Insurance denied coverage for my sister on visitor visa

[tonyboysmith]

My sister was visiting us for a few months. Unfortunately she fell sick due to stress and had to be admitted in the hospital for few days. She had insurance , but the insurance denied it stating it was a pre-existing condition , which is not correct. Now she has gone back to India. An enormous amount of  bill are coming in to her name. Now she not being in  the country who would be held responsible for the payment?

 

Please recommend suggestions to handle the situation with the insurance and the hospital.

[t75]

Send the bills to her. Leaving the US does not relieve her of the responsibility of paying the doctors and hospital.

 

If she had preexisting illnesses, she should have obtained coverage that covered it. She should ask for reconsideration if she had no preexisting conditions.

 

Contact the providers and negotiate lower amounts.

[omshiv]

What stress?

[pontevecchio]

@OP, This is not the appropriate forum to ask why? GOOGLE with the name of the concerned company and look. If you signed nothing you are not responsible. For non Surgical admissions I question why the amount is so excessive?

[tonyboysmith]

Thanks for the replies and Suggestions.

We are asking the insurance for reconsideration, because her's was not a pre-existing condition.

Will keep you posted.

[t75]

Be persistent with the request for reconsideration. Be prepared to supply statements from physician if requested. She needs to give  you authorization to deal with people on  her behalf because of Hippa regulations.

[vikkym]

tonyboysmith's post about this alleged problem is not genuine.

 

He posted the same query on various forums and when searched by his email address, no policy shows up. When we asked for the policy number, insurance company etc., he does not respond. 

 

Therefore, if you are genuine, I suggest that you contact your broker and provide him the necessary information (name of the person, policy number, insurance company etc.) and ask him to help.  Randomly posting everywhere on the internet is not going to help in anyway.  Your broker should be able to help you with getting the genuine claims processed. But they need some basic information and authorization from her first.

[tonyboysmith]

@t75.

Thanks for the reply. That's correct. I am working with both insurance and the hospital on this.

 

@vikkym.

Could you let me know who you are ? If you are from "*******", we did not buy insurance from you.

Also I posted this query on just one other forum.

So either provide useful sugesstion rather than questioning about the genuinity of my problem.

[t75]

If there is a governmental agency overseeing this health insurer, be sure to contact them as well.

[vikkym]

Please do not misunderstand. My sole purpose to post here was to find out if there is any way we or someone could help you with your situation.  I don't work for any insurance company and I have no reason to defend any of them if your claim is rejected in an unfair manner. 

 

However, the insurance company you claimed to have purchased the insurance from (as per your posts in other forums  and even in the insurance company's forum) can not find anything about you or your sister in their records either. Therefore, if you are genuine, make sure to contact the right insurance company and provide them the necessary information. 

 

In any case, for the benefit of users on this forum, please post the following information:

1. How old is your sister?

2. What date did she arrive in the US?  How long did she plan to stay in the US? 

3. What is effective date of the policy?  For how long did you purchase the insurance? 

4. When did her symptoms first start? 

5. When was she hospitalized? 

6. What exactly caused her the stress? How it was so intense that she needed to be admitted into the hospital? 

7. Did she have the other circumstances at home or in the US that would cause the stress? 

8. Whether she had any such symptoms in the past and had to seek medical treatment. 

9. Any previous mental or health issues related to this? 

 

The above information will help the users on this forum in providing proper guidance. 

[vikkym]

And of course, I strongly suggest that, you purchase the visitors insurance from a reputed broker that will be on your side and help you solve your problems.  There are thousand places to buy visitors insurance from and the price is the same everywhere for the same plan. However, the difference is in the service they provide. Go with the one that is eager to help you, not only at the time of purchase but also at the time of claims. 

[pontevecchio]

@OP

 

The confidentiality of medical Information is taken extremely seriously in this country. Even you are not supposed to be privy to all the details. Research the company involved and escalate it to the CEO level in a polite but factual manner. One thing you can mention is the amounts involved if you choose.

[chakrakr]

And of course, I strongly suggest that, you purchase the visitors insurance from a reputed broker that will be on your side and help you solve your problems.  There are thousand places to buy visitors insurance from and the price is the same everywhere for the same plan. However, the difference is in the service they provide. Go with the one that is eager to help you, not only at the time of purchase but also at the time of claims. 

