sell their insurance. They sell it as a “no worry, no hassle” policy, whereas in reality, the policy is riddled with exclusions. Then again, a more comprehensive insurance policy often costs much more than these Access America policies! sirwired No, you don’t really need to be a lawyer to understand trip insurance policies. Pull one up and read it sometime. They usually aren’t very long, and the exclusions are pretty clear. Compared to most legal documents (website Terms and Conditions, mortgage contracts, home purchase contracts, software licenses, etc.) they are a model of simplicity and clarity. But yes, I agree, if you are entering into an important legal contract, you need to read it. emanon256 Excuse my ignorance on this, but I thought that congress passed a bill stating that insurance policies could no longer have “preexisting conditions” clauses. I honestly don’t know how or when that goes into effect or if it only applies to health insurance, but I would hope it would apply to all insurance. Every time I have looked at travel insurance, I find so many loop holes and so many ways for them to not cover things that I have never been able to justify purchasing it. I do always read the fine print, and I have yet to find one that is not clearly one sided within the fine print. So I never purchase it. emanon256 Thanks! I will look into this next time I plan a big trip. I have only looked at the ones that the travel providers offer which I agree, are very clear and easy to understand. However, they seem so one sided I never bother. Chris in NC emanon, you are correct it would only apply to health insurance, but it is also under the assumption that everyone is required to purchase insurance. Tony A. You are right. The Waiver for Pre-Existing Medical Conditions is so easy to get if one buys the right travel plan and pays within 15 days. Problem is many people just click the (chepeast) Insurance Option from their Online Travel Site not knowing what they are really buying. Sorry. Alan Another scam operation we can cross off our vendor list. Good work on reporting this. Charlie If Ms. Murray had used a live, professional travel planner that did her/his job, they would have explained pre-ex and that she needed to purchased insurance within 14 days or so of initial payment for her trip. And to the characterization that travel insurance is a scam, nothing could be further from the truth. It is true that our agency has been in business 30 years so have a lot of history, but we have seen MANY thousands of dollars paid in claims for pre-ex conditions. The difference is that we did our job in counseling with the traveler, looking out for their best interests, and acting as their advocate. Lil I don’t think any insurance seller would have explained the pre-existing condition section of the policy, unless she mentioned that her travel companion had this ongoing condition. Travel insurance seems worthless unless it is the most clearcut claim. Bob Had a great experience with TravelGuard in 2008. Covered my wife’s hospitalization co-pay and extra travel expenses with no questions asked. You just need to read the complete contract which is not very complicated or even legnthy. Jeanne_in_NE “She’d planned a trip to Italy this fall with a companion, who fell ill just before they were about to leave. ” I’m sorry, her companion did not “just fall ill”. Susan N I wouldn’t call this a scam – the contract for the insurance was quite clear and unambiguous, and if you choose not to read the terms when you buy it, that’s your fault. sirwired This isn’t a scam at all. It’s a 100% standard insurance exclusion. You’d have a tough time finding a comprehensive policy WITHOUT a pre-existing condition exclusion. It’d be like crossing Honda off your list of companies you’d buy a car from because they have warranties that don’t last forever. If you cross all vendors with the exclusion off your list, you won’t be buying trip insurance at all. (Some vendors have optional ways to avoid the exclusion, but the default is to have one.) Rosered7033 My TA always offers insurance when the deposit is made, and again when the transaction is being completed. I make the choice what type of insurance to purchase and when, but I am guided by her suggestions and explanations. Maybe Orbitz CAN do this, but DID they? Sorry the trip was cancelled & she was unable to get a refund, but the policy IS fairly straightforward, and when there are questions, you, as a consumer, need to get the answers before you buy. I voted no, but I do admire her tenacity. Tony A. Access America (http://www.accessamerica.com/aa/AboutUnderWriter.aspx) is rated A- by A.M. Best. You don’t get that kind of rating if you are a scam operation. Tony A. If you go to Orbitz and try to book a ticket you will be offered a trip protection plan like this: Protect your travel investment with valuable Access America travel insurance. Get reimbursed up to 100% if you cancel or interrupt your trip for a covered reason like illness, injury, layoff, and more Emergency medical/dental, travel and baggage delay, and lost baggage coverage24-hour toll-free emergency hotline and concierge with award-winning support Limitations apply, learn