How many days of diarrhea do I have to endure before my insurance company helps me come home?

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By | January 11th, 2017

Montezuma’s Revenge.

Been there. Even done that.

Who would have thought that a small glass of water in Bangkok, a world-class city no less, would be the culprit? Instead of rushing to one of that city’s real world-class hospitals for a “stupid-tourist-drank-tap-water” pill, I cashed in United Airlines frequent flier miles for a flight home.

The cabin crew restricted a toilet for my exclusive use. Thanks, United.

Gabriele Russo, a Rome-based consultant, is a far more daring traveler. And yet he was prudent enough to have purchased what he considered a comprehensive traveler’s insurance policy from Globelink Insurance. The policy covered £5,000 (about $6,228) for emergency rerouting.

And on a recent trip, he needed rerouting. Badly.

“I spent a week in a lodge in the forest near the Peruvian town of Iquitos, where there is endemic malaria, Zika and dengue,” he wrote his insurer. “I started to suffer from intermittent fever and diarrhea three days ago and I have not improved despite the antibiotics I have been taking.”

A doctor in Iquitos recommended, on letterhead, that Russo move from the hot Amazon basin to a cooler climate. Russo opted for a flight to New York, advancing by two days the next leg of his trip. His fever had broken, and for now, he told his insurer’s representative, the doctor considered him safe to travel.

Globelink retains an intermediary medical specialist in Brighton, England, called Mayday Assistance and Claims, which reviewed Russo’s claim.

Not so fast, it replied in a series of emails:

  • Mayday wanted medical test results and a diagnosis from medical professionals other than those in Iquitos, a city of about 400,000 with two public hospitals.
  • The screener’s “medical team,” at that point, saw no proven need to change his schedule.
  • Finally, it noted that his air travel had been funded by airline reward miles, and any changes would need to be cleared with that airline’s customer service. It made no mention of covering the costs for alternate bookings.
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The terms of the Globelink policy make a distinction between covering a policyholder’s disinclination” to make or continue a trip and a medical necessity supported by a “medical certificate from the treating medical practitioner … explaining why it was necessary for you to cancel or curtail the trip.”


Russo contends that the medical letter from Iquitos meets that requirement in advising his departure from the Amazon basin.

Russo decided to follow this on-site doctor’s advice, he says, fearing a recurrence of the fever. Because of budget constraints, he used 75,000 Delta SkyMiles for a new ticket to New York. Valuing the miles at $953, plus tax, telephone costs and medical charges, his reimbursement claim totals $1,008.

Normally, we would recommend Russo follow our path of escalating email contacts — email to maintain a record rather than telephone calls. Keep the message detailed, short and neutral. Start at the lowest level and, if no response after two weeks, move to the next higher. Unfortunately, British-based Globelink is not currently on our contact list. (We’re working on it.)

Our site contains a series of FAQs covering issues raised by travelers. It can be found at our forum.

For anyone insuring against peril during adventure travel, or even travel to areas off the medical grid, the guarded response of Globelink and its medical gatekeepers should be vexing.

Diarrhea, as the nickname Montezuma’s Revenge suggests, is particularly common among travelers in Central and South America. Still, cases resistant to antibiotics can be life-threatening. A traveler’s claim from, say, Nome, Alaska, might be suspect, but one from the Amazon basin should not have caused Mayday to raise hurdle after hurdle. Luckily, Russo remained coherent, and able to protect himself. Had this not been the case, Russo had to trust that Globelink/Mayday would have become proactive and intervened.

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Mayday responded to his claim, reiterating its concern that the doctor’s medical letter was not sufficient to justify the need for an evacuation, and defending its recommendation that Russo seek a more complete diagnosis and tests at a larger hospital. It noted that while Russo believed himself fit to travel immediately, at the same time he expressed concerns about his condition going forward.

Finally, added Mayday director Craig Huffer, the firm was unable to provide lesser relief by rebooking his current itinerary because of reward-point restrictions on third parties. Russo thereafter did not respond to text or telephone messages, he stated.

Has Globelink really satisfied its service claim, “Globelink has always tried very hard to give the type of service which we ourselves would like to receive from other firms. . ." ?

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  • sirwired

    I agree that asking him to find another doctor in a different city was stupid. He didn’t self-diagnose and hop on the next flight home, and the doctor said the next step in treatment was to get the *bleep!* out of the Amazon. And he bought a coach-class ticket home, he didn’t charter a medical jet or anything. I wouldn’t have called this an “evacuation” at all, just a “Trip Interruption Return Air” (no idea what the equivalent in an Italian policy would be.)

