pandemic travel Travel insurance nightmare: $ 38,000 medical bill rejected

Duy Hoa Tran, a retired Vietnamese schoolteacher, arrived at Los Angeles in February 2020 visiting her 2 month old daughter and grandson. Two weeks later the door closed behind him. To prevent the spread of COVID-19, Vietnam close its borders. No commercial flights would be allowed in the country for the next 18 months.

Tran’s daughter, An Tran, who has a doctorate in business administration and teaches marketing at the University of La Verne, did what she felt was necessary to provide medical coverage for her then 65-year-old father during the pandemic. But the only option for a visitor with a tourist visa was travel insurance. In the beginning march 2020, An Tran found and bought a font for about $ 350 a month, from a company called Seven Corners.

She might as well not have cared.

The elder Tran had stayed in An’s house in Diamond bar about a year ago when he told his daughter he was having trouble seeing with her right eye. A visit to an ophthalmologist produced a solemn verdict: Tran suffered from severe glaucoma and would quickly go blind unless he had an operation.

Seven Corners has given written pre-approval for the procedures recommended by Dr. Brian Chen. To be sure, An Tran called the insurer “several times” to confirm that he would cover the expenses, but no one she spoke with would give her a definitive answer, she said. Chen, however, assured An that insurance companies generally covered the treatment, which was quite common.

At April 19, Tran underwent the first of three eye surgeries to resolve glaucoma. The surgeries – the last one was on July 19 – They succeeded. And then on 5 August, Seven Corners sent An Tran a denial of service letter.

The company’s policy excluded coverage for any “pre-existing condition”, that is, any condition “whether or not it is.

previously not manifested, symptomatic, known, diagnosed, treated or disclosed, ”the letter reads.

An Tran and her father were hooked for nearly $ 38,000 in medical bills, although Seven Corners pre-authorized the surgery and paid around $ 6,000 for insurance during the previous year and a half.

As for the bill, “My dad obviously can’t pay it,” Tran said. His $ 260 the monthly pension from the Vietnamese government is not enough for him to live in Vietnam, she said.

Surgical acts Duy Hoa Tran received are quite common in United Statessaid Dr. Davinder Grover, ophthalmologist in the Dallas zone and clinical spokesperson for the American Academy of Ophthalmology.

Medicare would typically pay about a quarter of the $ 37,896.83 Tran was billed for the surgeries, Grover said. If Tran’s daughter had known in advance that the insurance would not cover the procedures, the doctor’s office might have been willing to bill something like $ 12,000, he said.

The policy underwritten by An Tran had no deductible and provided coverage for up to $ 100,000 in medical bills, including COVID-19 care. But travel insurance usually only covers emergency or urgent medical expenses, depending on the California state insurance commission, which regulates policies in the state.

Megan Moncrief, marketing director for Squaremouth, which bundles travel insurance plans from various companies – including some from Seven Corners – and offers them through its website, said the language of the policy was not unusual for insurance trip. She noted the policy stipulation that it only covered certain acute conditions if the patient sought treatment within 24 hours of the first symptoms.

Moncrief said that the fact that Tran did not seek immediate treatment could be the reason his surgeries were not covered. (Seven Corners declined to comment on the case.) She admitted that it was hardly surprising that he didn’t rush to the doctor at the first sign of discomfort: “I don’t know if I am. wouldn’t have done that either if I had blurry vision. “

As for Seven Corners’ refusal to pay despite pre-certification, that’s not uncommon, she said. By pre-certifying, the insurer verifies that a procedure is a covered benefit but does not guarantee that the insurer will cover it for that particular patient.

Travel insurance generally offers little protection for any health problem related to a pre-existing condition, whether that condition has already been diagnosed, says Susan yates, general manager of the we for Falck Global Assistance, an international insurer.

“For visitors to the we, especially those who are not permanent residents or citizens, it can be difficult to get health insurance, ”she said. The Affordable Care Act does not cover tourists, although some resident non-citizens may purchase coverage.

“It is generally better for a visitor to purchase travel insurance in their home country, but in some countries (Vietnam being a), the insurance market is not developed, ”Yates wrote in an email.

Tran had tried unsuccessfully for months to return home to his town near Ho Chi Minh City, where his wife lives with another grandchild. On 14 occasions, An bought her tickets on scheduled commercial flights which were later canceled. He was also unable to secure a seat on charter flights organized by the Vietnamese government; these tickets were generally only available through third parties charging up to $ 10,000.

Eye surgeon Chen offered to discuss the case with KHN, but his medical group’s lawyer said it was his policy not to discuss insurance issues with reporters, even with consent. of the patient.

After KHN approached him to discuss the matter, Chen told An Tran that he was giving up his $ 8,144 fees for surgeries. The Acuity Eye group, where he practices, did not immediately confirm Chen’s offer, but told An Tran that he was also seeking clearances to waive his fees and all other charges.

At September 15th, Duy Hoa Tran finally managed to take a charter flight to return Vietnam. He is happy to be home, An Tran said.

Under California subsidiary liability laws, it could be responsible for its remaining bills.

Kaiser Santé news is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of KFF’s three main operational programs (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.

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