more. Unfortunately, this is a plan that does *not* WAIVE the pre-existing medical conditions exclusions. I DO find the statement “Get reimbursed up to 100% if you cancel or interrupt your trip for a covered reason like illness, injury, layoff, and more” a bit misleading. You need to click the learn more link and dig under to read the pre-existing medical exclusions are NOT waived. Tony A. On the contrary, and good insurance agent will ask if one needs a waiver of pre-existing medical condition exclusions since those plans cost more than ordinary plans. The agent can make more money with more expensive plans! Michael K …most of the major providers (…AccessAmerica… etc.) will waive pre-ex exclusions if you buy your policy within a certain amount of time… —— This is NOT really accurate for Access America. They include this double-talk language in their policy summary: The benefits do not cover conditions or events that, on the date of purchase, are either known to You or likely to occur. Please be aware that this stipulation may be applied to policies purchased with the Pre-existing Conditions Exclusion Waiver Michael K Don’t these 2 sentences contradict each other? — (1) [according to the orthopedic surgeon] her traveling companion had been in pain for the last two years and had “gotten progressively worse over the last six months.” (2) The doctor indicated that symptoms began approximately 2/1/11. As Ms. Murray’s travel insurance policy was purchased on 5/11/11 How many illnesses progress with perfect linearity? Michael K If I’m looking at the same Access America policy type, the relevant language from the policy summary is this: Pre-existing Conditions means the existence of symptoms in You, a Traveling Companion or a Family Member that would cause an ordinarily prudent person to seek diagnosis, care or treatment within 120 days preceding and including the effective date of Your insurance or a condition for which medical advice or treatment was recommended by a Physician or received from a Physician within 120 days preceding the effective date of Your insurance. If they want to be aggressive, they will nearly ALWAYS be able to argue (with the benefit of hindsight) that a prudent person should have sought diagnosis, care or treatment. The only clear exception is a random accident like getting hit by a bus. sirwired This is not a major issue. This is to keep you from say, calling to buy insurance AFTER you schedule an operation. Just like you can’t purchase flood insurance for a hurricane after the storm’s been named and it’s making a beeline towards your house, Access America won’t cover conditions that you were pretty sure were going to cause you to cancel prior to the policy purchase. TravelGuard has a similar exception to the waiver, although they word it differently; they require you to be able to take your trip, as scheduled, at the time you purchase the policy. You have general back pain, but feel up to going when you buy the policy? Covered. You go to the doctor and he tells you you are going to be bed-ridden for six months after the operation he needs to schedule, and you THEN go purchase insurance so you can recover the cost of your plane tickets? Not covered. sirwired To be fair, A.M. Best I don’t think covers customer service, claim approval rates, etc. I believe all they cover is financial stability and ability to pay claims. This is important of course, but really claim servicing will be more of an issue for most consumers. (And TravelGuard never skipped a beat during the AIG fiasco, despite the complete collapse of their parent company.) Bodega I voted no based on the policy purchased. I have said it many times and I will say it again, just because you make a purchase online does not mean you know what you are doing. This is a excellent case in point! There various types of polices that each travel insurance company offers, just like your own home owners insurance or car insurance company offers. You shouldn’t just buy the first one you see just because a company offers it. Are people getting dummer because of the internet and not using their brains anymore? I am beginning to wonder. Michael K Then why doesn’t Access America clearly spell it out that way? Do you trust them to follow the spirit of the clause in the manner you suggest? Or will they follow the letter of the clause in the manner most favorable to them? Given the breadth of articles we’ve seen about Access America on this website, how much confidence do you have in your response to that question? Bodega Oops, I guess I am, that should be dumber! guy999 pre existing condition is ridiculous, my back hurts today probably because i sit badly, so would my insurance not cover me if i have cancer of the back that was undiagnosed. Just having a symptom is not enough to say you have a diagnosis, and I think anyone sane would support that. I am becoming less and less a proponent of even buying insurance at all. Tony A. Chris, If you buy the Access America plan that Orbitz sells, it does *not* include a WAIVER for pre-existing conditions. Policy for my State (CT): http://www.accessamerica.com/documents/library/certs/ONC_C2.pdf However, if you simply go to the Access America website and