law offices of merwyn j. miller
191 calle Magdalena, suite 270 ē encinitas, San Diego County, ca  92024 ē 760-436-8832

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Drug Coverage
Keep Your Documentation
Check Your Time Limits
Final Thoughts

This is a continuing series of articles with a number of "parts." See Table of Contents and search for "Don't Leave Home Without Them" and "Don't Leave Home Without It."

Introduction: We continue our discussion about my wifeís and my five day adventure in an Argentine hospital due to a bout with pneumonia. As I have said previously, my wife is fine now and doing well. This month we will deal with drug coverage and final thoughts on what will probably be our last article on this subject. (back to top)

Drug Coverage: I now have only one claim left. My wife was directed (prescribed) to purchase three drugs upon her release from the Argentine hospital. We did that. Is that covered by my medical insurance? My drug coverage (a separate policy for me) does not cover when I am out of the country. My medical insurance (a Medicare supplement coverage) has $50,000 of foreign travel coverage (lifetime limit). Does it cover drugs? There is nothing in the policy and nothing I can find online about this. My agent did not know and the people she spoke to at the insurance company were unsure. So I filed the claim and awaited the result. My feeling was that the foreign travel coverage is meant to replace Medicare Part A and B when out of the country. Those Medicare coverages do not typically cover outpatient drugs. So I didnít think it was covered. It was only $50 so I was not too concerned but I filed the claim more for curiosity than anything else. To my surprise, the claim was paid. So my conclusion is that it does cover outpatient drugs. (back to top)

Keep Your Documentation: Keep all of your bills, notes, charge card slips, and documentation from the hospital, cruise ship, physician, etc. You will need them when you get back and are ready to file your claim. And whatever you provide when you first file the claim, they will probably want more, so hang on to all of that documentation until everything is completed.

Check Your Time Limits: When you get back, check your time limits for filing your claim for each coverage (they may be different). This information will be found in your insurance certificate or booklet. (Yes, youíre going to have to wade through some of the legalese.) (back to top)

Final Thoughts: When filing claims, donít be afraid to include a cover letter if you think that will clarify things. Further, if the person who did not have the medical emergency is going to deal with the claims, make sure you both sign the claim forms so that you have a foot in the door to get the adjustor to speak with the one actually filing the claims. Failure to do this may cause the adjustor to cite privacy reasons for being unable to speak to you. In reality, that is just a minor irritant as all that means is you will need your spouse or significant other to be by your side when you call and give the adjustor permission to speak with you (how they know it is really the authentic person is beyond me).

Stick to your guns with the insurance company and donít let them chase you away unless the amount in question is nominal. If necessary, use the term ďbad faith.Ē It might be helpful before you do so to do a google search on the internet on that and see what it includes. There are a number of articles written for the non-lawyer on this subject and you donít want to be using that term if the company is not acting in bad faith. Hereís my experience with that concept from last monthís discussion. (back to top)

Conclusion: I hope you never have a medical emergency on a trip. But if you do, I also hope that these series of articles will have you more prepared then we were for what was, at times, a truly terrifying adventure.

This is a continuing series of articles with a number of "parts." See Table of Contents and search for "Don't Leave Home Without Them" and "Don't Leave Home Without It." (back to top)

August 5, 2016