Warning - If You Are Planning On Traveling You Had Better Not Get Sick (A Rant)
@purplealabaster (22094)
United States
January 20, 2011 5:45pm CST
So, we are traveling visiting family. It was a planned trip, and we are supposed to be here for a month or two. What was not planned was my little one getting sick on the drive here, which takes two days. We ended up in the Emergency Room in two different states, but we made it here eventually. I was a "good girl" and got "permission" from my primary care physician as we were rushing to the ER. I also called our insurance company as soon as possible to let them know what was happening. When we got settled here, I followed up with a physician as per instructions from both the ER doctor and my daughter's regular pediatrician. I even cleared it with the insurance to cover all the bases. So far, so good right? Wrong.
The physician here feels that my daughter needs further medical care as does my daughter's pediatrician. The insurance company, on the other hand, with their vast medical knowledge and expertise believes that my little one will be fine until we get home and can be seen by her regular pediatrician. The fact that three doctors disagree with this and have said that a two day drive will most likely end in at best another trip to the ER or more likely an extended stay in the hospital apparently does not matter.
We pay a lot for medical insurance, and I know that they do not like paying "out of network" expenses. However, when you are in a different state, shouldn't they cover the medical expenses, especially when more than one doctor thinks that they are necessary? They apparently feel that people either are not supposed to travel for extended periods of time or if they absolutely have to travel, then they had better not get sick while they are away from home. Am I the only one that thinks this is ridiculous?
We pay a lot for medical insurance, and I know that they do not like paying "out of network" expenses. However, when you are in a different state, shouldn't they cover the medical expenses, especially when more than one doctor thinks that they are necessary? They apparently feel that people either are not supposed to travel for extended periods of time or if they absolutely have to travel, then they had better not get sick while they are away from home. Am I the only one that thinks this is ridiculous?6 people like this
12 responses
@allknowing (130066)
• India
21 Jan 11
I am not from the United States and so cannot say anything here with authority. But I do have several people there who are my relatives and they shudder at the thought of anyone visiting them without health insurance!! What's with US that without insurance one cannot survive there as going to private doctors is not heard of unlike here in India we can afford private doctors. Falling sick is normal and with this restriction how suffocated a person becomes when one has to go through Insurance who have so many rules and regulations! I do envy for what US is giving to its citizens but certainly not when it comes to falling sick.
2 people like this
@purplealabaster (22094)
• United States
21 Jan 11
The thing is that I do have health insurance, and we pay a lot for it - well, it is probably the "normal amount" that most people pay, but it is still a lot of money. I have never really needed medical treatment while I was out of state before, but I thought that as long as I had approval from my Primary Care Provider, especially if it was an emergency, and I notified my insurance company within 24 hours of treatment, then the insurance would authorize payment. I mean, it is not like we can magically appear back home for treatment when we are several hundred miles away from home.
I actually think that it might be better if I didn't have medical insurance, because there are different organizations and programs that will assist you if you need emergency medical treatment and do not have insurance. If you do have insurance, on the other hand, then you generally do not qualify for these programs as they assume that your insurance should pay for your medical treatment.
1 person likes this
@purplealabaster (22094)
• United States
21 Jan 11
That sounds good in theory, but I don't think that is really a viable option. If we do not have health insurance, then hospitals have to give you emergency care, but they generally only do the very minimum that they are legally obligated to do, which means that they very often do not give proper treatment to people. Also, we have to pay the bills out of our own pockets, which normally ends up costing more than the insurance premiums and co-payments. Insurance companies usually only have to pay a portion of what the hospitals and doctors charge, so if the bill is $2,000, for instance, then the insurance company might only have to pay $1,000. If a person without insurance has the same procedure and gets billed the same amount, that person has to pay the entire $2,000.
1 person likes this
@allknowing (130066)
• India
21 Jan 11
If more people opt out of insurance then the Insurance people will perhaps change their stringent rules.
1 person likes this
@hardworkinggurl (37063)
• United States
20 Jan 11
Ugh this angers me, as what is the point of paying for insurance when a claims examiner wants to apply their opinion. They have not examined nor know the history of the condition for them to assess personal opinions.
It is a rule with all insurances that if you do not have an in-network physician within 50 miles the claim gets paid in-network.