bought a BASIC plan, it does waive the exclusions you pay within 14 days. Read middle column of pg. 2 http://www.accessamerica.com/documents/library/certs/11BA_C.pdf The Lesson of the day – buy travel insurance from a *real* travel agent or seek help from the insurance provider. Travel Insurance companies have different plans and one needs to find the one that best fits their needs without paying more than necessary. In my office, we prefer TravelGuard since their plans are easier for us to understand and sell. Thumbs down to Internet Vending Machines. Michael K The Policy Summary is in (somewhat) plain English. But the ACTUAL policy that governs IS in thick legalese. And you can’t even see the thick legalese until *after* you’ve purchased the insurance (which is refundable for a limited time). Chris has posted other cases where it appeared the Policy Summary did not offer clear guidance and the thick legalese mattered. sirwired I thought the wording was pretty clear… “Conditions or events known to you, or likely to occur.” I suppose they could spell it out in excruciating detail and legalese, but that would make the policy harder to read. If the company were to torture the language to make the waiver meaningless, any insurance commissioner in the land would rule this exception invalid. Most of the Access America complaints on here, like this one, are for claims that were clearly excluded by the simple language in the policy which the policyholder unfortunately didn’t read. sirwired What company will not allow you access the full Description of Coverage online prior to purchase? The policy here certainly was available in full on the Orbitz website before purchasing. The only time I think this would apply would be the policies sold by human travel agents, and even then I am sure they would supply the full policy on request. Michael K Please explain how you managed to view an Access America Policy without purchasing it (refundable within 10 days of purchase) and receiving a “Letter of Confirmation.” The links to “Plan Details” always lead to the Policy Summary (and even those links are somewhat buried). sirwired 1) http://www.accessamerica.com 2) “Lets Get Started” “Trip Type” -> Cruise (or, you can select the policy type if you know which one you want) 3) The Deluxe plan appears on your screen; select “Description of Coverage” 4) Select state 5) Click “Click here to read the Terms and Conditions” 6) A .pdf of the Certificate of Insurance (which is the FULL policy text) appears on your screen. Michael K Again, the language that matters is not what you’re citing from the Policy Summary but the Policy document itself which IS spelled out in excruciating detail and legalese and IS hard to read. Just two weeks ago (Oct 20 2011) Chris wrote about an Access America denial that was justified in part by an exclusion on “mental or nervous health disorder[s]”. I cannot find that language in any Access America Policy Summary! I’m fairly certain it came from the excruciating detail and legalese! Mbods2002 I hardly ever say “no” but did this time. Maybe because I purchased an Access America policy not too long ago for a trip. They offered a lot of info which I read thoroughly, as is my obligation and even called to confirm I was purchasing the correct policy. It wasn’t a “cancel for any reason” because I waited too long after making my travel arrangements and making my first down payment. I knew all that, just slipped my mind. Point is, it’s up to us to read up and Access America’s exclusion and coverage is quite clear, I thought so anyway. Michael K Looks like it depends on your state of residence. When I do exactly what you describe and enter my home state, I get a 10 pg document that includes the following: Read Your Policy Carefully – This outline of coverage provides a very brief description of the important features of the accident and health benefits ONLY of your Policy. This is not the insurance contract and only the actual Policy provisions will control. The Policy itself sets forth, in detail, the rights and obligations of both You and Your insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY! —- So at least for some of us, reviewing the full plan in advance of purchase is not an option. And for some of us it is an option. Interesting… JE DC Sometimes I wonder if people actually read the entire story about a case (or maybe they just skim it?) before giving their feedback. I tend to be sympathetic to fellow travelers (like most people posting on this site) but I do feel Ms. Murray is definitely in the wrong on this one…. Her traveling companion has been in pain for two years and has clearly sought medical treatment for that pain. Her symptoms have gotten “worse over the last six months” and I will guess that she was told during this period that surgery might be necessary if her condition continued to deteriorate. Unfortunately it did and surgery was required. I think it’s safe to say she had a pre-existing medical condition. I like how Ms. Murray carefully chose her words when writing to Mr. Elliott, describing her friend’s condition as “some pain she had been having in her hip.” Doesn’t exactly give the full picture, does it? Once I read the