    But on the amount of the claim? Insurance will cover mileage re-deposit fees if you have to cancel, but they DO NOT reimburse for FF miles you use to buy a ticket home. They simply do not pay something you got for “free”. That said, at least he valued them at something vaguely resembling their wholesale value (a little high, but not crazily-so), instead of other claims we’ve seen like this, where the customer just sees how much it costs to buy that many miles at full retail and values their claim accordingly. (Even if said ticket would cost far less had it just been purchased with cash.)

  • DChamp56

    “I spent a week in a lodge in the forest near the Peruvian town of Iquitos, where there is endemic malaria, Zika and dengue,”
    Did he, before he left, consult his physician about shots/methods for not contracting them? He should have but it’s not mentioned here.
    My answer would be different based on the answer to this.

  • sirwired

    Certainly traveling to the jungle without adequate preparation would be a good reason for an insurer to refuse to sell a policy (or charge a lot for it), but it’s not a good reason to deny a claim.

  • There are malaria pills but they only reduce the chance of sickness, not eliminate it.
    There are no shots for Dengue or Zika. You wear lots of bug repellent, sleep under a mosquito net, and hope for the best.

  • FQTVLR

    The insurance company sounds like they took the letter at face value—the doctor “suggested” he go to a cooler climate rather than required immediate departure not only from the area but the country. Many of us have probably had a doctor suggest we do something or have a procedure, etc. but until it is required the insurance company will probably balk at paying for it. Sounds like Globelink based a decision simply on the doctor’s choice of words rather than on what was actually needed.

  • KennyG

    Or maybe the doctors choice of words was correct, and immediate evacuation was not a medical necessity, simply a suggestion that he might be better off at home. Thats a mile away from a medical necessity.

  • Annie M

    Thats is the first thing I thought of. Are they denying because the doctor simply told him to fly to a lower altitude, which would have been cheaper than a flight back to NY.

    But sirwired is correct – no policies cover air miles, some cover fees for redepositing.

  • Michael__K

    they DO NOT reimburse for FF miles you use to buy a ticket home

    Actually, based on the terms of Globelink’s “Regular” policy for EU residents, if he can provide “specific evidence of the monetary value of the tickets” then he SHOULD be covered under their Trip Curtailment provisions (equivalent to Trip Interruption on a typical US policy).

    http://www.globelink.co.uk/documents/Globelink-Wording-V1016.pdf

  • MarkKelling

    Iquitos is only at 341′ altitude. Not much lower you can go without being underground.

    No mention was made in the article about altitude, only about temperature: “A doctor in Iquitos recommended, on letterhead, that Russo move from the hot Amazon basin to a cooler climate.”

  • Bill___A

    The whole thing about any changes that you want other people to pay for, whether it is an airline re-routing or an insurance clam is: You have to get THEM to agree to the solution before you do it. You can’t take matters into your own hands and then bug them for the money after.

  • Harvey-6-3.5

    While there are drugs that can help prevent malaria (though some people experience very severe side effects), I don’t believe there are currently any methods, other than trying to avoid mosquito bites (maybe wear a leather burka at all times?) to avoid Zika or Dengue viruses. If he had contracted malaria, the local doctor, likely well versed in malaria, would have diagnosed this, so his symptoms better fit a viral infection (but YMMV).

  • AAGK

    The insurance company shouldn’t even have sold a policy to someone who chooses this destination. It sounds like the policy cost more than just purchasing a ticket home out of pocket. If he can produce medical records of every possible pre-travel precaution then it should probably pay the claim.

  • Bruce Burger

    The insurance company was right. The doctor said to get out of the Amazon to someplace cooler. The vast majority of Peru is not the Amazon and is much cooler and less humid than the Amazon. (In fact, on a recent trip, my son needed to avoid the hot Amazon — in a lodge with no electricity and therefore no A/C– for a day for medical reasons, so we stayed in a port town and rented a hotel room with great A/C.) And 3 days of diarrhea is common when traveling in developing countries. He was sick, but there was no medical need to leave the continent ahead of schedule.

  • DChamp56

    There is a shot to help with both Dengue and Malaria (other than quinine). Hopefully, he saw his Dr. and got shots before going.

  • DChamp56

    There is a malaria shot too (more effective than pill) and there IS a shot for dengue, just not Zika.

