This is how medi-care works.. (states, coverage, retirees, respect)

[nmnita]

Thank you to our government for the waste in time and money. I will try to explain what happened andwhy I am a little miffed to put it mildly:

Recently we took a cruise. While on the ship I pulled a muscle and had to see the ship doctor. I did have travel insurance so we arrived home and I called the company..Because I receiving SS I need to show the company medicare did not pay any benefits as the accident happened outside the USA. This morning I called Medi-care and here is what I was told. No, medicare will not cover any of my expenses. I asked if they could send me an email or a letter stating they would not cover the expenses. The answer; No, I have to file a form with them. OK, I could have bought that but here is the catch: 1-it will take about 150 to 180 days to hear back and the lady said, I am right, they will pay nothing, the case will be looked at and denied. So, instead of being able to send something stating they can not cover accidents outside the country I have to wait 6 months to recieve a form telling me this. luckily, I do have a suplimentary ins and they have a short form for me to fill out. They will cover all but $65, the $65 will be covered by the trip insurance. The insurance company will pay what our sup insurance will not and our sup insurance will then try to get the $65 from medi-care; pain in the tush, you better believe it.

[willow wind]

Might passing on this info to you insurer from Medicare.gov be helpful to you ?

http://www.medicare.gov/Pubs/pdf/11037.pdf


Basically your medical problem is not going to cost you a penny, but you're just upset that you had to make a few phone calls and shuffle paperwork around ?

[biscuitmom]

I'd blame the travel insurance company, who IS supposed to pay and is trying to stall, more than I would Medicare, who as willow wind shows, clearly states what it does not cover.

[Ariadne22]

Huh? Pretty stupid travel insurance company, imo. Your angst is misdirected.

Last Medigap insurance brochure I received lists all Medigap lettered plans and clearly states in big bold letters - FOREIGN TRAVEL NOT COVERED BY MEDICARE.

Any company selling travel medical insurance should know that, seeing as how retirees are a big part of their business, and they surely know this:

Will Medicare pay for medically-necessary health care
services I get on a cruise ship?

Medicare may cover medically-necessary health care services you get on a cruise ship
in these situations:

• The doctor is allowed under certain laws to provide medical services on the cruise
ship.

• The ship is in a U.S. port or no more than 6 hours away from a U.S. port when
you get the services, regardless of whether it’s an emergency.

Medicare doesn’t cover health care services you get when the ship is more than 6
hours away from a U.S. port.

http://www.medicare.gov/Pubs/pdf/11037.pdf

The standardized Medigap letter plans have a $250 deductible for foreign travel. Clearly, you must have some type of employer retiree plan to have it cover all but $65. Your travel insurance people got off cheap.

You need to b*tch at the insurance company people who told you call Medicare in the first place - since they KNOW Medicare doesn't cover medical care on a cruise when ship is more than 6 hrs. from port.

[nightlysparrow]

Basically your medical problem is not going to cost you a penny, but you're just upset that you had to make a few phone calls and shuffle paperwork around ?

Agreed. Count your blessings.

[brokensky]

Originally Posted by nmnita

Thank you to our government for the waste in time and money. I will try to explain what happened andwhy I am a little miffed to put it mildly:

Recently we took a cruise. While on the ship I pulled a muscle and had to see the ship doctor. I did have travel insurance so we arrived home and I called the company..Because I receiving SS I need to show the company medicare did not pay any benefits as the accident happened outside the USA. This morning I called Medi-care and here is what I was told. No, medicare will not cover any of my expenses. I asked if they could send me an email or a letter stating they would not cover the expenses. The answer; No, I have to file a form with them. OK, I could have bought that but here is the catch: 1-it will take about 150 to 180 days to hear back and the lady said, I am right, they will pay nothing, the case will be looked at and denied. So, instead of being able to send something stating they can not cover accidents outside the country I have to wait 6 months to recieve a form telling me this. luckily, I do have a suplimentary ins and they have a short form for me to fill out. They will cover all but $65, the $65 will be covered by the trip insurance. The insurance company will pay what our sup insurance will not and our sup insurance will then try to get the $65 from medi-care; pain in the tush, you better believe it.

I am confused.

I always buy travel insurance because other insurance typically won't pay for such coverage. It sounds like you understood this, too, and were smart enough to take out trip insurance.

So you had to use the insurance coverage and now you are upset because . . . of what? You had to fill out forms?

[bUU]

Originally Posted by biscuitmom

I'd blame the travel insurance company, who IS supposed to pay and is trying to stall, more than I would Medicare, who as willow wind shows, clearly states what it does not cover.

THIS.

We're often driven to needing better service from our service providers than they've offered us. In this case, you cannot even buy faster service (from Medicare) because that will cost everyone more money. They have policies and procedures, and make clear what they do and don't cover, and all that is public and should be good enough for the travel insurance company to use without forcing you to wait for a specific claim to be processed.

[marc515]

Agree your angst is misdirected. Our government has spelled out medicare benefits quite clearly here, and it appears your travel insurance is simply stalling, hoping that if they stall you long enough you'll get frustrated and simply give up.

Recommend you contact a manager at that insurance company. If you get no results, you could always post on thier FB page.

Good luck.

[MadManofBethesda]

Originally Posted by nmnita

Thank you to our government for the waste in time and money. I will try to explain what happened andwhy I am a little miffed to put it mildly:

Part of your problem is that you purchased travel insurance from a company that provided excess (secondary) coverage to whatever other primary health insurance coverage you might have. Secondary insurers want to see written proof of whatever reimbursements your primary insurer did or did not provide.

To avoid this problem in the future, purchase your trip insurance from a company that provides primary coverage, rather than secondary. Travelex is one such company, but there are others. You can use insuremytrip.com to compare policies from many different companies. With primary coverage, you simply submit your claim forms directly to your travel insurance company and they pay them in accordance with the terms of the policy you purchased without respect to any other coverage you might have.

[arwenmark]

For those not that familiar with travel insurance, most of them are secondary insurers and only pay after all others coverage has been paid. THERE ARE some that are primary insurers but you have to look for them when seeking to purchase travel insurance. I usually buy from insuremytrip.com because you can compare various policies and see exactly what you are purchasing.
HOWEVER, the insurance companies KNOW perfectly well that Medicare does not cover anything out of the country, they even use that info as a selling point, so requiring you to provide proof seems a bit underhanded to me.