 

There is not a single company offering travel/visitor's insurance which is licensed to Department of Insurance in most states (I believe only in KY they need to be licensed) .  All these operates as surplus line insurance.   I am yet to see a broker who fights with  the insurance company to provide the benefits .

[vikkym]

You said "you are yet to see a broker..." but of course, you have not worked with all the brokers out there.  We have been consistently helping our customers for the past 13 years, not only before purchase, during purchase but most importantly, after purchase. We have a dedicate staff in our brokerage company to solve customer's claim related issues.  Yes, we do fight with the insurance company for legitimate claims and go all the way up to the Vice President of Claims Department, as appropriate, and due to the volume of our business, they do listen to us.

 

 I am yet to see a broker who fights with  the insurance company to provide the benefits .

[vikkym]

tonyboysmith, 

 

You have still not answered my questions that I asked on March 7, 2014.  How does anyone know that your claim was genuine that was denied?  

 

Please answer those questions so that it will help others in analyzing the situation whether the insurance company acted in a fair manner or not.  

 

People should know the truth either way.  If they processed the claim correctly, then also,  and if they didn't process it correctly, then also. 

[chakrakr]

There is not a single company offering travel/visitor's insurance which is licensed to Department of Insurance in most states (I believe only in KY they need to be licensed) .  All these operates as surplus line insurance.   I am yet to see a broker who fights with  the insurance company to provide the benefits .

 

You said "you are yet to see a broker..." but of course, you have not worked with all the brokers out there.  We have been consistently helping our customers for the past 13 years, not only before purchase, during purchase but most importantly, after purchase. We have a dedicate staff in our brokerage company to solve customer's claim related issues.  Yes, we do fight with the insurance company for legitimate claims and go all the way up to the Vice President of Claims Department, as appropriate, and due to the volume of our business, they do listen to us.

 

Of course I have not .  But I am very wary of a broker who asks someone to share all private information in a public forum.  As a broker you should know that many of these information are protected per HIPAA.     BTW,  if you are the broker of a decent insurance company why do you need to "fight"  for a legit claim :) Also,  why do you need to go up to VP ?  Legit insurance companies have a defined appeal process   rather than going to VP of claims.

 

What you are saying is -- Your insurance company listens only to those who give a volume of business but will give a damn to an individual customer.    I suggest you start selling products of a insurance company which listens to individual customers  and do not make them "fight"  for a legit claim.  

[vikkym]

Your posts are contradictory. First you said you have not seen a single broker who would "fight" for their customers' claims, and now you are claiming, that brokers should not have to help either.  You are twisting the word "help" or into "fight" which is misrepresentation.  Most of the legitimate claims who have trouble are not because the insurance company is not acting properly, but things like the hospital didn't send the medical records, the customer didn't send the HIPAA authorization form, the claim was clearly ineligible and so on.  There are some claims which are highly into a grey area and the subjective decision could be made either way.

 

Again, it is a wrong interpretation insurance companies do not care about individual customers but listen to those who give big business. Of course, the insurance companies we work with a defined appeal process and sometimes, the customers exhaust that appeal process and would like us to help us further with their claims. What I really meant to say is that due to our long experience, we know exactly who would be the best person in a given company for a given situation.

 

Regarding this original poster, we already offered him to help privately but he refused.  And I agree that the private information should not be posted online However, you can always share some information (without revealing private information) regarding your problem that would help others analyze what happened. He is bad mouthing the insurance company publicly without providing any material information about why the claim was rejected or what happened. It is not fair to put one sided story without listening to both the sides.

 

And in you case you are not aware, broker is not a broker of one insurance company. In fact, brokers do NOT work for any insurance company but they work with many insurance companies and work in the best interest of the customers. On the other hand, agent works for one insurance company.  And we offer visitors insurance from all major companies in the US market, and not just one. If you are aware of a visitors insurance company that is way better than others, you should let everyone know. However, per your comments, there is no legitimate or decent insurance company in the US market that provides visitors insurance. In your opinion, if everyone is bad, you should not even buy anything. 

[vikkym]

Many times, the customers also have very unreasonable expectations from the visitors insurance and end up being not satisfied. 