You go ahead and do as the experts say, and if they pay out of network you have the pediatrician give you a letter explaining the reason why he suggests further examination. You call up the insurance and place an appeal, with the claim number you fax the letter and sure enough the claim gets approved.
This angers me that a claim examiner wants to tell a parent to wait to save a few bucks, do they not realize that waiting will cost them bigger bucks later.
2 people like this
@hardworkinggurl (37063)
• United States
20 Jan 11
I was too quick with the enter button and did not mention. I do hope you little begins to feel well soon.
2 people like this
@purplealabaster (22094)
• United States
21 Jan 11
Thank you for the information, HWG, because I had no idea that if there is not an in-network physician within 50 miles, which is obviously the case as we are out of state, then the claim could be paid as in-network. I will definitely be looking into that and following up on that.
I am very lucky that my daughter's pediatrician as well as the doctor down here are working with us. They have faxed back and forth to make sure that there is a documented "paper trail" to make it easier for me to appeal if it comes to that. They are also composing a letter to the insurance company to justify further treatment. The doctor she is being referred to is a specialist, which you would think would think would indicate to the insurance that it is more than just a "stubbed toe" (so to speak) that could be taken care of at any old time. In fact, the doctor here specifically said that my little one is not allowed to travel any extended distance until after she has seen the specialist, so I am wondering just how the insurance company expects us to get home to see her pediatrician.
I am very lucky that my daughter's pediatrician as well as the doctor down here are working with us. They have faxed back and forth to make sure that there is a documented "paper trail" to make it easier for me to appeal if it comes to that. They are also composing a letter to the insurance company to justify further treatment. The doctor she is being referred to is a specialist, which you would think would think would indicate to the insurance that it is more than just a "stubbed toe" (so to speak) that could be taken care of at any old time. In fact, the doctor here specifically said that my little one is not allowed to travel any extended distance until after she has seen the specialist, so I am wondering just how the insurance company expects us to get home to see her pediatrician.1 person likes this
@hardworkinggurl (37063)
• United States
21 Jan 11
Geeze purple what is our world coming to, after all you pay for the insurance, it is not handed to you for free.
So to a sense the country wants to dictate and control our health care, hmm, did not know that meant that we should take the opinion of a claims examiner over the well educated and experienced medical professional.
2 people like this
@gabs8513 (48686)
• United Kingdom
21 Jan 11
That is just awful
I mean People get sick and it is not as though they request to be sick
You are paying for the Insurance so what is their Problem
I really hope you will get this sorted out and I hope that little one is feeling better
@purplealabaster (22094)
• United States
22 Jan 11
Thank you, Gabs. I also hope that this turns out well not only with the insurance but also with my little one's health. She is doing better on the medicine, so I hope that she will continue to get better, and I am definitely praying that the tests show that the illness was just a fluke and not an indication of a more serious problem. We wouldn't be having this issue if she were sick at home, because the insurance would cover everything (other than the co-payments of course) so I don't see why we are having it now as where we get sick really should not matter, because it is not like we plan it or anything.
@Kashmeresmycat (6369)
• United States
21 Jan 11
You know Purple, I'm at a loss for words. I'm completely appalled at this and all I can think of is "How dare they tell you she'll be fine until she gets home". That's beyond comprehension, after 3 doctors telling you she'll become worse. I seriously don't know what to say except again, how dare you.
What the he!! sense does it make when all this time you are paying for insurance. It should be covered EVERYWHERE, no matter where you go. It's too bad the newspapers cannot follow your story and show people what disregard, even after paying for years, these insurances have concerning proper emergency care, especially for children. It's too bad you can't sue them for child endangerment, telling you she'll be alright until she gets home...absurd, absolutely absurd. I hope something becomes of this, I really do, for just putting you through all the emotional aggravation of it all.
I hope she is feeling better soon. You are doing exactly what any other mother would be doing, taking care of your daughter.
2 people like this
@Kashmeresmycat (6369)
• United States
21 Jan 11
The part that really gets me, I mean REALLY gets me, is that the insurance company, who are NOT doctors and have not examined your child, have the audacity to tell you she'll be alright and you can wait until you get home. THAT's what made my jaw drop to the floor, and again I say, how dare you tell me this. Isn't that practicing medicine without a license?..seriously. It's no different than getting legal advice from someone who is not a lawyer.
