Losing My Mind Managing Complex Travel Insurance Claim
November 29, 2023 2:42 AM Subscribe
I got sick in Japan and spent $8355 on medical bills at 3 hospitals in 2 countries. I'm pulling together a travel insurance claim, but every time I contact the provider - WorldTrips - they remind me that *all* required hospital documentation must be provided, which is making me think they'll deny my claim if any of the myriad of documents they require isn't present. How do I manage this, because it seems like they're playing a game I can't win, and I can't afford to lose $8355.
I had an ER visit at a rural Japanese hospital, 2 follow-ups at a Tokyo hospital, and surgery at a hospital in Kuala Lumpur. Today I did a 5hr round trip to get my CT scan files and medical certificate from the rural Japanese hospital, because I don't speak Japanese so the only thing I could do was go out there and use Google Translate - which worked! - but I now realize that the medical certificate says I had an X-ray - which was an initial diagnostic procedure which I don't think is relevant because I then needed a CT scan to diagnose the problem (kidney stones) - and I didn't get a copy of the X-ray and I reckon WorldTrips are going to make this a point of contention, or that I have medical certificate - which says what I presented with and what the diagnosis was - instead of admission notes and discharge notes as they requested, and I am realizing that they can keep playing the game of "you didn't give us *exactly* everything we asked for" ad infinitum - even though I have legitimate proof of diagnosis and treatment at all 3 hospitals - so I'm wondering:
1. How do I manage this, because it feels like I can't win?
2. What recourse do I have if they reject my claim because I haven't met their stringent documentation requirements?
3. Do I really need to do another 5hr round trip to try and get a copy of the X-ray (all of my subsequent diagnostics have been CT scans)?
I had an ER visit at a rural Japanese hospital, 2 follow-ups at a Tokyo hospital, and surgery at a hospital in Kuala Lumpur. Today I did a 5hr round trip to get my CT scan files and medical certificate from the rural Japanese hospital, because I don't speak Japanese so the only thing I could do was go out there and use Google Translate - which worked! - but I now realize that the medical certificate says I had an X-ray - which was an initial diagnostic procedure which I don't think is relevant because I then needed a CT scan to diagnose the problem (kidney stones) - and I didn't get a copy of the X-ray and I reckon WorldTrips are going to make this a point of contention, or that I have medical certificate - which says what I presented with and what the diagnosis was - instead of admission notes and discharge notes as they requested, and I am realizing that they can keep playing the game of "you didn't give us *exactly* everything we asked for" ad infinitum - even though I have legitimate proof of diagnosis and treatment at all 3 hospitals - so I'm wondering:
1. How do I manage this, because it feels like I can't win?
2. What recourse do I have if they reject my claim because I haven't met their stringent documentation requirements?
3. Do I really need to do another 5hr round trip to try and get a copy of the X-ray (all of my subsequent diagnostics have been CT scans)?
Response by poster: Ah: i should add that WorldTrips use a team called Medical Care Management for health insurance claims. Here is the text they have sent me on numerous occasions, always emphasizing the last section (as if to say "we're not going to do anything until we've got *everything* we've asked for..."):
Please submit within 60 days of services rendered the below items in PDF format (at your convenience and if you did not sent any of the below list previously):
• International claims /Invoices.
• Proof of payment / Bank statement / Credit card statement.
• Copy of passport (all pages).
• Itinerary (flight tickets).
• CSA (Claimant Statement Authorization) Form.
• All medical records. Laboratory results. Radiological films (not only reports). Pathology reports. Admission Note. Progress notes. Discharge Note.
Please note that all claim submissions are subject to review with WorldTrips claims department, and WorldTrips the underwriter will make the final decision of eligibility according to policy provisions for all submissions.
Please allow us 30-45 business days, from the date of receipt of the last required document, to review the information provided. Once the claims have been reviewed, either an Explanation of Benefits or letter detailing any additional information required will be mailed showing the results of WorldTrips review.
posted by 7 Minutes of Madness at 5:21 AM on November 29, 2023
Please submit within 60 days of services rendered the below items in PDF format (at your convenience and if you did not sent any of the below list previously):
• International claims /Invoices.
• Proof of payment / Bank statement / Credit card statement.
• Copy of passport (all pages).
• Itinerary (flight tickets).
• CSA (Claimant Statement Authorization) Form.
• All medical records. Laboratory results. Radiological films (not only reports). Pathology reports. Admission Note. Progress notes. Discharge Note.
Please note that all claim submissions are subject to review with WorldTrips claims department, and WorldTrips the underwriter will make the final decision of eligibility according to policy provisions for all submissions.
Please allow us 30-45 business days, from the date of receipt of the last required document, to review the information provided. Once the claims have been reviewed, either an Explanation of Benefits or letter detailing any additional information required will be mailed showing the results of WorldTrips review.
posted by 7 Minutes of Madness at 5:21 AM on November 29, 2023
I'm not reading the same urgency into this message as you seem to be?
