May 12, 2023 by Robert Tillotson – Consultant with Offshore Health Benefits

So from time to time, I receive complaints from an individual or a family that their overseas medical insurance plan is not covering a family member, after being approved at 100%, with no pre-existing conditions written in the “Offer” or “Approval Letter.”

I always hate to hear these types of complaints and ask a series of questions: Which company is covering you? Did you received a formal approval which specifically outlines what exactly is NOT covered? How long have you been on this plan and what exactly is the insurance company not covering? The truth is that many companies have very strict language in their “Pre-existing Conditions & Exclusions” descriptions which sometimes super small and placed at the very end of a Benefits Summary. Imagine this. This language is usually written very vaguely and in a way where it may apply to just about anything.

A great example is a client of Offshore Health Benefits who lives in Costa Rica for 10 months out of the year and 2 months in the USA (New York). One of the dependents is a 18 year old college student who had to have her tonsils taken out. The premium for this family is about $22,000 a year for the four and a $2000 per person deductible ($2 million dollar plan). The daughter ended up in a MD’s office and was told it was time to have the tonsils removed. The rate with insurance would be around $17,000 in New York City using a network PPO specialist. Mom, thought all is good so they arranged to have outpatient surgery. They would pay the $2000 deductible and the rest would be covered and the child could return to Costa Rica for the rest of the summer, after a week of rest in the city. A day before the planned surgery, this well known global medical insurance company denied the claim and would not approve the surgery. Mom was furious and received the run around after calling Member Services so many times. She was promised a call back in 24 hours, which did not happen.

After receiving no return call, she contacted my office. Our team immediately got involved and escalated the matter to management. Keep in mind, the daughter was now hours away from surgery and sick in bed. We were told the surgery would not be covered due to a “Pre-existing Condition.” Turns out the daughter went into an outpatient emergency (clinic) room 6 months before because she thought she had strep throat, she was put on ZPAC antibiotics and dismissed, and everything was fine for a while.

I went on to ask the insurance company why they did not outline such an exclusion in their offer letter and they simply said, “we don’t outline pre-existing conditions.” Keep in mind, I had been offering this company for over 15 years and they had always made offers which outlined such conditions. A mistake had to have been made by medical underwriting but no fault was admitted. My team was furious. After many calls and a delay, and threats, we were able to get the operation covered but it was a fight. We have since stopped offering this company. Imagine if this would have been a more serious condition in a Costa Rican hospital?

Lesson learned. Do not go with any global medical insurance company who does not offer and state what is covered and not covered, in writing, up front (applies to 12 month comprehensive coverage plan with a guaranteed renewal). We were lucky. Most agents do not even mention any of these issues in hopes a quick sale and commission check (commissions will be discussed in my next writing.)

Contact my office for a list of reputable companies and a list of companies who are not worth the paper the plan is written on. We are on to these type of companies and encourage you to research.

Happy traveling. – Robert Tillotson (licensed and bonded)

Robert lives part time in the Caribbean, Latin American and the States with his dog Roscoe and girlfriend and has been with Offshore Health Benefits since 2002.

*for more information and international medical quotes for you and your family, contact info@offshorehealthbenefits or visit OffshoreHealthBenefits.com (Offshore Health Benefits is a preferred broker for many global insurance companies and offers 10% off annual premium and no cost wellness benefits).