Stuck in pandemic, his travel insurance failed to cover his $ 38,000 medical bill
By Arthur Allen | Kaiser Santé news
Duy Hoa Tran, a retired Vietnamese schoolteacher, arrived in Los Angeles in February 2020 to visit his daughter and 2-month-old grandson. Two weeks later the door closed behind him. To prevent the spread of COVID-19, Vietnam has closed its borders. No commercial flights would be allowed in the country for the next 18 months.
Tran’s daughter, An Tran, who has a doctorate in business administration and teaches marketing at the University of La Verne, did what she deemed necessary to provide medical coverage for her then 65-year-old father for the pandemic. But the only option for a visitor with a tourist visa was travel insurance. In early March 2020, An Tran found and purchased a policy, for around $ 350 per month, from a company called Seven Corners.
She might as well not have cared.
Elder Tran had been staying at An’s in Diamond Bar for about a year when he told his daughter he was having trouble seeing with her right eye. A visit to an ophthalmologist produced a solemn verdict: Tran suffered from severe glaucoma and would quickly go blind unless he had an operation.
Seven Corners has given written pre-approval for the procedures recommended by Dr. Brian Chen. To be sure, An Tran called the insurer “several times” to confirm that he would cover the expenses, but no one she spoke with would give her a definitive answer, she said. Chen, however, assured An that insurance companies generally covered the treatment, which was quite common.
On April 19, Tran underwent the first of three eye surgeries to resolve glaucoma. The surgeries – the last date of July 19 – were successful. And then, on August 5, Seven Corners sent An Tran a denial of service letter.
Company policy excluded coverage for any “pre-existing condition”, meaning any condition “whether or not it has manifested before, symptomatic, known, diagnosed, treated or disclosed,” the letter said. .
An Tran and her father were expected to pay nearly $ 38,000 in medical bills, although Seven Corners pre-authorized the surgery and paid around $ 6,000 for insurance in the previous year and a half.
As for the bill, “my dad obviously can’t pay it,” Tran said. Her monthly pension of $ 260 from the Vietnamese government is not enough for her to live in Vietnam, she said.
The surgeries undergone by Duy Hoa Tran are quite common in the United States, said Dr. Davinder Grover, a Dallas-area ophthalmologist and clinical spokesperson for the American Academy of Ophthalmology.
Medicare would typically pay about a quarter of the $ 37,896.83 Tran billed for the surgeries, Grover said. If Tran’s daughter had known in advance that the insurance would not cover the procedures, the doctor’s office might have been willing to charge something like $ 12,000, he said.
The policy purchased by An Tran had no deductible and provided coverage for up to $ 100,000 in medical expenses, including COVID care. But travel insurance typically only covers emergency or urgent medical expenses, according to the California State Insurance Commission, which regulates policies in the state.
Megan Moncrief, director of marketing for Squaremouth, which aggregates travel insurance plans from various companies – including some from Seven Corners – and offers them through her website, said the police language was not unusual for the ‘travel insurance. She noted the policy stipulation that it only covered certain acute conditions if the patient sought treatment within 24 hours of the first symptoms.
Moncrief said that the fact that Tran did not seek immediate treatment could be the reason his surgeries were not covered. (Seven Corners declined to comment on the case.) She admitted that it was hardly surprising that he didn’t rush to the doctor at the first sign of unease: “I don’t know if I would have did that either, if I had seen cloudy. “
As for Seven Corners’ refusal to pay despite pre-certification, that’s not uncommon, she said. By pre-certifying, the insurer verifies that a procedure is a covered benefit but does not guarantee that the insurer will cover it for that particular patient.
Travel insurance generally offers little protection for any health issue related to a pre-existing condition, whether or not the condition has already been diagnosed, says Susan Yates, managing director in the United States of Falck Global Assistance, an international insurer.
“For visitors to the United States, especially those who are not permanent residents or citizens, it can be difficult to obtain health insurance,” she said. The Affordable Care Act does not cover tourists, although some resident non-citizens can purchase coverage.
“It is generally better for a visitor to purchase travel insurance in their home country, but in some countries (Vietnam being one) the insurance market is not developed,” Yates wrote in an email.
Tran had tried unsuccessfully for months to return home to his town near Ho Chi Minh City, where his wife lives with another grandchild. On 14 occasions, An bought her tickets on scheduled commercial flights which were later canceled. He was also unable to secure a seat on charter flights organized by the Vietnamese government; these tickets were generally only available through third parties charging up to $ 10,000.
Eye surgeon Chen offered to discuss the case with KHN, but his medical group’s lawyer said it was his policy not to discuss insurance issues with reporters, even with consent. of the patient.
After KHN approached him to discuss the matter, Chen told An Tran that he was waiving his $ 8,144 fee for the surgeries. The Acuity Eye Group, where he practices, did not immediately confirm Chen’s offer, but told An Tran that they were also seeking approval to waive his fees and all other fees.
On September 15, Duy Hoa Tran finally managed to take a charter flight to Vietnam. He is happy to be home, An Tran said.
Under California’s subsidiary liability laws, it could be liable for its remaining invoices.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and surveys, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.