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.

Got questions? Why not call us on 1300 819 888 or send us an email to info@goinsurance.com.au

 

Contagious Diseases Series: Cholera

Contagious Diseases Series: Cholera

Cholera is an acute diarrhoeal illness caused by the bacterium Vibrio cholerae.  Left untreated, it can cause death within a matter of hours.

Cholera, which causes severe diarrhoea and dehydration, is most often seen in people who have travelled to developing countries.    

Globally, researchers believe that there are between 1.3 and 4 million cases each year.  It is also estimated that Cholera is responsible for between 21,000 and 143,000 deaths worldwide every year.

Although the Cholera organism has been detected in some rivers along the east coast of Australia, infection in Australia is very rare.  Almost every Australian case is contracted whilst the person is overseas, usually having visited countries where the disease is still common.

How do you get it?

The bacteria responsible for Cholera live in the faeces of infected persons.

Cholera is mostly transmitted through the consumption of food or water which is contaminated by infected faeces.  For travellers, this usually means drinking contaminated water, eating food which has been washed with contaminated water or prepared with soiled hands.  It can also be contracted by eating fish or shellfish that was caught in contaminated water.

Person-to-person contamination is rare but it can happen, particularly when there is contact with microscopic amounts of an infected person’s faeces or vomit.  This usually occurs through direct personal contact or indirect contact (eg by touching contaminated surfaces such as taps, toilet flush buttons, nappies, toys and linen).

Where in the world is it?

Whilst infection can occur in any country, Cholera is most prevalent in developing countries where hygiene standards and sanitation are poor.  Travellers to some parts of Africa, Asia, South America, the Middle East and Pacific Islands are at risk.

What are the symptoms?

Many people will not develop any symptoms or at worst only experience mild to moderate illness.  A small number of people will develop severe symptoms and in this case it is extremely important that urgent medical treatment is sought.

Symptoms usually manifest within 2 hours to 5 days.  Most people experience symptoms 2-3 days after the bacteria has been ingested.

The most obvious symptom is the sudden onset of painless and profuse watery diarrhoea (sometimes referred to as “rice water” faeces).  Other symptoms include nausea, vomiting, dehydration, weakness, lethargy and muscle cramps.

How is it diagnosed and what is the treatment?

Diagnosis can only be confirmed by testing a stool sample.  If you think you have been infected, it is important you consult a doctor.  If left untreated, symptoms can worsen and lead to death, particularly in the case of small children, older and/or infirm persons.

Although it can prove fatal, Cholera is easily treated with immediate rehydration – that is, replacement of fluids and salts lost through diarrhoea.  This typically involves oral rehydration fluids which can be purchased over the counter at most pharmacies.  However, if the patient is severely dehydrated and/or not able to tolerate oral rehydration, they may require hospitalisation and IV fluid replacement.  Authorities state that with prompt rehydration, less than 1% of Cholera patients die.

Antibiotics may be prescribed and whilst they shorten the duration of illness, it is rehydration which is key to recovery.

How can you minimise the risk of contracting Cholera?

Pre-travel Cholera vaccinations are available to minimise the potential of infection.  The vaccine only provides partial protection (approximately 50%) and remains effective for up to 6 months (maybe longer in adults).

However, the risk of infection for travellers in afflicted areas is thought to be less than 1 in 500,000 if appropriate food and water guidelines are followed.

Vaccination is generally only recommended for high-risk travellers – eg people who are at increased risk of diarrhoeal disease or suffer conditions which result in impaired immunity.  It is also recommended for certain travellers such as aid and refugee camp workers who will be in rural or remote locations for a long period of time and in close contact with locals.  Vaccination is not routinely recommended for all travellers and prevailing medical advice is to take care whilst travelling to practise high quality sanitation and safe food preparation.

