Top-Up Tales

Posted on March 31st, 2020 by Medipac

George had not been feeling well for quite some time but he was not worried, as he had excellent travel medical coverage from work and he had topped up with the best private insurance plan there is – Medipac. His internal pains got progressively worse, so he went to a Florida hospital, was seen as an outpatient and received myriad tests to determine his problem. He was told to go home (which rarely happens) and they would let him know the results of all the tests and advise him what to do. George’s employment plan ran out at midnight, that same day.

The day after his employment coverage ran out, the Medipac Top-Up plan came into force. I hope that we all remember what a pre-existing condition clause is, and what it means. This clause basically says that you have no coverage for a condition which arose in the previous 90 days, prior to the effective date of your policy. George has no coverage under his Top-Up plan for whatever he has, and nobody knows what that is for certain, yet.

The next day, George is forced to go to the hospital by ambulance and, after four days and $150,000 later, he expires. Guess who is going to pay the bill? George’s heirs will at this point, since George’s employment plan refuses to pay. We already know that Medipac has no responsibility to pay. Another snowbird left in limbo! Or, more correctly, his heirs left in limbo. I smell a bunch of rich lawyers circling somewhat like vultures.

So, what do we have to think about? First comes – “What liability does the employer’s insurer have after the plan ends?” If you are with Medipac, that is simple –Medipac pays medical costs to reach a diagnosis; if it is not feasible to reach a diagnosis, we will bring you back to Canada for further assessment and treatment. We take care of you until your emergency is over! Unfortunately, the employer’s plan refused to either continue medical testing or, in the alternative, evacuate George to Canada. My guess is that they had no benefit to evacuate George anyway. Most employer plans do not have specific evacuation coverage and the payment is left to the discretion of a claims clerk, usually long after the fact. That, of course, would mean that George may have to both arrange and pay for his own medical evacuation.

Point two – “What if George did not have a continuing Top-Up and was scheduled to return home?” Would the employer plan still drop him like a hot potato (with an “e” on the end in some jurisdictions)? My guess is “Yes.” Their policy is done and my guess is – so is George. I have seen situations in which some unwise people have bought low-limit plans with maximum limits of $25, or $50 or $100,000. Some insurers, knowing that the hospital bills will be much higher than the policy limits, simply write a cheque to the hospital. They then wash their hands of the “unpleasantness,” having paid out the policy maximums. Their contractual obligations have been fulfilled. Or have they?? What about moral obligations? At Medipac, we believe that we have a moral obligation to assist you until your emergency is over, period.

Point three – “What does this ‘emergency is over’ mean?” To Medipac, it means exactly what it says. We will take care of you until your emergency is over! One of the more distressing things we see happen is a person, such as George, who goes into the emergency room and is prescribed a medication to ease their stomach or chest pain. All is fine for two weeks, although the pain has not gone away. Then the real cause appears as an appendicitis attack, a gall bladder attack, a heart attack, etc. Some insurers will try and treat this as a “pre-existing condition.” That is not really the accurate phrase, but my inference is clear. “You already had this, we paid your bills, and you are not covered now,” is what they mean. The trap is in the recurrent clause. It basically states that what you have already had, on your trip, is not covered after they fix it once. Did this happen to George, too?

Point four – George is now dead and his family is distraught, and trapped in a foreign country. What do they do now? How do they get him home? How does George get home? Why would any company just drop them like that hot potato? Fortunately, Medipac was there and we stepped in to solve all those critical details for the family.

The $150,000 hospital bill is still outstanding and we have decided to get seriously involved in getting the employer’s insurer to pay for it, as they should have already done. Wish us luck. And the real moral of the story is, if you have a top-up plan with anyone – call them, too, when you have a medical issue. Keeping everyone advised of what is happening might have avoided this nasty situation.

One further thought is to make sure that you really understand your employer plan coverage. Many plans only cover you to age 65, some reduce your maximum travel medical benefit to $10,000 or $25,000, which is nothing. Emergency medical evacuation, drug prescriptions, out-patient care (some plans only cover you while you are in hospital) and many of the smaller benefits may not be covered. Have a wonderful 2018 and you can sleep well with Medipac’s program.