So You’ve Had a Travel Insurance Claim…. Now what?

By Pam Langevin, Senior Broker

We often hear from clients who want good coverage and peace of mind knowing they won’t have any surprises in the event of a claim while on holidays. In Canada, where the health care system is funded through taxes, health care is not something we are used to spending money on. So when it comes time to purchase travel medical insurance, and prices are high, people look for ways to save money. However, comparing costs between various companies becomes a tricky endeavour because the price alone does not tell the whole story. When you encounter a low low price, it is time to start asking questions about why the price is so low.

You did what you were supposed to and you called the phone number on your wallet card to advise them that you needed medical attention. This call isn’t answered by the actual insurance company, but rather by what is called the assistance centre.

This centre is staffed 24 hours a day 7 days a week by individuals who will assist you through any medical situation you face. They will have asked you plenty of questions which you answered verbally at the time of the call. And now you are home, hopefully with your medical situation being resolved and life returning to normal.

What now? Well, you will be faced with more questions. These will be in paper format called a claims form. This form will ask all the basics such as your name, address, date of birth, policy number etc. It will also ask for details of the medical situation along with any receipts or invoices for medical expenses you have incurred. In addition, the forms will include a consent and authorization form. This form will provide the assistance centre with authorization to obtain any personal information that is required to resolve the claim.

These forms seem tedious and redundant and you may wonder why they are necessary. They are necessary because they give the claims centre the tools that they need to finalize your claim and make payments to the medical centres as necessary. Ensure that you mark your claim or file number on every sheet and every receipt, then take copies to keep for your files and finally submit them to the assistance centre.

Once the assistance centre receives these forms, they may require additional information from the attending physician at the time of the medical situation in addition to medical information from your family doctor here back in Canada. Obtaining this information can be a lengthy process and can sometimes cause a delay in the final resolution to your claim.

On average a claim can take up to six months to be closed. During this time it is not uncommon for individuals to receive additional copies of their invoices, past due notices or even calls from collection agencies. This can be very disconcerting. When you receive invoices or past due notices, simply mark your claim or file number on the top and forward it to the insurance centre. If you receive calls from a collection agency, call the assistance centre to advise them. You should not make a payment for any of these. The assistance centre will be negotiating with each medical facility to reduce the billed amount.
The insurance company will submit any invoices for medical care to your provincial healthcare body. This is done as your provincial healthcare will cover out of province medical expenses to the same value had your medical situation occurred at home. By negotiating and recouping some of the costs from the provincial healthcare body, the insurance companies are keeping their costs down as much as possible. This allows them to keep their expenses as low as possible so that they can keep their rates down for the next year.

Once the claim has been resolved, you will receive a cheque from your provincial healthcare body. At this point, you will then deposit those cheques and issue the payment of the same value to the insurance company.

Occasionally, things don’t go that smoothly and you may experience hiccups along the way. The claims centre may ask you for information that you have already submitted. They may ask for invoices that you have already included in your original submission. Again, we recommend that you keep copies of everything so that you can resubmit any documents as needed.

In a perfect world, everything will go smoothly, but if it doesn’t, remember that you can always give us a call to assist you. We will help you with the claim form, making copies of your documents, and even following up with the assistance centre if necessary. With any new product you receive, you should have a warranty. Just consider us your warranty!