Medical claim Denied

I cannot believe that a doctor would be writing up anything that was never discussed with a patient, it simply does not make sense to me; there would be no point in doing so.

There has to be a little more to the story.

Pay the providers then go after the insurance. It is the right thing to do. By the way: The patient did not need to be aware of the pre existing condition just the doctor and that there was one is enough to preclude payment.

I'd agree that it does seem like there is more to the story than we know from what is posted here - but I'd also say a couple of other things:

- what a doctor says and what the patient hears can be two different things
- "pre-existing condition" has differing definitions
- insurance companies look for ways to not have to pay insurance


Jay

portliz wrote:
Friends of ours have had their medical claim denied. Lots of money after a medical emergency in Texas. They have exhausted the appeal process with the insurance company. They are determined to fight this to the bitter end. They did not knowingly leave Ontario with a pre-existing condition. They did not think to ask to see what doctors were writing in the medical reports and consequently notes were made that were untrue. Any personal experiences that might be helpful? Any people fighting the same battle? We often hear scary stories and then we never hear the resolution.

My suggestion to you now is STOP posting anything to do with this. Your pals honesty is now being called into question. Next it will be yours. And people will be asking questions, the answers to which has nothing to do with anyone here.

Ask the Moderator to erase this entire thread and leave it in private where it belongs.


Gary Haupt

Gary, unfortunately I have to disagree with you on this one my friend. Many of us from Canada who spend a significant amount of time in the U.S.are faced with having to require supplemental travel insurance.

The question of pre-condition medical information is a valid concern when acquiring travel insurance. That is why I would be specifically interested in knowing anything at all that could affect coverage.

I don't think anyone is personally attacking the OP's friend, I simply want to make sure that all the facts are on the table. Often an omission of information whether intentional or not will result in a claim denial. We need to make sure that Canadians travelling outside of the country understand this.

... Eric

Hi,

Anything that is life threatening is dealt with in a timely manner. Wait lists do exist, but they exist in USA, too. Unlike USA, we have the freedom to go to any facility in our Province.

The supplemental insurance is a night mare, which gets worse the older you become. They are for emergency care only. As soon as the patient can travel they come back to Canada.

My out of pocket cost for a broken leg in Canada was $60. In USA the average cost is $17,000.00.

westernrvparkowner wrote:
Given the long waits for some procedures that I hear exist in the Canadian Heath system, if the policies didn't exclude them, people would just buy a supplemental policy and come to the states for instant surgeries and care. Somewhere in the back of my pea-brain I hear an alarm going off that your friends aren't exactly telling you the truth, the whole truth, and nothing but the truth regarding what exactly they knew about their health condition before they went to Texas.

This is precisely why it is so important for a person to thoroughly understand their insurance policy before they have a situation where it is necessary to use it. Welcome to the world of insurance and aggravation!