insurance company’s response to Mr. Elliott I think it was pretty clear there was more to the story than Ms. Murray wanted to share. sirwired That IS strange… And, as a side-note, the language you talked about earlier about the pre-ex waiver not applying for known conditions doesn’t appear in the full policy. Although it may be implied… I dunno… Rosered7033 Thank you two for pursuing this line (and not resorting to name-calling or other pettiness.) Would you mind sharing what state DOES share this info on the Access website? Just a hunch, but I am guessing CA. JE DC The don’t contradict each other at all. Sentence two is saying that the symptoms (that indicated her condition has gotten progressively worse over the last six months) started 2/1/11. She had symptoms of a hip problem before (dating back two years). In the last six months the symptoms have gotten serious enough to require surgery. djp Death is a pre existing condition…so what isnt??? Linda Bator As a travel agent, I can tell you that’s true! Not only will we have brochures with basic info, we would have them contact the insurance company with ANY specific questions. And by-the-by, we offer Travel Guard which WAIVES the pre-existing waiver if purchased within 14 days of the trip deposit. Linda Bator Absolutely! As a travel agent, we ALWAYS offer a third party insurance, as it covers the traveler’s needs more than the tour operators (we like Travel Guard – fits our clients’ needs well) Linda Bator ONLY health insurance policies Linda Bator As a local travel agent, I thank you for realizing the worth of the services we provide — and for keeping your business in the local area as well! :) Linda Bator Not true. I have asthma that is under control, but there was a time when the doctor was trying out several different treatment options, with various results. At that time, it would have been excluded from coverage because it was an ongoing problem, but since it has been under control for over 2 years, should I have an attack now that requires cancellation, I am covered — and I know this, because it has also happened to a client of mine! Linda Bator They would not consider that pre-existing, but in this case, she’s had treatment for 2 years for a problem which had gotten progressively worse, and within the 120 days before the trip purchase, had gotten worse still, so this was considered something the average person should have considered might be a cause to cancel their trip. It is not the “symptom” that flagged this woman — it was the ongoing problem worstening over time. TEXTBOOK pre-existing condition! Pugpsych Hello Chris, Having been denied last March due to a death in the famiy, I would,very much, like to be made aware of the actual claims that company DOES cover!! Is there any way to research? Could their claims paid out be public knowledge? They make a LOT of money from us travelers who think we are being smart to cover ourselves; only to find out NOTHING is ever really covered!! Thanks, Linda Tony A. But Alan called it a “scam”. I understand that Access America does pay out on valid claims and has the financial backing to do so. It ain’t a scam. Rosered7033 And as a BTW, if the tour operator offers insurance through their company and then files for bankruptcy, the ins. policy they issue won’t even be worth the paper it’s written on. Tony A. Death is *after* your existence. So it can’t be *pre*-existing. Although we are all per-destined to die. Michael K NY is the lone problem among about a dozen large states that I’ve tried so far. For OH and OR I did not see a “certificate of insurance” but there is no NY-like disclaimer. For WA, I got “This product is not available in the state selected.” Michael K Can you disclose which insurer your client used? My point is that there is a lot of room for insurer’s discretion in this literal language. “Prudent” is vague enough for people to interpret differently — especially with the benefit of hindsight that the patient didn’t have at the time. Mark K So if I buy the coverage and then suffer a heart attack, does this mean that because there is a history of heart attacks in my family and I am overweight and have other contributing factors to heart attacks they can deny ny claim I make because a heart attack is “likely to occur” even though I have no symptoms or history of personal heart issues? Or if I slip and fall on a rainy day breaking bones, are they going to deny claims because a slip on a wet surface is “likely to occur”? The wording is open to interpretation to exclude nearly anything. Michael K Without medical knowledge and and records from an earlier examination, how do you know exactly at what point the problem became serious enough for surgery? Without additional information, how can you rule out that she required surgery 7 months earlier or even 2 years earlier? JE DC When she required surgery isn’t the issue—it’s whether or not she had a pre-existing condition…and it seems clear that she did based on the facts we’ve been presented with in Mr. Elliot’s story. Clare Okay, imagine this scenario: John Doe plans a big trip months in advance. Around the same time, he starts getting headaches and concludes that he needs new glasses. After buying