Here are our top tips to help minimise the potential of infection if travelling to high risk areas:

Eating and drinking
  • Consume pasteurised milk and dairy products.
  • Avoid food prepared by street vendors.
  • Avoid raw or soft-cooked eggs. If eating eggs, eat hard boiled eggs only.
  • Avoid raw or undercooked fish and meat.
  • Avoid salads, fresh fruit juices and raw dairy products.
  • Consume bottled (and sealed) water. If not possible, make sure the water has been boiled, filtered and treated.
  • Use bottled water while cleaning teeth / dentures.
  • Avoid drinking local water (including cordial, ice cubes and ice blocks).
  • Avoid public drinking facilities (eg bubblers and water fountains).
Hygiene
  • Wash your hands and wash them often – particularly after visiting the toilet and/or before eating or drinking.
  • Carry (and use) hand sanitizer.
  • Avoid contact with people who are sick.
  • Avoid touching your face and mouth. If you need to, ensure your hands are clean.
  • Don’t share utensils, cups or plates.
  • Do not share personal care items.
  • Avoid close contact with others (eg kissing and hugging).

Many travellers are exposed to Cholera.  Fortunately there are measures you can take to minimise the risk of infection.  Please speak to your doctor to find out how best to protect yourself while travelling.

Got questions?  Why not call us on 1300 819 888 or send us an email info@goinsurance.com.au

 

Civil unrest

Civil Unrest: What you need to know

Civil unrest can happen anytime, anywhere.

There’s no doubt that civil unrest can impact your travel plans and it’s important to understand the risks and how your travel insurance might be able to help.

So what is civil unrest?

Quite simply, it is any activity which involves a mass act of civil disobedience.  Examples include demonstrations, riots and strikes.  In all cases, it involves participants who act in a hostile manner towards authority and the authorities have difficulty maintaining public safety and control over the participants.

Civil unrest takes many forms ranging from peaceful demonstrations which cause no particular disturbance to violent riots where authorities use force to control participants.

Some regions and countries are known for long term civil unrest.  Conversely, in other countries it can occur at a moment’s notice.

So what do you need to know if you’re travelling to an area where there is civil unrest?

First and foremost, safety is the number 1 priority.  To find out if the destination is safe, research is key.

Mainstream media will always be a good source of information about local conditions but more importantly, the Australian Government’s Department of Foreign Affairs and Trade (DFAT) will always provide information and advice to travellers about the safety of international destinations.  DFAT’s smartraveller website has a wealth of information about international destinations including safety considerations.  It is updated in response to new and emerging risks facing Australians who are travelling to or through other countries.  It’s a good idea to sign up to the email alert service run by DFAT to keep you up to date with the latest information for your chosen destination/s.  You can do this by clicking here.

Travel insurance which offers cover for cancellation or curtailment of the trip in the event of civil unrest is a must.  Take the time to read the policy you are planning to purchase to make sure you understand if it is covered and if so, how the policy responds.

Some policies will provide cover if you need to cancel the trip if civil unrest stops you from travelling as planned.  Other policies will only respond if the Australian government’s travel advisory is at the “Do Not Travel” level.

In all cases where the policy requires the Australian Government travel advisory to recommend against travel to the country, the unrest (and/or advice against travel) must occur after you purchased the policy.  You cannot purchase a policy to cover you for civil unrest if it has already commenced and the travel advisory against travel is in place.  In this case, it is a known risk – that is, the risk that your trip will be affected by it is known/likely.

Whilst most policies will cover you if you have to cancel the trip due to civil unrest, not all of them will cover you if you are already at the destination and you want to leave because it has arisen.

Also, be aware that travel insurance doesn’t cover disinclination to travel.  The civil unrest needs to affect your planned travel.  If the Australian government considers it safe for Australian travellers to be in the location where civil unrest is occurring, it is unlikely your travel insurance will offer any form of compensation simply because you just don’t want to go.

Remember too that civil unrest does not always involve violence and often it is quite safe for people to be in a location where civil unrest is happening.  Just be mindful that situations involving civil unrest can be volatile and it’s always best to stay away from areas where protestors are congregating.  It goes without saying – don’t participate in any form of civil unrest as it is likely this will invalidate your travel insurance if you are injured in a demonstration.  Always remain vigilant, keep abreast of Australian government travel advice and media reports.  Stay away from locations where protests are taking place and always obey instructions provided to you by local authorities.

