Flying you home and palming you off onto the state seems kinda shady to me. That’s not really “medical cover”, it’s just a flight home. And to make matters worse they made out as if flying him home was doing him a favour.
EDIT: Reading some of the other comments makes me think I’m just another mug who doesn’t read his insurance policies. But I still think that offering “£5,000,000 in medical cover” without qualifying that it really means "£5,000,000 in medical cover, only if we absolutely can't get you home and get the NHS to do it for free", borders on deliberately misleading.
I agree with your sentiment and believe this is just a shitty fly-by-night fake "insurance" company that collects premiums and dispenses plane tickets, but insurers aren't obligated to pay top dollar for whatever course of treatment you deem necessary without any opportunity for negotiation. If they're footing your bill, they get to have a say in the matter of when and how the job gets done.
He paid pennies for the "coverage." With that being the case and his being a British citizen, their treatment plan for everything is likely to fly patients back to the UK whenever possible. You don't become a billion-pound company charging 200 pounds at a time while also reimbursing first-world medical claims for travelers who aren't paralyzed in an ICU. I doubt they offer similar coverage to non-Brits for the same price, if at all.
We have similar plans wrt auto insurance in the US. You can either get proper insurance and pay a fair amount or the legal bare minimum for pennies, and when you get in your first at-fault accident you quickly learn what it is you have (or haven't) been paying for.
I've certainly never thought that was the case, and I don't think my comment implied that (I've edited it for clarity anyway).
What I meant was, I've always assumed that if I had an accident abroad, it would cover me for any surgery I needed in the immediate aftermath, until I was well enough to either resume my trip, or fly home somewhat comfortably.
I still don't think that's an unreasonable assumption, but I've learned something today!
Depends on the policy but I doubt there is a "somewhat comfortably" clause - if you want your insurance policy to cover you you generally have to follow what their policy requires and with cheapo insurance like this, if you are clear to fly, you are expected to fly home.
It's gonna be very difficult to get onto a plane and then claim you were unable to fly even if Singapore is a world closer to Indonesia than the UK.
I feel for this guy though, the situation sucks.
Yep, and this post has been an education for me!
However, I still have issues with the way it's marketed. I think part of the problem is showing these huge numbers for medical cover. It's almost a psychological trick, in the same way that lottery players see an enormous jackpot and somehow conflate it with the likelihood of winning. It's falsely reassuring.
In reality, most claimants are going to spend much less than 1% of that £5 million limit before they get flown home. It only really applies to people who are at death's door and end up with a long stay in intensive care, or need a fully-staffed medical flight to get them home.
Exactly, but you're saying it like it's a bad thing instead of "this is just what travel insurance is and why it's so cheap."
I still think it’s marketed in a deliberately misleading way.
With travel insurance generally, I think there's a distinction between emergency medical care you need RIGHT NOW and medical care that you need at some point.
If I get hit by a train and need to be pieced back together, am in the ICU, etc. I'd expect travel insurance to pay for that, up to the total coverage. If I get diagnosed with a slow moving cancer that needs treatment (but not today), I wouldn't expect travel insurance to cover it. I'd expect this to be laid out in the longer agreements I'm sure he had to sign to get this insurance. That's the difference between travel insurance and health insurance. I (Canadian) can get travel insurance for a trip to the US for damn cheap; that doesn't mean I can go live in the US and use that insurance for my day-to-day stuff.
Whether this particular incident is closer to the train or the cancer might be an open question. I think the key point, and maybe where he loses the argument, is that he already flew to Singapore. He took a ~3 hour flight in a worse state then when the insurance company advised him to fly home. Don't think he's going to win this one.
Also a ~14hr flight is a completely different proposition. Totally healthy people feel like shit after a flight that long. I really wouldn't want to take one if I was already in significant pain.
My trick is simple: Get an Amex Platinum if you need insurance for under 2 weeks [1] and buy insurance from your bank for anything longer. Banks compete on trust, so they don't randomly fuck you over. I actually used my bank's health insurance when I needed it and they were nothing but professional. It was RBC Canada, if it matters.
[1] Reach out to me if you do this and we'll both get enough points for a free transatlantic flight.
That emergency procedure, not the follow-up, seems more in line with what the plan is designed to cover.
That's bizarre to me as well. Why does he think not claiming reimbursement for covered expenses is being reasonable?
Part of me wonders whether this set fraud alarm bells ringing and made them scrutinise his case more. (Not that that excuses anything the company did subsequently).
What you did after the accident was reasonable. Claim the bills that you were covered for.
> And yes, because it turned out to be a fairly manageable bill. But the 2nd procedure was going to be considerably more, so I notified them. To clarify, I didn't want any long term care at all, I was only asking them to cover the 2nd operation that I was already scheduled in for.
Which they specifically told you you weren't covered for.