Also, why would they say this:
Please submit within 60 days of services rendered the below items in PDF format (at your convenience and if you did not sent any of the below list previously):
if it weren't standard and normal practice for them to receive claim information in partial batches?
Send them what you've got, get the process moving forward, keep requesting your records from your hospitals, and then when/if they require more, send whatever else you've received. It certainly sounds like you've been through enough lately. Let them do their jobs now.
Worst case you send exactly what you have and nothing more, okay, maybe they'll only be able to adjust part of your claim. Part of $8355 is still less than $8355, and you will be in a better place than you are now.
posted by phunniemee at 5:30 AM on November 29, 2023 [7 favorites]
Also, why would they say this:
Please submit within 60 days of services rendered the below items in PDF format (at your convenience and if you did not sent any of the below list previously):
if it weren't standard and normal practice for them to receive claim information in partial batches?
Send them what you've got, get the process moving forward, keep requesting your records from your hospitals, and then when/if they require more, send whatever else you've received. It certainly sounds like you've been through enough lately. Let them do their jobs now.
Worst case you send exactly what you have and nothing more, okay, maybe they'll only be able to adjust part of your claim. Part of $8355 is still less than $8355, and you will be in a better place than you are now.
posted by phunniemee at 5:30 AM on November 29, 2023 [7 favorites]
Something I like to remind myself of when dealing with things like this is that the vast majority of people making claims aren't anywhere near as well-equipped as I am to prepare to that giant list of materials, yet the company persists and hasn't long-since been flamed and/or sued out of existence.
People are collectively not very good at following instructions like those. I bet the insurer gets all kinds of random submissions they can't do anything with, like a blurry photo of someone's tour package's website. I know I have, when processing less complex applications than this. I think they're laying it on thick so all the keywords are there together, not because they're signalling malicious intent. The key is to just not ever give up in despair, because that's how these processes really get people.
posted by teremala at 5:44 AM on November 29, 2023 [6 favorites]
People are collectively not very good at following instructions like those. I bet the insurer gets all kinds of random submissions they can't do anything with, like a blurry photo of someone's tour package's website. I know I have, when processing less complex applications than this. I think they're laying it on thick so all the keywords are there together, not because they're signalling malicious intent. The key is to just not ever give up in despair, because that's how these processes really get people.
posted by teremala at 5:44 AM on November 29, 2023 [6 favorites]
Response by poster: Forgive me - a few more clarifications:
• My concern isn't one of urgency, it's about the implication that they're going to hold out on me until I satisfy their extensive list of documentation.
• My concern with the hospital I visited today is that I can't easily request records from them because I don't speak Japanese and they only provide a contact phone number, so if more documents are required I'll have to go back there (and also I'm not in Japan indefinitely, so if they're required later, I'm screwed).
• Ultimately I think what I'm asking here is: do I have any leverage or recourse if they use e.g. a missing X-ray to deny my claim?
posted by 7 Minutes of Madness at 5:52 AM on November 29, 2023
• My concern isn't one of urgency, it's about the implication that they're going to hold out on me until I satisfy their extensive list of documentation.
• My concern with the hospital I visited today is that I can't easily request records from them because I don't speak Japanese and they only provide a contact phone number, so if more documents are required I'll have to go back there (and also I'm not in Japan indefinitely, so if they're required later, I'm screwed).
• Ultimately I think what I'm asking here is: do I have any leverage or recourse if they use e.g. a missing X-ray to deny my claim?
posted by 7 Minutes of Madness at 5:52 AM on November 29, 2023
Is there any chance your travel insurance provider has a translator that you can use over the phone?
I used my travel insurance when visiting a hospital in Mexico earlier this year, and I called the hotline that tells you where to go/what to do because I was having paperwork issues at the admission desk. After acting as an intermediary for 15 minutes between the admin and the insurance company person, I asked if they could put a Spanish/English translator on the line and talk to the administrator on my behalf because I had exhausted my language skills, and it worked! And the problem was some procedural issue that had nothing to do with me and everything to do with insurance company policy so it was great to wash my hands of their paperwork problem.
posted by A Blue Moon at 6:07 AM on November 29, 2023 [4 favorites]
I used my travel insurance when visiting a hospital in Mexico earlier this year, and I called the hotline that tells you where to go/what to do because I was having paperwork issues at the admission desk. After acting as an intermediary for 15 minutes between the admin and the insurance company person, I asked if they could put a Spanish/English translator on the line and talk to the administrator on my behalf because I had exhausted my language skills, and it worked! And the problem was some procedural issue that had nothing to do with me and everything to do with insurance company policy so it was great to wash my hands of their paperwork problem.
posted by A Blue Moon at 6:07 AM on November 29, 2023 [4 favorites]
If you can't use the services of a professional translator/interpreter for whatever reason, do you know *any* Japanese-speaking people? A neighbor, your landlord/AirBnB host, the friendly person at the convenience store? Asking for x-rays isn't a complex translation task; asking a layperson for help (even a stranger! offer money, gifts, and/or your eternal gratitude!) seems like an option. Even a tourist information office might be able to help you with this. And if you have to leave Japan before you get the films, there are plenty of Japanese-speakers who could call the hospital for you, either professional interpreters or helpful friends-of-friends-of-friends.