You know, if you would have done that (waited until you came home), and something happened to her, everyone would be looking at you saying what kind of mother are you? And what mother would let their child become sicker because the insurance company said it was ok. So you would be at fault for endangering your child?????? Why does the insurance company get away with this???? Oh, I'm so pi$$ed off right now you couldn't imagine.
I wish, I really wish, this could be taken further and you could be compensated for all this aggravation and IGNORANCE.
2 people like this
@purplealabaster (22094)
• United States
21 Jan 11
You know, you have a good point about the child endangerment issue. The doctor said that my little one is not allowed to travel any extended distance until she has had the tests to find out exactly what is causing her illness and has had follow-up treatment if required. If we were to make the trip home, as the insurance company has stated that we should do before the follow-up treatment, we were told that she would likely get as sick (if not sicker) than she was on the trip here. That would definitely be child endangerment, in my opinion, especially when it is going against the doctor's recommendations.
Thank you for the well wishes and support by saying that I am doing the right thing as a mother. I mean, I think that I am, but it still helps to hear it from other people. I have already said that my little one is going to be seen and treated no matter what the insurance company says, because that is the most important thing. The money and payment issue can be sorted out later.
Another thing that really makes me angry when I think about it is that most insurance companies will pay for Erectile Disfunction medications and other such things without a second thought. I am not saying that these medications should not be covered. However, when the fact that I do not happen to be home when my child got sick causes me to have more problems getting approval for medical treatment for my little one for a condition that could be extremely serious, and other people have absolutely no problem getting approval for treatment of a limp appendage, I think there is a major problem not only with our health care system but also apparently our priorities as a nation in general.
1 person likes this
@purplealabaster (22094)
• United States
1 Feb 11
I am just as angry as you are at the moment. The doctors put in the request for treatment, and the insurance company denied it (again) saying that my little one can get all the necessary treatment at home, so they will not pay for it where we are. They insurance company did agree that they would pay for it at home, though, which means that they do in fact feel that it is necessary medical treatment and their ONLY objection to it is where the treatment will be given ... as if we can just magically appear back home to get treated!
... as if we can just magically appear back home to get treated!
@purplealabaster (22094)
• United States
21 Jan 11
Yeah, not being treated is NOT an option, especially when it is a young child. I know how sick she was on the trip here not to mention that she was also in a lot of pain, and I will not put her through anything like that again if I can help it. I would gladly go through it myself if it meant that she didn't have to, but obviously that is not an option, either. Therefore, I will get her the treatment and deal with the insurance company later if it comes to that. Her health is the most important thing, and it really angers me that insurance companies seem to ignore that fact.
2 people like this
@purplealabaster (22094)
• United States
21 Jan 11
"it's practicing medicine without a license" I completely agree with this, and as far as I know that is illegal.
Well, the person that I talked with at the insurance company initially was very nice and helpful. When I followed up with the doctor here, though, some idiot at the insurance company told the billing department at the doctor's office that they would not pay, and she could just get treated when we got home. That was my first clue that this was going to be a major ordeal. We got that straightened out, but now the insurance company is going to fight any other treatments that she will need here. I will fight it as far as I can, but if push comes to shove I will pay it myself, since she needs the care. It just makes me furious that we pay a lot of money for insurance, and then when we really need it they refuse to pay. It really makes me wonder whether or not other people have the same problem. The insurance company acts like we can schedule when we are going to get sick or have an accident or whatever. If we could, I am sure that most people would opt to not get sick at all.
That was my first clue that this was going to be a major ordeal. We got that straightened out, but now the insurance company is going to fight any other treatments that she will need here. I will fight it as far as I can, but if push comes to shove I will pay it myself, since she needs the care. It just makes me furious that we pay a lot of money for insurance, and then when we really need it they refuse to pay. It really makes me wonder whether or not other people have the same problem. The insurance company acts like we can schedule when we are going to get sick or have an accident or whatever. If we could, I am sure that most people would opt to not get sick at all.2 people like this
@jdyrj777 (6530)
• United States
21 Jan 11
Iam in total agreement with you. In fact i cant stand any insurance company. Be it health auto or whatever. You always have to pay them every month and when you do have to use them they have all these false reason why they should not pay. They still have you pay the money part too. They are all like legal theives. I dont even have health insurance. I just go to clinics. I knew someone once who did not have a car and they wanted him to have non owner atuo insurance. I laughed and told him it would be a cold day in H3LL when they pull that crap on me.
