“He said/she said” dispute with insurance company costs family $34,500 — now what?

puertoCarla Baker’s 85-year-old father was seriously injured while vacationing in Puerto Vallarta, Mexico. Good thing he’d bought an insurance policy through Access America, which covered his hospitalization and medical evacuation.

Actually, not so good. Access America didn’t pay all of his bills, leaving the family tens of thousands of dollars poorer.

What now?

Baker picks up the story after his accident on June 8:

After he was taken to the hospital, both my step-mother and Dr. Alejandro Rios, a physician at San Javiar Hospital, called Access America. My step-mother could not reach a human, only a recording. Dr. Rios spoke to an Access America representative and waited for a day and a half for Access America to make arrangements and advance the funding for an air ambulance trip back to the States.

The family waited at the hospital until late June 8th and well into the afternoon of June 9th waiting for Access America to get back to Dr. Rios. At that time, it was determined that my father needed to be air ambulanced back home due to intense pain and the need for surgery. The family had to scrape together the $34,500 to pay upfront for the flight.

Baker filed a claim with Access America and were reimbursed $10,200 for their canceled flights. But they denied the remaining $24,500, insisting that there was no record of the Bakers contacting Access America after the accident.

I really don’t know what we could have done differently given the circumstances. The reason that this appeal is occurring so late after the accident is that it took six months to get a denial of coverage letter from Medi-Care and then we had to go through his secondary insurance to get another denial.

We feel that Access America was negligent in this case for not providing timely service and that my father should be reimbursed. Any help that you can provide in reaching a fair resolution would be appreciated.

I contacted Access America on Baker’s behalf. Here’s its response:

We have thoroughly checked our records and cannot find any record of Mr. Baker, his family, his doctor or a hospital contacting us for help on his behalf.

Our phone lines are staffed 24/7/365 and we do not utilize any sort of answering machine or answering service.

Callers to our main number are prompted to push “9″ if the caller is traveling and needs help. Those calls are routed to our assistance group which is staffed 24/7/365. Our assistance group has no record of being
contacted.

I am very sorry that Mr. Baker has been ill and I wish him and his family the best. I’m also very sorry that we have not been able to assist him further. As was described in our letter to Carla Baker, we did make a significant consideration in reimbursing him for $10,200 in transportation expenses.

True enough, a $10,200 reimbursement is nothing to sneeze at. But Baker’s insurance policy promised full coverage, and that’s not what he got. I ran the response by Baker.

It sounds like this has turned into a “he said/she said” situation. I don’t understand why they don’t have any record of two calls being placed to them.

At this point in time, even if I could get a Spanish interpreter to contact Dr. Rios at the hospital, I don’t know if he would remember the situation. It sounds like Access America would not take his word either since they don’t have a record of his call.

Access America seems to be insinuating that the ten family members and a physician who were involved in waiting word from Access America are lying. I am so frustrated. Any ideas?

I have a few thoughts on this case.

A polite appeal to Access America, containing a letter from Dr. Rios that corroborates Baker’s account, might be helpful. But chances are, she will have to take Access America to court in order to recover her money.

This also underscores the importance of asking for names, extensions and reference numbers when you call an insurance company. First, get the name of the person you’re talking to. Ask for an extension. And before you get off the phone, ask for a reference number or case number — and make a record of it — so that you know that they know you made the call.

I’m troubled by the discrepancies between the Bakers’ account and Access America. Unfortunately, it may be up to a judge to decide who’s right.

(Photo of Puerto Vallarta, Mexico by Stewart Leiwakabessy/Flickr Creative Commons)

  • Billie Keirstead

    These travel “insurance” companies seem to always want to discredit physicians. Nayve doctors should file a class action slander suit.

  • Carver

    I got burned once when a dishonest attorney lied about not having a conversation with me. Therefore if proof of a conversation is required, I generally advise e-mail or fax with confirmation receipt.

  • Titophe

    I assume these calls were made from cell phones and/or from his hospital bedroom. Couldn’t the phone bills prove that the calls took place ?

  • Tim Tye

    Aren’t there outgoing phone records of the calls that were made? These would at least establish that attempts were made to contact Access America.

  • Lisa S

    Wow! I was going to use Access America when I bought travel insurance for my trip to Ecuador, but I will go with Travel Guard now.

  • Brian

    How about telephone records showing a call was made to the Insurance Company. You cannot use 800 numbers in foreign countries so there must be some type of record.

  • http://www.travelinsurancereview.net/ Damian Tysdal

    A frustrating situation indeed; I hope they are able to come to a better resolution somehow.

    I think Chris’s advice is perfect. Get in touch with a person even if it means calling several numbers (carry these numbers with you when you travel). If you can’t get through on an assistance line, call the “sales” line where someone will usually pick up. Get as much confirmation information as possible, including a claim number, case number, and operator ID.

  • Gerry

    Forget Access America. I’m completely unsurprised that they “have no record” of any calls. No company ever has any record of your calls when it costs them money. Neither did they receive your faxes or your letters, unless you remind them that the letter was sent return receipt requested, and they signed for it. Then they’ll suddenly be able to locate it.

  • Mr Bad Example

    Here’s another tip I learned from an attorney regarding “Proof of Service” for lawsuits and the like.

    Send a copy certified return receipt requested and one regular mail. If the company or individual refuses the certified letter and NOT the regular mail letter many courts will consider it Proof of Service” should the need for litigation occur.
    Our attorney did this with mt wife’s ex husband over child support and it worked splendidly.

  • Kathleen Pierz

    Phone records (fixed or mobile) will confirm the calls; this is not too difficult. I am happy to provide translation services should the family require further assistance contacting Mexico. Mr. Elliot knows how to contact me.

  • Geoff

    As I always ask…..did they use an ASTA travelagent? They have great power with the insurance company. I have sold Travel Guard and Access and would only consider Access. Odds are that the Dr. talked, but did not initiate the claim.

  • Joel Wechsler

    Any family traveling with an elderly parent should look into Medjet Assist, which sells both annual and short-term coverage. They cover air evactuation to the hospital of your choice, noquestions asked. It isn’t cheap but it’s worth it for what it does. I have sold this product repeatedly, and none of my clients has ever had a claim denied

  • dennis kavanagh

    I suggest the family consult an attorney about suing the insurance company for bad faith. Make sure the attorney is an expert in the area of insurance bad faith litagation.

  • Bette Green

    I always use AccessAmerica and blessedly have not had to use. This is really a concern to me. I travel to St Maarten when I don’t use my own cell phone and calls are made with a rental phone, so no proof of call would exist, if push came to shove. I will be seeking a new insurance company next time I travel. This is just wrong.

  • Rob in Ottawa

    With every contact, get the name, time and date, and the phone number called.

    Recently, when dealing with a complicated warranty claim, I opened an online document on Google Docs, in which I tracked every communication related to the claim, including notes on every conversation. Since it was online, I could update and check it from home, work and on the road. It paid off handsomely.

  • http://www.clarkecomputer.com Charles Clarke

    Interesting that his mother couldn’t reach a person, but the doctor could. Did the doctor really reach them? Or maybe they only have non-English speakers?

    On the other side, it is interesting that Access America was able to find the claim to reimburse the cancelled flights, but not the air amulance. If they are going to pay part, why not pay the whole? What is their explanation for that?