 

Following are few examples that we encountered just in half a day today: 

 

- A lady wants the visitors insurance company to pay for stair-lift installed in her house so that it would be easier for her elderly mother who is to visit the US soon.

- Wants to buy insurance because he wants to get blood pressure test done for his father.

- Wants to bring his father to the US for cardiac second opinion.

- A person bought the cheapest fixed coverage $25k plan and now wants to upgrade because his father is already sick.

- Mother has constant back pain and needs to go to chiropractor routinely.

- Parents are here for almost 1 year, no insurance for the past 6+ months and now wants to buy for just one month because father is already sick and he wants to visit the Dr tomorrow.

 

None of the above situations can be expected to be covered by any visitors insurance company, as it would be a pure loss.

[t75]

None would have been covered for USCs in the past.

 

If there were the requirement that all visitors have COMPREHENSIVE insurance purchased BEFORE entry into the US for the duration of the stay, few people could afford to visit.

[chakrakr]

Your posts are contradictory. First you said you have not seen a single broker who would "fight" for their customers' claims, and now you are claiming, that brokers should not have to help either.  You are twisting the word "help" or into "fight" which is misrepresentation.  Most of the legitimate claims who have trouble are not because the insurance company is not acting properly, but things like the hospital didn't send the medical records, the customer didn't send the HIPAA authorization form, the claim was clearly ineligible and so on.  There are some claims which are highly into a grey area and the subjective decision could be made either way.

 

Again, it is a wrong interpretation insurance companies do not care about individual customers but listen to those who give big business. Of course, the insurance companies we work with a defined appeal process and sometimes, the customers exhaust that appeal process and would like us to help us further with their claims. What I really meant to say is that due to our long experience, we know exactly who would be the best person in a given company for a given situation.

 

Regarding this original poster, we already offered him to help privately but he refused.  And I agree that the private information should not be posted online However, you can always share some information (without revealing private information) regarding your problem that would help others analyze what happened. He is bad mouthing the insurance company publicly without providing any material information about why the claim was rejected or what happened. It is not fair to put one sided story without listening to both the sides.

 

And in you case you are not aware, broker is not a broker of one insurance company. In fact, brokers do NOT work for any insurance company but they work with many insurance companies and work in the best interest of the customers. On the other hand, agent works for one insurance company.  And we offer visitors insurance from all major companies in the US market, and not just one. If you are aware of a visitors insurance company that is way better than others, you should let everyone know. However, per your comments, there is no legitimate or decent insurance company in the US market that provides visitors insurance. In your opinion, if everyone is bad, you should not even buy anything. 

 

Let me ask you -- why a person holding a US comprehensive health plan (like the one offered by the employer)  do not have to go through a "broker"   to help/fight (You  said "Yes, we do fight with the insurance company"   so do not blame me of misrepresentation)  ?      

 

Why does the Hospital / Doctor's office never have a problem sending all records to US insurance companies but you claim they do not send records to those surplus line insurance companies ?

 

For the claims in grey area   (whatever you mean by that)  why would a customer need to go through a broker to get it paid and not directly to the insurance company ?

 

Where did  OP bad mouth any particular insurance company ?  And if he did,  why are you bothered ?  By your own admission you do not work for any insurance company ?   Why is the insurance company directly not refuting it ?   How do you know for sure that he purchased the insurance from your brokerage ?  Do you face such frustrated customer so often that you know every person complaining about a Visitors Insurance is your customer :)

 

I am very aware of the difference between broker and agent.  However,  you do not seem to know that a broker is NOT required to sell policies of ALL insurance companies.   You have the right to sell policies of companies which you think will not deny legit claims.

 

I say it again,  all insurance companies  selling visitor policy in US are NOT licensed  to the Department of Insurance and not regulated by them.  You can complaint to DOI  regarding your US healthcare insurace or auto insurance  but not against these insurance.   I have experience dealing with one such company (which  has one of the largest Visitors Insurance market)  and no ,  a "broker"  did not help but a letter from an Attorney helped. 

 

My personal suggestion is to buy Visitors insurance from home country.   This is based on what I know about India. All companies selling visitors insurance in India are regulated and you can file a complaint with Ombudsman ... it works.      I would guess there are similar regulations in most other countries. 