this insurance policy but before leaving on the trip, he goes to the optometrist, and discovers that something more is causing these headaches than just outdated prescription lenses. He gets referred here and there for tests, and ultimately is diagnosed with a brain tumor requiring immediate surgery. Obviously he has to cancel his trip. I’m not saying that this mirrors exactly the situation in this case–I’m a bit confused about what exactly was happening with the OP’s friend and when! But what I am saying is, as Access America describes their policy in their letter to Chris, they WOULD deny John Doe’s claim. His headaches would constitute “an illness that you had symptoms of, on the day you purchased your plan.” Like he’s supposed to know that he has a brain tumor? How many travellers would be able to self-diagnose something like that?! Yet Access America’s wording clearly indicates that it expects people to do so! Thanks for enlightening us about this outfit, Chris–it’s one more travel-related company to cross off the do-business-with list. Michael K You’re missing the part that pre-existing conditions are supposedly COVERED if they already existed 120+ days before you purchased insurance. Michael K You’re not kidding! Did you read Chris’ April 8 2011 column (“”Is a ‘natural cause’ a pre-existing condition?”)? http://www.elliott.org/the-troubleshooter/the-travel-troubleshooter-is-a-natural-cause-a-pre-existing-condition/ Badbadbear Thank you…Great information to have. sirwired I’m in NC. The full policy pops right up. sirwired So true. 1st-party policies never include protection against default. 3rd-party policies usually do. sirwired No, they are not going to deny your claim for such a heart attack. That is not a reasonable interpretation of the language, as it would render the available pre-ex waiver completely moot. (Any insurance commission would beat the ever livin’ tar out of a company that tried to read it that way.) Now, if you are admitted to the hospital with chest pain, and the doctor says you are going to have a heart attack any week now without a transplant, and you THEN go and buy a policy, then yes, the insurance company is going to fight (and likely win.) I’m not sure what you are getting at with your slip and fall example. Unless you intend to go and TRY to fall, accidental injury while running (no matter how foolhardy) would never fall under a pre-ex exclusion. Tony A. The issue is what is the meaning of pre-existing condition? Access America defines Pre-Existing Condition as – any injury occurring to a policy holder, a traveling companion, or family member prior to and including the effective date of an insurance policy; any illness occurring to a policy holder, a traveling companion or a family member during the specified time period prior to and including the effective date, for which a medical diagnosis or treatment by a physician has been sought or advised or for which symptoms exist which would cause a prudent person to seek diagnosis, care or treatment, or require taking prescribed drugs or medicine unless the illness remains controlled without any change in the required prescription. For the purposes of determining any pre-existing conditions: the effective date of insurance will be the trip cancellation insurance effective date if the policy includes trip cancellation; if that benefit is not included, it will be the trip departure date. So, assuming the headaches (SYMPTOMS) occurred within the look-back period of 120 days; and John Doe went to the doctor for it and the doctor diagnosed it to be brain tumor, then John Doe had a pre-existing medical condition 120 days before the date of insurance. Makes sense? sirwired You aren’t reading the pre-ex exclusions correctly. They are covered if they existed more than “X” number of days before policy purchase, AND they were effectively controlled by medication (no scrip changes allowed) OR required no doctor visits due to the symptoms. sirwired They can certainly TRY to argue crazy interpretations of language. Which is why we have insurance regulators in every state to keep insurers in line. Rosered7033 To that point, who made the decision WHEN surgery was necessary? Was it the doctor (which it should be), or is the ins. co. interpreting the Dr.’s notes? Without the doctor specifically stating in the patient’s file that surgery was recommended and imminent, the ins. co. should not be second-guessing the date at which it was decided the patient needed an operation. sirwired That article did not offer nearly enough detail to make a decision as to the validity of the initial claim denial. I guarantee that the insurance company did NOT slam down a “rejected” stamp as soon as they saw the words “Natural Causes” nor is it at all likely they sent a letter stating “Natural deaths are a pre-existing condition.” (Such a letter surely would have been included in the article if it existed.) A death certificate listing Natural Causes merely excludes accidental death, suicide, and homicide as causes of death. It makes no statement as to if there were preexisting medical conditions leading up to the death. That information is in the full medical record, which wasn’t provided as part of