My friend and her health insurance, got hurt in a foreign country...
March 16, 2018 11:21 PM Subscribe
She has a Medicare Advantage Plan. We were in Freeport the Bahamas and she tripped and hurt her wrist. She did not get any kind of treatment on our trip. When we got back to the USA she went to the doctor and it was then determined she had broke her wrist, she had to have surgery with metal plates.
Now her insurance is asking questions, like where did it happen at? Does she need to tell the truth or does she need to withhold the fact she was in another country? She is really worried if she tells them she was out of the country when it happened they will deny the medical charges.
I think since she got no medical treatment until she got home to the USA 4 days later she will be ok.
Need advice on how to handle this. Thank you in advance!
Now her insurance is asking questions, like where did it happen at? Does she need to tell the truth or does she need to withhold the fact she was in another country? She is really worried if she tells them she was out of the country when it happened they will deny the medical charges.
I think since she got no medical treatment until she got home to the USA 4 days later she will be ok.
Need advice on how to handle this. Thank you in advance!
Answer all questions honestly. Period. Lying in connection with Medicare coverage involves Federal criminal penalties.
This is Medicare, not insurance. The MA plan has to cover what Medicare would cover, and this is well described at www.medicare.gov.
Where the injury occurred has nothing to do with coverage. Metahawk got it right, up to the "but." There are numerous issues if she is treated out of the country, but not when she is not.
posted by megatherium at 1:59 AM on March 17, 2018 [5 favorites]
This is Medicare, not insurance. The MA plan has to cover what Medicare would cover, and this is well described at www.medicare.gov.
Where the injury occurred has nothing to do with coverage. Metahawk got it right, up to the "but." There are numerous issues if she is treated out of the country, but not when she is not.
posted by megatherium at 1:59 AM on March 17, 2018 [5 favorites]
Lying is fraud. Fraud means claims can be denied.
My mom fell and broke her ankle in Mexico. Her health insurance covered her surgery and rehab once she was back in the states. Her travel insurance covered the medical costs to stabilize her for travel in Mexico and the costs to get her back to the US.
posted by peanut_mcgillicuty at 6:08 AM on March 17, 2018
My mom fell and broke her ankle in Mexico. Her health insurance covered her surgery and rehab once she was back in the states. Her travel insurance covered the medical costs to stabilize her for travel in Mexico and the costs to get her back to the US.
posted by peanut_mcgillicuty at 6:08 AM on March 17, 2018
This is pretty standard for accidents--the insurance company wants to know if someone else's liability/homeowner's insurance should cover the damages, like if she had slipped on some uncleared ice in front of a supermarket. Typically for something minor like this, especially if it occurred out of the country, she should just be honest as any attempt to collect from another agent will be more expensive than just paying for the treatment.
I got a similar questionnaire after my then-toddler needed his forehead glued back together after a playground accident and quite honestly reported that he had inexplicably run straight into someone else's stroller and cut himself on an exposed screw. We never heard anything back after that and the treatment was covered without a problem.
posted by The Elusive Architeuthis at 9:50 AM on March 17, 2018 [1 favorite]
I got a similar questionnaire after my then-toddler needed his forehead glued back together after a playground accident and quite honestly reported that he had inexplicably run straight into someone else's stroller and cut himself on an exposed screw. We never heard anything back after that and the treatment was covered without a problem.
posted by The Elusive Architeuthis at 9:50 AM on March 17, 2018 [1 favorite]
They are asking because if the accident occurred at work then they would need to enter workmans comp insurance from her job as the payer to take the place of her plan. If it occurred because a motorist struck her, they would need to use the driver's auto coverage. If the hotel's liability plan is paying for the treatment, they need to enter their liability insurance info. ETC. She can just say she fell by walking outside in Freeport. They will just use her personal coverage unless she specifies otherwise. And it will be covered so long as she follows her plans guidelines for referrals and whatnot.
posted by WeekendJen at 4:27 PM on March 17, 2018
posted by WeekendJen at 4:27 PM on March 17, 2018
I broke a bone in my foot in Paris. I thought I only sprained my ankle, so I treated it with ice and elevation for seven days before I got back home and went to my orthopedist for x-rays. Medicare and my Blue Cross supplemental plan covered everything. I never got any questions about where the accident occurred (it was in a public park).
posted by Joleta at 9:23 PM on March 17, 2018
posted by Joleta at 9:23 PM on March 17, 2018
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In my experience, coverage is based on the location of the doctor, not where the illness or accident occurred. But also understand that there is a lot of money at stake. I would call her insurance, tell them she is planning a trip out of the country next summer and wants to understand what her coverage would be if hypothetically something happened overseas. They will probably say that foreign doctors are not covered. She can then ask if treatment would still be covered when she returned home.... Pretty sure the answer would be yes, it is covered but if I were her, I would rather hear from the company than a stranger.
posted by metahawk at 12:36 AM on March 17, 2018