[sadanand2013]

chakrakr, 

 

My parents are visiting the US in the next two weeks. They are 74 and 69 years of age. I was about to buy the insurance from the US based company. But after reading your posts, I started looking into India based companies. And after couple of days research, I have the following questions about Indian companies. As you seem to be very knowledgeable about this matter, could you please help me answer the following questions? 

 

1. All Indian companies seem to offer the plans that have severe sub-limits for people of the age 55 years and above. Those limits seem quite low to me.  Are there any plans with no sub-limits? 

 

2. What is the A.M. best rating of those companies? 

 

3. When I visit the Dr, they ask for the insurance card. Do they give insurance card?  Does it have US based contact numbers? 

 

4. Do they participate in any PPO network?  Which one?  How do I search the participating providers in my area?  Is there any online link? I called one company and they said we can visit any provider, but will those providers bill directly or do I have to pay first? Will they charge network negotiated fees? 

 

Do they provide cashless benefits? Or do I have to first pay and file for claim? 

 

5. Will the claims be handled in the US itself or in India? 

 

6. If my parents decide to stay beyond six months, can I renew their insurance?

 

7. If they go back home early, can I get the refund? 

 

8. Please note that I will be buying insurance for my parents and I am in the US.  What US state are they licensed in?  Are they licensed in any US state?  

 

My parents are planning to travel to different states. Are they licensed in each state? 

 

If I have a problem with them, where can I complaint?  Can I complaint to US Department of Insurance?  How about Better Business Bureau? 

 

You indicated that we can file a complaint with Ombudsman. Are they located in India or in the US? If in India, at their age, my parents are not going to be running around to different places in India.  Nothing happens in India without going in person. Moreover, my parents will be visiting here in the US and will not be in India. In that case, how will they complain? Doesn't the fact that something like Ombudsman facility exists say that many people are routinely having problems with Indian companies? 

 

What about their agents?  Are they licensed anywhere in the US?  What about their claims administrators? Are they licensed anywhere in the US?  Whatever action needs to be taken against any of them, I would like to take here in the US. What recourse I have against Indian companies in the US? 

 

9. Is their customer service open 24 x 7 or only according to Indian day time?  If my parents get sick or injured during the day time in the US, will they be open? Do I have to call them in India? 

 

Please help me decide as I need to purchase it soon. 

 

Thank you in advance. 

[t75]

If you buy India based insurance, no US based government agency has jurisdiction over any problems or complaints you might have. They may have US based help but you will need to check each one out.

There is at least one US based company that offers coverage for people coming to the US; their limit is $50K for travelers 70-79 and $10 K for 80 plus.  I have used them for USCs traveling abroad.

[chakrakr]

Hello vikkym.  There was no need to create yet another false ID to promote your business. Your fakeness is pretty clear from your post :)

 

1. I do not know what are the limits of Indian companies.  You will have to do your own research .  But remember ,  they DO pay whatever limit is there unlike some of the US (actually most of those by a underwriter in  London ) based surplus line insurance which denies legit claims.

BTW,  those who got sold by the tall claims of such :"agents"  regarding coverage for pre-existing conditions,  here is something from a much hyped insurance plan --"

For Insured Persons 65 years of age and over: Up to $2,500 Lifetime Maximum"

 

2. I do not care about AM Best rating.   All I care is   is there a way to get the payment from them if they unjustly deny a claim.
You never hear about AM best for BCBS or other similar companies.

For the layman -- AM Best rating  DO NOT  say ANYTHING about how good the insurance is about paying claim.  It is an indicator of the financial strength of a company . How the financial strength is acquired (probably by denying legit claims)  is NOT checked by AM Best.

3. Most of the companies  DO give insurance card as they have tie up with US based TPAs (since you are from Insurance industry you sure know what is TPA). BTW,  MANY doctor's office DO NOT accept the insurance card provided by the surplus line insurance companies

 

4. Again ,  most of the Indian Insurance have network and online link. You just need to google.  Hope you know how to google and search.