2 people like this
@jdyrj777 (6530)
• United States
22 Jan 11
The person that was told to get non-owner insurance was not a citizen and i wondered if they were just trting to take advantage of him. I had never heard of that before either. He said they told him it would cover him in what ever auto he was driving. Which is crazy because most states now require the auto to have insurance before it can be on the road and it covers whatever driver is in it.
The last time i had a car. I renewed in insurance for 6mo. while it was in the auto shop. They told me the car needed very costly repairs and wouldnt be worth it because the cars value wasnt good. So i desided to junk the car and cancel the insurance. They told me my refund would be in the mail. When i got the check it was only about $30. I was only paying about $30 a month. I called and asked why it was only $30. and i paid $180 for 6 mo. He said there was a $30 dollar cancellation fee. I told him i renewed while it was in the shop @ $180. Cancelled 10 days later even if you took 1 full mo. and $30 cancellation fee. I still should get back $120. why is the check only $30.? He never gave me an answer none of them did. So that insurance company ripped me off. Its one reason i do not have a auto today. Its also why i dont get health insurance, instead i just go to clinics.
But i do understand that a family especially with children you want to be covered. Im just a single grandma so it works for me.
You would think that after months of paying and never getting into a accident that they would give a person a break and give them like 3 months where they dont have to pay. But NO they love ripping off people.
@purplealabaster (22094)
• United States
21 Jan 11
You are right that most insurance companies try to find reasons why they can't (really it why they won't) pay a claim. Then, they end up raising your premiums, even if they do not pay for the claim.
I really have not had many problems with our health insurance up to this point, and I thought that it was actually really good. I am starting to reconsider this opinion, though. I am still holding out hope that they will do the right thing and approve the treatment as we will not have a final determination before next week, so I am keeping my fingers, toes and any other extremities crossed that they will approve it.
I have never even heard of non-owner auto insurance, and that sounds absolutely ridiculous. In fact, we were told that the insurance is actually on the vehicle not on the driver (someone hit us that had insurance on their own vehicle but they were driving a vehicle owned by someone else that was not insured and we were told it was the vehicle that was insured, so the driver's insurance was not liable for the accident), so it would be completely absurd to have non-owner auto insurance as there is no vehicle to insure.
I really have not had many problems with our health insurance up to this point, and I thought that it was actually really good. I am starting to reconsider this opinion, though. I am still holding out hope that they will do the right thing and approve the treatment as we will not have a final determination before next week, so I am keeping my fingers, toes and any other extremities crossed that they will approve it.
I have never even heard of non-owner auto insurance, and that sounds absolutely ridiculous. In fact, we were told that the insurance is actually on the vehicle not on the driver (someone hit us that had insurance on their own vehicle but they were driving a vehicle owned by someone else that was not insured and we were told it was the vehicle that was insured, so the driver's insurance was not liable for the accident), so it would be completely absurd to have non-owner auto insurance as there is no vehicle to insure.
@Hatley (163781)
• Garden Grove, California
21 Jan 11
hi purple I really think they should not let a bunch of overfed and overpaid business men run health insurance companies. they should have medical people running health insurance who know about illness and disease. all those business suits care about is not paying out money.
thats why horrid things like what happen with your daughter happen as those morons do not know anything about illness except maybe hang overs from to much booze.I had always thought in an emergency one's health insurance should kick in in an out of state emergency where you must go to the nearest clinc. I am 84 and my Evercare from Secure Horizons says for me to go to the nearest clinic if I am in a different state and get ill so why cannot that apply to a child too, children and old diabetics have more risks in an emergency than do middle aged people. I do not understand a paid for health insurance not paying for care in out of state emergency. thats just plain awful.Purple alabaster I sure do also think
it really stinks, its ridiculous.
2 people like this
@purplealabaster (22094)
• United States
21 Jan 11
Someone said that insurance companies do have doctors that review cases, so perhaps that is why they agreed to hear arguments for why she needs the follow-up care here instead of waiting until we get back home. I do hope that they realize that this is potentially very serious and agree to the follow-up care. I mean, two trips to the Emergency Room within several hours of each other should give even an incompetent person with a hangover a clue that this is something serious not to mention that three doctors have all agreed on what they think that it might be.