If eventually your claim is denied, you can file a complaint with the appropriate regulatory body (in the US this is usually the state insurance commission), take the company to small claims court, complain to executives, get an outside ombudsman or a bunch of other things.
posted by mskyle at 7:16 AM on November 29, 2023 [2 favorites]
If eventually your claim is denied, you can file a complaint with the appropriate regulatory body (in the US this is usually the state insurance commission), take the company to small claims court, complain to executives, get an outside ombudsman or a bunch of other things.
posted by mskyle at 7:16 AM on November 29, 2023 [2 favorites]
Having had a stupid experience with a travel insurance company, I think your concern is justified.
Seconding finding/paying a Japanese speaker to help - either in person or just by writing you the message you need so you can show it to people. (You might even post here on Jobs for someone to either help you or connect you to someone else.)
If you can't get anyone to help over the phone, try writing (email? I've heard fax is still used a lot in Japan?), which has the advantage that is you can't find a Japanese speaker you can use a translation like you did before, though you'll want to be careful (for example, do reverse translations of the output it gives, look up individual medical terms both in dictionaries and on Google/Wikipedia to make sure they're correct, etc (I'd also include an English version alongside the translation). Keep it as simple as possible with respect to grammar, vocabulary, and structure - something like "Hello, I apologize for bothering you. I was treated at X hospital on [date]. My insurance asks X hospital to send: [bullet point list of records] Thank you, [name and all ID and contact information you can think of]"
Basically, try writing before making another trip.
If your claim gets rejected you can probably appeal. Note that usually they take their time rejecting you, and may or may not do it using paper mail instead of electronically, and the appeal process will also take time, and it could be a giant pain designed to make you just give up.
But maybe not - they might be fine. I wouldn't be as optimistic as some posters here, but I also wouldn't borrow trouble worrying about things that haven't happened yet. Get the most complete records that you can, submit them, and potentially continue to submit new documentation after your initial submission.
posted by trig at 8:31 AM on November 29, 2023 [1 favorite]
Seconding finding/paying a Japanese speaker to help - either in person or just by writing you the message you need so you can show it to people. (You might even post here on Jobs for someone to either help you or connect you to someone else.)
If you can't get anyone to help over the phone, try writing (email? I've heard fax is still used a lot in Japan?), which has the advantage that is you can't find a Japanese speaker you can use a translation like you did before, though you'll want to be careful (for example, do reverse translations of the output it gives, look up individual medical terms both in dictionaries and on Google/Wikipedia to make sure they're correct, etc (I'd also include an English version alongside the translation). Keep it as simple as possible with respect to grammar, vocabulary, and structure - something like "Hello, I apologize for bothering you. I was treated at X hospital on [date]. My insurance asks X hospital to send: [bullet point list of records] Thank you, [name and all ID and contact information you can think of]"
Basically, try writing before making another trip.
If your claim gets rejected you can probably appeal. Note that usually they take their time rejecting you, and may or may not do it using paper mail instead of electronically, and the appeal process will also take time, and it could be a giant pain designed to make you just give up.
But maybe not - they might be fine. I wouldn't be as optimistic as some posters here, but I also wouldn't borrow trouble worrying about things that haven't happened yet. Get the most complete records that you can, submit them, and potentially continue to submit new documentation after your initial submission.
posted by trig at 8:31 AM on November 29, 2023 [1 favorite]
Response by poster: Final update: WorldTrips/ Medical Care Management did not mention the missing X-ray, and they paid in full, no questions asked. Oddly, they didn't tell me they were paying in full, nor was there any update in my online account indicating that my claim had been approved and paid - the money literally just appeared in my bank account and I never heard from them again.
posted by 7 Minutes of Madness at 12:35 PM on November 2, 2024
posted by 7 Minutes of Madness at 12:35 PM on November 2, 2024
This thread is closed to new comments.
I did a travel insurance claim for a rural-ish Turkey hospital and it was really straightforward. They wanted most of all the financial paperwork, not the medical paperwork so much. They needed the full itemized bill for processing. I had to go back to them to follow-up on my credit card bill for the hospital which we did by email - they didn't reject my claim, but said oh can we also have this after the first set of paperwork went in.
I also got the email and phone numbers of the hospital and the medical translator just in case, and provided those to them also.
posted by dorothyisunderwood at 4:50 AM on November 29, 2023