 

5.  Many provides Cashless benefit.  Even if not,  it is MUCH better to get reimbursed then to not get paid AT ALL.

 

6.  I do not care where the claims are handled .  All I care is will they pay a claim.

 

7. All plans are reniewable (within limits because visitors do not stay for ever) and cancellable

 

8.  None of the Indian insurance companies are licensed in US.  But guess what  nor are ANY of those surplus line insruance companies.  That is the reason  these insurance companies care less to pay your claim ,  because they know that Department of Insurance cannot do a damn.  For Indian companies , you have Ombudsman

 

9.  You CANNOT complain to Department of Insurance against ANY of the surplus line insurance.   And BBB  is NOT a legal or regulatory body.   They CANNOT enforce anyone to pay.   BBB is nothing better than something like yelp or mouthshut.    Educate yourself.  You need it for your business

10. Complaining to Ombudsman DOES NOT require visiting or going in person.  You need to come out of stone age.  Complaints can be filed online and it works.  Try it .

 

11. I hope your parents (!)  are just VISITNG.  You are not planning to keep them illegaly in US for ever.   And if they are genuine Visitors ,  it MUCH easier to complain where they live rather than in a  country where they are visiting for a short duration. 

BTW,   from one of the largest selling so called US  Visitor Insurance policy "

Sole and exclusive jurisdiction and venue for any court action or administrative proceeding

relating to this insurance shall be in Marion County, Indiana, for which the Insured Person expressly consents."

So you expect your parents to fly from India to Marion County, Indiana to file a lawsuit ?  Is that easier or filing a complaint in  their native place is easier ?

 

12.  If having Ombudsman indicates that "many people have problem with these Indian companies"  then having the Department of Insurance in every state must be crying out loud that "many people are routinely having problems with US companies" ?      What a brilliant logic !

 

13.  You are asking about recourse .   What recourse do you have against those surplus line US (actually london) based companies  short of going to court ?  Do you enjoy going to court and paying thousands to lawyers ?  That is your prerogative  but most people would like to get things settled in an easier manner.

Let me quote soemthing from the policy of one of the largest selling Visitor Insurance product (underwriter is S****) --
"THIS INSURANCE IS ISSUED PURSUANT TO APPLICABLE SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE
PROTECTION OF STATE INSURANCE GUARANTY LAWS TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE
OBLIGATION OF AN INSOLVENT UNLICENSED INSURER"

Similar language exist in all .   So do not try to make a false claim that one can file a complain at Department of Insurance against these Visitors Insurance which you sell

 

BTW,  why are you worried about agents.  If I have a problem with my Employer provided HEalth Insurance ,  I never look for Agent.  I use their formal appeal mechanism  and if it fails,  Department of Insurance.
If you need to go through an agent to get your legit claim paid that itself is an indicator that the insurance is shady.

 

 

14.  Why are you concerned  if the customer service is 7 X 24 ? I never have to "call" any one  except my doctor when I am sick or injured .  Why do you need to "call" an insurance company if you are sick or injured ?  Are they doctors?  It is more prudent to call 911 or the Doctor's office.
If an insurance is asking you to call them when you have a heart attack instead of 911,  I would run from that company .  Calling 911 will save my life not insurance.
Ask your insurance companies to change their modus operandi.

 

 

Finally,  thank you for giving me the opportunity to expose the truth about  those shady insurance companies which you represent.

[chakrakr]

If you buy India based insurance, no US based government agency has jurisdiction over any problems or complaints you might have. They may have US based help but you will need to check each one out.

There is at least one US based company that offers coverage for people coming to the US; their limit is $50K for travelers 70-79 and $10 K for 80 plus.  I have used them for USCs traveling abroad.

 

Neither does the US agency have any control over those selling products in US.   Here is a quote from a much hyped insurance product's policy  "THIS INSURANCE IS ISSUED PURSUANT TO APPLICABLE SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE

PROTECTION OF STATE INSURANCE GUARANTY LAWS TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE

OBLIGATION OF AN INSOLVENT UNLICENSED INSURER" 

 

Practically State DOI have no jurisdiction over these companies. 

 

For Indian companies,  there is a Government controlled grievence redressal mechanism in Visitor's Home Country

[sadanand2013]

It looks like someone has vested interest in promoting Indian companies, in spite of thousands of negative reviews I found online.

 

I purchased the insurance from the US based company.  While they are visiting the US, better to buy locally from the US.