the article. However, I can certainly see a recent diagnosis of high blood pressure as being a pre-existing condition leading to a proper denial if the cause of death was, say, stroke. JE DC As sirwired said—you are incorrect that pre-existing conditions are covered under the scenario you presented…the response from the insurance company in the story states that they most definitely are NOT covered in this case. sirwired Firstly, the presence of such an exclusion is NOT a reason to cross Access America off the list. ALL trip insurance companies have such exclusions in ALL policies except for Any Reason policies. It’d be like crossing Honda off your list of car companies because their warranties eventually expire. It’s a reasonable exclusion; policies would be far too expensive without it. Lets say you get a bad cancer diagnosis after you book your trip. If you then go and purchase an insurance policy, knowing you are going to file a claim the second the policy arrives in the mail, the insurance company would quickly go bankrupt if they had to pay such claims. Your scenario is a relatively straightforward question. Pre-ex exclusions have a “lookback” period of a length that varies by company and policy. (AA uses a 120-day period.) If he scheduled (or should have scheduled, due to, say, missing work because of the headaches) that appointment to see the optometrist for the headaches during that 120-day period, that’s a preexisting condition, and the claim would be denied. However, if, (and this is a big IF), he’s purchased a policy that has a pre-ex waiver available (many/most 3rd-party policies do) and meets the requirements for receiving such a waiver (there are usually time and insurance amount requirements), then the ONLY way he’d be denied in that case would be if he had the tumor diagnosis prior to policy purchase. The headaches, unless already disabling, would NOT exclude a claim. I’ve taken advantage of such a waiver before, and therefore had no hassle whatsoever when filing a $3000 claim. Bodega You can’t insure yourself for default. Some tour companies have cancellation waivers, which isn’t insurnace. Those that offer insurance can’t offer default coverage. Marvin As a retired physician I know that except for sudden accidents, everything preexists before it exacerbates to a diagnosis. Let’s assume the writer is “of a certain age.” Most people… let’s say on Medicare,” can be found to have some joint pain. It’s a companion of age… perhaps some arthritis or tendon sclerosis. Does that mean every person that must cancel a trip because of an orthopedic problem can have their insurance claim denied? Nonsense. One can have years of some digestive problem and finally require surgery for an ulcer. Many chronic medical problems have a history of years… certainly not the few months before travel. There is no way to know when some chronic condition will erupt to a point where a doctor will advise against travel. Tony A. Sirwired, the irony here is that most plans actually have a waiver for pre-existing exclusions if people just pay within 14 days. And the plans that don’t have them also usually allow them to be added for about 10 bucks. The OP simply bought the wrong plan from Orbitz because they sell the cheapest, stripped-down plans. All these discussions would be moot if the OP bought the policy from a human agent. Joe Reynolds The definition of “pre-existing condition” can be a vague one and should have a better definition. Of course if one has a heart attack and the insurance company says it was caused by atherosclerosis and you had that condition before you purchased the insurance, it was a pre-existing condition. If one takes that approach I think the insurance company is wrong. People do need to take some responsibility for themselves. Like if you develop a problem don’t wait over a month to check it and if you think it may develop into something else, by all means take out the pre-existing condition coverage. You have to tell the doctor how long you have had the problem and he has to record it and the insurance company can access those records. Lclar Doesn’t it strike anyone incredible that FIRST one has to buy a policy, and THEN they will be given a chance to see the details of what you bought??? (Imagine this applied to buying a car: “Yeah, sign the contract and then we’ll let you know what accessories are included. Hey, you can always cancel.”) I’m an attorney. I’ve always insisted on getting the complete terms and conditions of any insurance contract I’m expected to buy. If you push hard enough, there’s usually a place where all of the details are available. And if you can’t read all of the terms, DON’T BUY, and tell them why. This is an unconscionable way to run a business, and the insurance industry should be ashamed. Tony A. Lclar, I was able to read the (lousy) Access America policy that Expedia was selling before I need to buy and pay for it and the airline ticket. The same is true if I did it on Access America’s website. I think people just don’t look for (hard enough) or read the policies before they buy. Michael K So if (for example) she honestly felt her condition was under control with occasional use of over-the-counter meds (and