Your article says
>At this point, it’s 4 days until my scheduled surgery to have a plate fitted in my hand, and each reply from Insure and Go takes 3–4 days
The e-mails you include from Insure and Go have time stamps of June 6 and June 7. Perhaps they took more time before or after that, but during the time sensitive part of your narrative they were responsive. It was you that didn't respond to their June 7 e-mail requesting the not fit to fly until at least June 12.
>The patient may want to forward onto the treating doctor to help point out to us where in the manual the reason why he is not fit to fly as our decision would still be curtailment and he would have been fit to fly. http://www.iata.org/publications/Pages/medical-manual.aspx
(1) Claim your expenses that are clearly covered by your policy. The care in Bali, taxi ride in Bali, Flight to Singapore, Taxi in Singapore, Hospital stay, and the hotel in Singapore. That's gotta be at least $6,000 that you're just leaving on the table.
(2) Call your Doctor and ask him to write a better letter in support of your claim. It should be something like this:
To Whom it may concern,
I have reviewed the IATA manual and my patient Mr. Badger was unfit to fly pending his surgery. The manual states:
The following tables are provided as a guide to the timeframe that should elapse between a medical event and the intended flight. The timeframes may be changed following considered medical assessment of a specific case.
After my medical assessment I found Mr. Badger unfit to fly because:
(1) [Bad thing that might happen] because [medical reason bad thing might happen] (2) [Bad thing that might happen] because [medical reason bad thing might happen] (3) [Bad thing that might happen] because [medical reason bad thing might happen]
Thank You,
Dr So and So
If after they "review" my case they ask again, I will reach out to the DR who treated me and waste more of his time, but I'm confident the insurance company would have still found a way to weasel out of it, even if the DR had been more explicit. I imagine it wasn't his first time writing a "not fit to fly" note, after all...
They inquired if he had a pre booked flight home:
>> Our medical team believe this injury may require long term care, so we would see if beneficial that you return to the UK for treatment, if you have a pre booked flight home please advise us on the date?
His response to that line was:
>> The medical team here have suggested that I will require physiotherapy once a week for 4 to 6 weeks. I have no return flight booked at present, as I intend to stay in Asia for some time yet. I did consider travelling home to have surgery in the UK, but the medical Service is excellent and I'm already scheduled in for the procedure on Monday.
The partial quote you took, "I intend to stay in Asia for some time yet", was his justification for not having a pre booked flight home, not an expression of his refusal to comply with their recommendations.
> He wanted to keep traveling and avoid the NHS.
You've also mistaken his desire to finish receiving treatment in Singapore as a desire to avoid the NHS. His desire was to receive the most immediate care possible and the surgery was intended to install a plate to stabilize his hand and ensure that it heals properly.
They were asking him to fly for 20+ hours in a coach seat, considering his hand was unstable that seams unreasonable. It also increases the likelihood of additional injury as he travels.
The were asking him to transition his medical care from one hospital to another in another country on the other side of the globe. That by itself would introduce considerable delay in treatment as the new medical team would need to fully access his treatment up to that point and establish a new treatment plan. The surgery he was prescribed was to stabilize his injury to ensure it healed properly, delaying that treatment could potentially lead to improper healing.
As someone who popped a pulled tendon and had to wait 6 months (MURICA!) for an appointment with an orthopedist at which point my injury was healed (thankfully correctly), I can fully understand his desire to stay put and finish his treatment.
That has a cost. I'm Canadian and if I wanted to get a scan, it could takes months. If it's actually an emergency, it will be much faster, if I paid for it at a private clinic, it would be much faster too. Non urgent immediate care has a price.
> The surgery he was prescribed was to stabilize his injury to ensure it healed properly, delaying that treatment could potentially lead to improper healing.
They aren't there to give him "proper healing", they are there to support emergency situation.
If you go to your hospital and it takes 6 months, it's because they believe that 6 months is still "proper healing". If it takes him longer in UK, it means that it's still "proper healing".
His first hospital stay was an emergency, he didn't want to make the claims, but that was what was claimable.
If his doctor in Singapore though that he couldn't take the plane, then that's what he should have gotten as proof.
At least in the United States there's a distinction between Emergency, Urgent and Route care. I would classify this as urgent.
> They aren't there to give him "proper healing", they are there to support emergency situation.
Again, I'm not sure how it is in Canada but in the United States once you've undergone Emergency Surgery and you are stabilized; they move you into the non-emergency care ward and any followup procedures or treatment are on a needs basis.
My assumption was that after his emergency surgery he was transitioned to a non-emergency care team that was responsible for for the follow up surgery.
If he were undergoing emergency surgery to install the plate, I'm not sure they'd make him wait.
It's right there in his e-mail. He was concerned:
"About potential waiting times on the NHS".
>They were asking him to fly for 20+ hours in a coach seat, considering his hand was unstable that seams unreasonable. It also increases the likelihood of additional injury as he travels.