1 person likes this
@ifa225 (14364)
• Indonesia
21 Jan 11
Hi Purple,
if we bring some kids with us when traveling, health is number one condition to make the plan goes smooth.
almost every week end i plan to go vacation with my family, but there is something that make the plan messed, like sick, my kids are getting exam or anything.
so, it is better to stay at home every week end
@purplealabaster (22094)
• United States
21 Jan 11
Yes, health is definitely a concern when traveling. If I had known that my little one was sick, then we obviously would not have made the trip until she was better. She didn't show any signs of being sick until after we were already on our way, though, and by the time that we realized how sick she really was, it was way too late to turn around and go back. We are staying with family, and we just wanted to get her into a familiar and stable environment, so she could relax, take the medicine, and feel better. There was no way for us to have known this was going to happen. In fact, if the doctor is correct, it could have actually been the traveling that brought a more serious condition to our attention, so it might be what they call a "mixed blessing", although it definitely does not feel like a blessing at the moment.
1 person likes this
@ifa225 (14364)
• Indonesia
21 Jan 11
[i]In fact, if the doctor is correct, it could have actually been the traveling that brought a more serious condition to our attention, so it might be what they call a "mixed blessing"
[/i]
There is always lucky in the 'unlucky situation'. even you have to face a hard situation because of the illness.
now i hope she is okay and you and with your family could plan another travel which you can enjoy
2 people like this
@purplealabaster (22094)
• United States
21 Jan 11
You are right that sometimes even the worst situations you can find something positive in if you look hard enough, but sometimes it is extremely difficult to find that one positive thing among all the bad.
Thank you so much for the kindness and good wishes. We will not be doing any traveling in the near future, but we are still out of state and visiting relatives, so hopefully we can have some good times while we are here.
We will not be doing any traveling in the near future, but we are still out of state and visiting relatives, so hopefully we can have some good times while we are here.1 person likes this
@vandana7 (98826)
• India
22 Jan 11
Hi PA - my first response was lost - I am writing this again. First and foremost I would like to wish you a happy new year. :)
Secondly, I would go with what your daughter's pediatrician back home suggests, and not the insurance company, nor the pediatrician at your family's place. If he/she is willing to endorse whatever treatment that the physician at the other end is offering, I wouldnt see much problem with it. Physicians do consult over the phone, dont they? Moreover, the pediatrician back home knows your little one's constitution better than others. So his/her decision would be final, whatever the insurance company says.
I too am facing the same dilemma in a different context. When I was younger, i couldnt afford to take my papa around. Today I can, but he does not feel all that well at times, and that scares me, because I dont want to be stranded in a foreign country with nobody to turn to. Out here, I can ask friends to fly down. But in another country that wouldnt be possible, isn't it?
1 person likes this
@purplealabaster (22094)
• United States
23 Jan 11
I am hoping that you are having a wonderful New Year as well, Vandy.
Yes, it is definitely a good thing to consult my little one's regular pediatrician and get her input on the situation, which I have done throughout this entire process. The doctor here and her regular pediatrician are even faxing information back and forth, which they feel is better than consulting over the phone as faxes leave a "paper trail" where phone conversations do not. That way, if the insurance company decides to deny treatment I have a better basis for an appeal. I really appreciate how they are working together and thinking ahead to make sure that not only will my little one get the best care possible but also that I have the best chance possible of the insurance paying for her treatment.
I understand your dilemma with your dad. The thought of being stranded in a foreign country with a sick relative and nobody to help me would terrify me as well. I think that it is sad that when we are younger we generally do not have the money to travel and do all the things that we would like to do. Then, when we are older, we might have the money to do them but not the ability to do them due to age or health issues or other concerns.
@topffer (42156)
• France
21 Jan 11
Hello purple,
I am pleased to have some news from you, and sad for what happens to your little girl.
I am completely unable to give an answer, but I don't understand how an insurance can say the opposite than three doctors ? As usual, insurances are here to ask for their bills, and try to don't pay when you need them : it is the same everywhere .
If you take the risk of a the return trip, and go again to the ER, will they be responsible for something ? Maybe a written medical certificate sent by fax is able to change their mind ?