any changes were X days prior) then she has a case that she should have been covered, right? Without digging deeper and without just taking Access America’s word for it, I have no idea and I don’t think you do either. Michael K 90+% of the time, the cause of death involves preexisting conditions whether the victim was aware of it or not (e.g. heart disease, cancer, stroke, etc.) That doesn’t mean that the death was expected. Much of the remaining <10% you can probably assign some blame to the victim (drugs, alcohol, violence, seat belts, crossing the street outside a crosswalk…) How many clear cut cases are there outside of lightning strikes, tragic falls, and getting hit by a bus in a crosswalk? Michael K I’ve discovered (see comment thread further up) that this is absolutely true for NY State, but apparently not for most other states. Michael K How do you explain the fact that Access America is the topic of the lions share of Chris’ travel insurance cases and has more negative customer reviews than every other company combined on sites like travelinsurance.com? The only possibilities I can think of are: 1) They have 80+% market share (I doubt it) 2) They have much more restrictive policy terms 3) They lure unsavvy customers who aren’t getting what they think they are 4) “Crazy” / “aggressive” interpretations of language. Vacaygirl Why is it that so many people cheap out on the “cancel for any reason” option or trip protection altogether and then scream when they are denied benefita they are not entitled to? How is that fair to those who do pay for the policy in full upfront for someone else who didn’t to have the same privledges? Michael K How do you reconcile: It’s a reasonable exclusion; policies would be far too expensive without it. with: most plans actually have a waiver for pre-existing exclusions if people just pay within 14 days. And the plans that don’t have them also usually allow them to be added for about 10 bucks. ? Michael K The problem is that very few illnesses emerge instantaneously out of thin air. It is almost always a gradual process and often the patient can point to subtle signals with the benefit of hindsight. A prudent person doesn’t generally rush to the doctor for common headaches, or for common flu symptoms or for a surface wound. Yet the headache could be a brain tumor, the flu symptoms could be leukemia, and the surface wound can lead to a life threatening infection. If these cases are not unequivocally covered, then IMO, travel insurance is practically useless for protecting yourself against unexpected illnesses. Mark K I was specifically referring to the portion of the quoted reference about excluding things that are “likely to occur.” Isn’t the whole point of buying insurance because things are “likely to occur” that would prevent the traveller from traveling? There are numerous injuries, illnesses and other medical conditions that are “likely to occur” to any person and does this mean they are excluded from coverage in this policy? I completely understand that if I am informed by a doctor that I have a medical condition and it is not corrected or controlled and I buy travel insurance I am not covered if something happens related to that condition. I have no problem with that. Tony A. MichaelK, my travel outfit is in NYC and we have never had issues accessing and distributing the policies first before we sell them. We like TravelGuard so that’s what we sell. However, I can easily find the policies for Access America (AA) for NY State. See below: Basic: http://www.accessamerica.com/documents/library/certs/11BA_NY.pdf Classic: http://www.accessamerica.com/documents/library/certs/11CL_NY.pdf Deluxe: http://www.accessamerica.com/documents/library/certs/11DL_NY.pdf The AA policy the Orbitz sells for NY can be found here – http://www.accessamerica.com/documents/library/certs/ONC_NY2.pdf I am confused why would-be buyers cannot seem to find the policies for travel insurance they are thinking of purchasing. I second Bodega’s comment – are people just this dumbed down already? Michael K I don’t believe these are not the final insurance contracts. There is also no certificate of insurance (unlike for other states). The PDFs you link to all include the following disclaimer: This outline of coverage provides a very brief description of the important features of the accident and health benefits ONLY of your Policy. This is not the insurance contract and only the actual Policy provisions will control. The Policy itself sets forth, in detail, the rights and obligations of both You and Your insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY! Michael K That should say: I don’t believe these are the final insurance contracts sirwired You buy insurance to protect yourself from things that are possible to occur, not likely; the two are very different. “Likely to occur” is something like: Doctor tells me I need to schedule surgery; even though I haven’t scheduled it yet, it’s likely that I will do so and won’t be able to travel. “Possible to occur” would be: I have high blood pressure for which I just started taking meds; it’s possible that I will have a stroke, but no doctor has told me I’m doomed. I’ll get caught by a