IMHO if his hand is well enough to be discharged then the presumption is it's well enough to travel. Of course, he can provide evidence from his doctor to rebut that presumption. The insurance co asked for that but it's not clear he ever provided it.
>The were asking him to transition his medical care from one hospital to another in another country on the other side of the globe.
Which is the service he paid for. Travel insurance is to pay for emergency care until you are able to fly home. If he wants an "any hospital, for any treatment, in any country" policy those are sold too, but, naturally, are much more expensive than Bronze level travelers insurance.
Oooh please elaborate on your personal insult.
>Do you work for the insurance company or something?
I am a software consultant, which, I suppose gives me a higher than normal aversion to people trying to get more than what is in their clearly stated contract.
I generally am sympathetic to the conclusion of the author that the intent was to screw him out of his money. Having working in insurance, I have heard from reliable sources that this is a common tactic and attitude at most insurance companies and I believe that to be true.
Then, on top of that, issues for the insured are compounded by bureaucratic snafus etc. which I find abhorrent given that the industry generally runs on claims of being there for you when they are needed.
I have said previously that it boggles my mind that insurance is legal, especially health insurance. I think car insurance and house insurance and such make more sense, but health insurance strikes me as being like an ugly Running Man style game show called "You Bet Your Life" and I go through life shaking my head at the idea that the world is apparently okay with this state of things.
Even car insurances do this even if you think they don't. They'll look for a reason to not pay you a dime even if it's on legally uneven feet.
When an insurance is profit motivated, then maximizing profits is the first instincts. Maximizing profits happens by maximizing the deny:payout ratio. My car insurance did this by denying me reimbursement on a covered repair because I didn't go the the repair shop the insurance would have preferred (of which I was informed later and per law this doesn't matter anyway).
On the other hand, my statutory insurance has covered any of my eye-care costs with zero questions asked or simple policies usually simply copied from the relevant laws (1 free pair of glasses per calendar year, up to 200€ IIRC, 10€/day for hospital stay beyond medical emergency, etc).
The difference? Statutory insurance here is non-profit. Most insurances, even the private ones are non-profit. Very few insurances operate for profit at all.
Other than the management overhead, the fees collected go straight into covering medical costs or are invested into fonds as a reserve.
No, I don't think car insurance is better about being willing to pay. I just think that it actually helps encourage driver responsibility on the road and it's less of an issue if you can't afford a car than if you can't afford medical care. I don't think the ACA actually insisting that all Americans have health insurance encourages anyone to eat right, exercise etc.
At the highly ethical, respectable company where I worked, this was going on:
Periodically, some actuarial would have a cow about how some benefit was costing too much. The policy would get sent to the legal department for review. Legal would find some defensible creative new interpretation for the language of the benefit in question. They would announce that we has been paying this benefit "wrong" the entire time the policy existed. They would retrain the entire claims department to "pay the benefit correctly."
Private health insurance is by definition avoiding the NHS, which was 10,000 miles away anyway, so I’m not sure what point you’re making here? If the terms of the policy were we’ll fly you home in cattle class and dump you on the taxpayer then that should be made clear
https://www.insureandgo.com/media/1228/iag_mf_pw_adv_0518.pd...
Page 20 says:
What you are covered for
We will pay up to the amount shown in the table of benefits on pages 4 and 5 for any costs for the following that are reasonable and necessary (see definition on page 14) as a result of you being unexpectedly injured or ill during your trip.
1. Emergency medical, surgical and hospital treatment and ambulance costs.
It also says:
Special exclusions which apply to section B
We will not cover the following:
2. Any treatment or surgery which we think you do not need immediately and can wait until you return home. Our decision is final.
12. Any medical treatment that you receive after you have refused the offer of returning to your home area, when, in the opinion of our medical advisors, you are fit to travel.
You can’t say “immediately” then take 4 days to reply, that’s unrealistic
It seems to me that the whole thing is "I bought travel insurance and I thought I would be getting global health insurance, but it turns out it's really travel insurance."
I guess because the NHS is paid through your taxes it may not have been so blindingly obvious to someone in the UK that anything similar to what he is asking for would have cost at least "300£ per month" (and that is assuming he is young and healthy) instead of "300£ for 18 months".
>I intend to stay in Asia for some time yet. I did consider travelling home to have surgery in the UK, but the medical Service here is excellent and I'm already scheduled in for the procedure on Monday. I was concerned about the long haul flight and travel time with a broken hand and fractured rib, as well as potential waiting times on the NHS.
So he's pretty clearly trying to game the situation. He wanted to keep traveling and avoid the NHS. The letter from the doctor saying he was not fit to fly simply states:
>The patient Badger Ryan Sean was admitted from 11/6 to 12/6 for an operation for a right index finger proximal phalanx avulsion fracture on 31/5 and was not fit for flying before his operation for his fracture.
It's reasonable for the insurance company to ask for more details and a specific reason why he wasn't fit to fly.