.
If you take the risk of a the return trip, and go again to the ER, will they be responsible for something ? Maybe a written medical certificate sent by fax is able to change their mind ?
1 person likes this
@purplealabaster (22094)
• United States
21 Jan 11
Top, I am so glad to see you again, my friend! *HUGE HUGS*
I am not sure how the insurance company can justify denying the treatment, either, when three doctors have agreed, and I know for sure that at least two of the doctors have documented it - the third doctor was the Emergency Room doctor, so I am not sure whether or not it was documented in the paperwork, but she did verbally tell us.
I am also not sure whether or not the insurance company would cover the ER trip if we did decide to try to make the return trip without further medical treatment. I suspect that they would deny it, however, and say that we went against the doctors orders by traveling when it was documented that my little one should not make any extended trips without the follow-up care - it is one of those "darned if you don't and darned if you do" type situations I think ... pretty much anything that will get them out of having to pay the money.
I am sad to hear that insurance companies are like this everywhere. For some reason, I had thought that other countries actually had better health care systems/insurance companies than the United States did.
1 person likes this
@purplealabaster (22094)
• United States
21 Jan 11
I wonder what planet these people were from that they did not consider your friend's case an emergency. I mean, the one doctor told her that it was too late for the operation, which meant that she was doomed to die ... I would think that would absolutely fit under the definition of emergency!
Hey, if we are living in a castle, then do we get to dress all fancy and have servants and drink from goblets and everything ... or do we need "prior authorization" for those sorts of activities?
1 person likes this
@topffer (42156)
• France
21 Jan 11
In fact it was an authorization from the administration that my friend did not asked, because she thought -- and the new surgeon also -- that her case was an emergency 
.
Even if we live in two different worlds for health care -- mainly public for me and private for you --, we have the same problem : we need authorizations. We are living in Kafka's Castle 
.
.
Even if we live in two different worlds for health care -- mainly public for me and private for you --, we have the same problem : we need authorizations. We are living in Kafka's Castle .1 person likes this
@rosegardens (3034)
• United States
21 Jan 11
Geesh. You pay for your insurance, yet they are telling you how your care should be handled? Did you fax them the doctors reports?
I bet if you call an attorney, they would change their tune rather quickly.
I hope your baby is ok.
2 people like this
@purplealabaster (22094)
• United States
21 Jan 11
Thank you for the good wishes for my little one - we need them right now!
I don't have the doctor's reports myself, but the doctors are in touch with each other and are working together to try to get approval from the insurance company. I do hope that it does not come down to my getting an attorney, but that might actually be a less expensive option than paying the medical bills out of our pockets, especially if my little one needs the kind of medical care that they are worried she might need. Besides, why do we bother to have insurance if they will not pay when we really need it?!
I don't have the doctor's reports myself, but the doctors are in touch with each other and are working together to try to get approval from the insurance company. I do hope that it does not come down to my getting an attorney, but that might actually be a less expensive option than paying the medical bills out of our pockets, especially if my little one needs the kind of medical care that they are worried she might need. Besides, why do we bother to have insurance if they will not pay when we really need it?!1 person likes this
@purplealabaster (22094)
• United States
21 Jan 11
Thank you for the well wishes. My little one is starting to respond better to the medicine, so she is doing alright for now. If she does not get the treatment that she needs, though, then she could end up just as sick as she was before or even worse, which is what three doctors have now said. We are all hoping that the further tests that she needs will reveal that there isn't a more serious problem and the medicine she is taking now is all that is required, but that does not seem very likely at this point.
I also hope that we can settle this amicably with the insurance company, but I am worried that if these tests reveal what the doctors are concerned about, then we are going to have an even bigger fight with the insurance company, because she will have to have even more medical treatment before we can return home. It is a good thing that we were planning on spending such a long time here visiting, because otherwise the situation would be even worse, and that hardly seems possible right now. *sigh*
I also hope that we can settle this amicably with the insurance company, but I am worried that if these tests reveal what the doctors are concerned about, then we are going to have an even bigger fight with the insurance company, because she will have to have even more medical treatment before we can return home. It is a good thing that we were planning on spending such a long time here visiting, because otherwise the situation would be even worse, and that hardly seems possible right now. *sigh*1 person likes this