pre-ex exclusion, but not a “likely” clause. sirwired Plans with an optional pre-ex waiver still require the pre-ex waiver (and policy) to be purchased within the same strict time limits that policies that already have it bundled require. sirwired That’s why there are limited definitions of a pre-existing condition as it applies to the exclusions. It does not mean “any condition present before death.” It means: any condition exhibiting symptoms requiring a doctor visit and/or a medication adjustment within X number of days before policy purchase. If you have no symptoms and suddenly need a triple-bypass from a heart attack due to undiagnosed atherosclerosis, you’ll be fine with filing a claim. The insurance company is certainly going to be going through your medical file very thoroughly, and it’ll take them a few weeks to ponder about it, but they’ll pay. Carver Hi Mark I understand your confustion. However, terms of art such as “likely to occurr” are generally well defined with the subject area. So while the phrase may be general and open ended in normal language, it would have a specific and well defined meaning within the insurance field. sirwired You are right, without full access to the medical file and medical training, we can’t tell for sure. But, on the other hand, this does not appear to be an unreasonable denial on it’s face, and it would be unreasonable for us to assume that the insurance company is in the wrong. It appears from the correspondence that the original writer was not aware of the pre-ex clause at all, and that is the source of the complaint. It does not look like the complaint is that the pre-ex clause is being applied incorrectly. Even Chris seems to admit this. Geoff Access America has a bunch of policies, so a blind condemnation shows porr judgement. I sell the classic plan, more expensive, and if purchased within 14 days of deposit, covers pre-existing conditions. Travel Guard sells the same type of insurance in thier gold plan. This is why ASTA travel agents can really help clients and save tons of money sirwired And the exclusions specifically state that they only apply if a prudent person should have gone to the doctor for them. Yes, it is a judgement call. But no, the insurance isn’t useless. Michael K Based on the rate of articles about Access America here and the number of customer complaints about them posted online (more than every other travel insurance company combined by my unscientific count) I have little confidence in Access America applying these judgement calls in good faith. But otherwise I agree, in principle, the insurance isn’t useless. Michael K If it was another insurer I would agree. I’m reluctant to give Access America any benefit of the doubt given their track record according to their customers. Tony A. MichaelK, what they are saying is that they are selling primarily TRAVEL insurance and NOT HEALTH insurance. They will reimburse you for some medical expenses you incur on your trip but they want to make it clear it is not health insurance. Tony A. The anger here is misdirected towards Access America. It should be towards Orbitz. Here’s why. Go to Orbitz and make a fare search for NYC to Venice (VCE) for 24NOV – 30NOV. Select the Delta $811.90 fare. Enter a fake name and keep on clicking continue till you get to the insurance offer. Look, Orbitz wants $60.89 for their trip protection plan by Access America. Click on learn more and read the policy for NY State. Note that you do not get a waiver for pre-existing condition. Now go to Access America’s website. Enter the same trip dates and key in your age as 56 years old, and your State as NY. Access America’s BASIC Plan is only $43 and it includes a WAIVER for pre-existing conditions if you pay within 14 days. So please don’t be an idiot. Why pay Orbitz more (about $18 more) and get LESS? Go directly to the insurance site, pay LESS and get a WAIVER for free. Next time please use your head before you buy anything online. Better still use a good travel agent. Cheers. Mark K Thanks. I knew I should have gone to law school. ;-) Arizona Road Warrior As a long-time reader of this blog, it is common that the people that write to Chris do it in a way to support their claim, position, etc. It is common that we don’t get the whole story. Bgirl_nw How about this one…Access America plan purchased for a flight to travel for surgery. Surgeon’s office changed surgery date, so original flight needed to be cancelled and rebooked for a week later, at a much higher price. The cancellation had nothing to do with my medical condition–it was a scheduling error on the docs part. Should I have not even purchased the plan in this instance? I admit, I purchased it hastily without reading the plan. Charlie The schedule change is due to a human error, not an accident, and would certainly not fall into any of the covered reasons I saw on their website. I would ask the doctor to cover the difference since it is his mistake. If a travel agent had made a similar mistake and booked you on the wrong cruise and you bought airfare based on the agent’s incorrect information, would you have filed an insurance claim or asked the agent to make good on the mistake? Same thing applies here.