Claims Explained Inpatient Medical Expenses

Claims Explained: Inpatient Medical Expenses

No one goes on holiday thinking they will end up in hospital.  But it does happen.

It is a condition of most, if not all, travel insurance policies that if you need inpatient medical treatment while travelling (or will incur medical costs over a certain amount), you need to notify the insurer.

Why is this?

There are a few reasons why it is important you notify the insurer that you have been hospitalised for medical treatment.  Let’s take a look at a few.

Policy response

Most travel insurance policies will cover you for accidental bodily injury or illness which occurs while you are overseas.  The cover extends to compensate you for normal and necessary medical expenses to treat the injury or illness.  This includes hospital charges and doctors fees, nursing, medication, ambulance transfers and repatriation if medically necessary.

However, policies do carry exclusions and it is important for your insurer to be given the opportunity to assess your situation and determine if the policy responds to cover you for the cost of treatment you need.  It may be that you need treatment which is not covered by the policy.  If this is the case, the travel insurer will mostly likely provide all possible assistance to you but you will be responsible for the costs incurred.  Alternatively if the policy does respond, the insurer can take responsibility for all billing issues so that you don’t have to pay upfront.

Duty of care

Travel insurers have a duty of care to their policyholder to ensure treatment is of a standard comparable to what they would receive in Australia.  Not all hospitals and clinics around the world are of the same standard we enjoy in Australia.  It may be that you’ve been injured and require surgery but the hospital where you have been admitted may not have the necessary surgical expertise or equipment.  In that case, the travel insurer will be able to arrange for you to be transferred to another facility where you can receive appropriate and high quality care.

Similarly, it may be more appropriate for you to return home to Australia for medical treatment (instead of being treated overseas).  If this is the travel insurer’s determination, they can arrange for you to be repatriated.  Depending on your medical status, this could involve air ambulances, doctor or nurse escorted travel or via commercial flight with or without a non-medical escort.  The insurer can also arrange for a relative to travel to you if medically necessary.

Appropriate services and standards

Sometimes, foreign hospitals can set upon a treatment plan which may not be considered “best practice” in Australia.  Travel insurers have medical advisers on staff and on call.  These experts can liaise with the treating doctors to agree treatment plans to give you the best chance of a quick and full recovery.  If the hospital is ill-equipped to provide the necessary services, again your travel insurer can arrange for you to be transferred to another facility.

Cost control

Travel insurers have global networks of assistance providers, hospitals and healthcare facilities.  This means they have often inspected hospitals and clinics around the world to ensure the facilities are of an appropriate standard.  They may have also negotiated preferred provider contracts with certain hospitals.  This helps to ensure the travel insurer’s policyholders not only receive quality care in a timely fashion but these contracts often include agreed pricing for services rendered.  Travel insurers also audit medical invoices to verify that services provided to the patient are appropriate for the medical condition and the charges are commercially realistic.  If the charges are exorbitant, travel insurers (or their cost containment agents) can enter into negotiations with the hospital’s billing department to settle on an agreed price.  This is a routine practice and not unusual for travel insurance claims.

It is not uncommon in some countries like the United States for hospitals to over-charge foreign travellers (and their insurers) for medical treatment.  This also occurs in other locations such as certain European and South American countries.  When a travel insurer has vetted a hospital or clinic and agreed a pricing model, you notifying the travel insurer of your hospitalisation not only helps ensure you receive appropriate and quality medical care but also, the travel insurer pays a fair and agreed price for that treatment.  If you do not notify the travel insurer and self pay with a view to claiming reimbursement, you may have prejudiced the travel insurer’s financial position because you could have “over-paid” for the treatment provided to you by the hospital.

There are other reasons why it is a condition of a travel insurance policy that you notify the insurer if you require urgent or high cost medical / inpatient care.  One of the most important though is that the travel insurer can support you at a very stressful time and ensure you receive appropriate medical care and organise repatriation if necessary.  Travel insurers have a wealth of resources at their disposal to take care of the situation and help you recover quickly and return home safely.

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