  • Pegtoo

    Exactly. Call the insurer to verify coverage. Do not assume. I was specifically reminded of that last week when I purchased a travel medical policy for my daughter.

  • cscasi

    “A doctor in Iquitos recommended, on letterhead, that Russo move from the hot Amazon basin to a cooler climate.” Nothing mentioned about altitude.

  • cscasi

    One way to be sure, is to tell the doctor what you want in the letter (if he will do that and if you are not asking him to write something that is factually incorrect or is not what he recommends).

  • The Dengue vaccine is only approved in Mexico. It is NOT approved in the US. There is no malaria vaccine as there are too many types of malaria and they keep morphing. The shot is only a replacement for the pills. Quite inconvenient in a foreign land.

  • The Original Joe S

    Typical insurance scumbags. Take your money, then scroo you when you need them. Another company to avoid.

  • The Original Joe S

    you stray from the issue. The insurance should cover him, regardless of what you think he should have done before the trip. The insurance company knew where he was going; if it meant so much to the company, they should have advised him to get the treatments before he went. Their fault…..

  • The Original Joe S

    maybe the company wanted him to go six feet underground, so they wouldn’t have to pay……..

  • The Original Joe S

    another brilliant remark from you……..

  • The Original Joe S

    assuming the OP knows that the insurance company is a gang of dirtbags, and need to be nailed down on all 4 corners to get them to do the right thing.

  • The Original Joe S

    Thank you for your diagnosis, Doctor Burger!

  • Nathan Witt

    As I understand the chronology, he got sick, got a letter from the doctor, called the insurance company, was told that his doctor’s note wasn’t good enough because their local “review team” knew better than the actual doctor treating him, and that anyway, his original flight was award travel, so they (the insurance company) couldn’t change his flight. At that point, he expended additional miles to get to New York, probably because he didn’t have an extra pile of money to buy another ticket (Good thing he bought insurance!). Now, he’s used up an additional 75,000 miles in addition to the miles he already used booking his original ticket. As to the value of those miles, what would it take to make him whole? That seems to be the correct metric to determine his reimbursement, since the wholesale value of those miles, while interesting, won’t put the miles back in his account.

  • sirwired

    The “retail” rate for miles is meant for somebody a couple thousand shy of a big trip to top-off their account, not to buy enough miles from scratch to then turn around and buy a ticket. It would end up costing WAAAYYY more than the ticket itself was worth. (Which is why the policy has specific language that if you buy a ticket using miles, you’ll get what the ticket would have cost had you used cash. (And you need to provide evidence as to what that was…))

    (For reference, United charges $35/1k miles at retail, while the wholesale rate for the things is only about $10/1k.)

  • Nathan Witt

    I get what you’re saying. And maybe the LW needed to call his airline, get the total cost to change the ticket, and tell his insurance company that information. It’s hard to tell from the post whether he did that or not. But if he did, and if the insurance company still refused to honor their commitment, well, he did what he needed to do to resolve the situation without their help, and since it seems *to me* that they were stonewalling him to try to save a buck, I wouldn’t mind seeing them pay through the nose to restore his miles, if only to remind them in the future that leaving their clients sick and stranded despite medical documentation to that effect might well be more expensive than doing the right thing.

  • Lindabator

    I think the problem was the doctor noted getting to a cooler area would help – not stipulating he had to leave the country immediately — he should have asked what they would have suggested, which probably would have been a visit to a hospital in the capital city to ensure he could travel to NYC, or that it was not necessary. As for claiming what you “feel” the tickets are valued at, agree with you – no company pays for what you got for free

  • Lindabator

    which would be fees attached to changing those tickets — instead he just used miles to purchase, which might only show a small tax value

  • Lindabator

    so he may have asked the insurer where they would recommend – it could have easily have been the capital city, and a quick trip to the doctors there

  • Lindabator

    they insure, not babysit – they are not there to check on health issues prior to a trip. they felt he should see another doctor better qualified, and I think the reason was the doctor only recommended a cooler area – they needed a better diagnosis

  • Lindabator

    you are so defensive! just because the client did not want to visit a doctor who could put in writing that it was not a suggestion to a cooler area, but a medical emergency – not bad guys. Had he done as asked, he wouldn’t have this problem. You can’t go by “suggestions” and “feelings” when settling claims – hard facts are what is needed — I have never had a client’s claim refused, because I instruct them on just what they need to do – BEFORE they do anything.