Got questions about civil unrest and travel insurance?  Why not call us on 1300 819 888 or send an email to info@goinsurance.com.au

 

Onus of Proof: What is it and why it is so important?

Claims Explained: Onus of Proof

Onus of Proof sounds like a legal concept and it is.

Onus of Proof isn’t complicated though – it just refers to the responsibility of proving (or disproving) a fact.

When it comes to making an insurance claim, the claimant bears the Onus of Proof to demonstrate a valid claim against the policy. This means you must prove that you sustained a loss and that it is covered by the policy.

To discharge the Onus of Proof, you would normally be asked for evidence of the event and the loss you suffered. Let’s look at some travel insurance examples.

To claim for loss or theft of property, the insurance company will normally ask you to provide a police report (or similar document). This helps to verify that the theft / loss event happened while you were travelling and during the period of insurance. It will also outline the circumstances of the loss. The insurance company will ask you to provide evidence that you owned the items that were lost / stolen and what they were worth. Some insurers are very specific about the documentation they will accept as proof of ownership (eg purchase recepts and valuations). Other insurers may be more flexible and accept other forms of proof such as photographs, user manuals, repair dockets or statutory declarations. It’s best to check with your chosen provider regarding what is acceptable proof in the event of a claim.

To claim for medical expenses, the insurance company will ask you to obtain a report from the doctor to confirm the illness/injury and the diagnosis given. You will also be asked to obtain an invoice from the doctor to verify the services provided and the charges. If the injury / illness relates to your past medical history, the insurance company may ask for access to your past medical records.

If your claim is for travel delay, cancellation or curtailment, the insurance company will usually ask you to provide a letter from the airline confirming the reason for the disruption to your travel. You will also need to show evidence of the additional costs incurred due to the disruption and/or details of any pre-booked travel arrangements which were forfeited.

Providing this type of documentation helps you to discharge the Onus of Proof to show that you have a valid claim against the policy.

Once you have demonstrated that you have a valid claim against the policy, if the insurer agrees with you, the claim will be processed. However, if the insurer does not agree that you have a valid claim, the Onus of Proof shifts to it to demonstrate that an exclusion applies (or any other term within the policy which serves to limit or deny your claim).

If the insurer discharges the Onus of Proof to show that an exclusion applies to deny or limit your claim and you do not agree with its assessment, the Onus of Proof shifts back to you to show that the insurer’s decision is wrong.

Legally speaking, there’s a bit more to it than this simple explanation. Onus of Proof though essentially means you need to prove your claim and the insurer needs to disprove it (if they consider it isn’t covered).

Got questions about proving a travel insurance claim? Why not call us on 1300 819 888 or send an email to info@goinsurance.com.au

Contagious Diseases Series: Cholera
|

Cholera is an acute diarrhoeal illness caused by the bacterium Vibrio cholerae.  Left untreated, it can cause death within a matter of hours. Cholera, which causes severe diarrhoea and... Read More

Civil Unrest: What you need to know
|

Civil unrest can happen anytime, anywhere. There’s no doubt that civil unrest can impact your travel plans and it’s important to understand the risks and how your travel insurance... Read More

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 … Read More

Contagious Diseases Series: Cholera
|

Cholera is an acute diarrhoeal illness caused by the bacterium Vibrio cholerae.  Left untreated, it can cause death within a matter of hours. Cholera, which causes severe diarrhoea and dehydration, … Read More

Civil Unrest: What you need to know
|

Civil unrest can happen anytime, anywhere. There’s no doubt that civil unrest can impact your travel plans and it’s important to understand the risks and how your travel insurance might … Read More

Claims Explained: Onus of Proof
|

Onus of Proof sounds like a legal concept and it is. Onus of Proof isn’t complicated though – it just refers to the responsibility of proving (or disproving) a fact. … Read More

British Airways Strikes – September 2019
|

British Airways have notified travellers that there will be significant delays and cancellations impacting flights on 9, 10 and 27 September 2019. As this British Airways strike event is now … Read More

Hong Kong Protests – 5 August 2019
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Demonstrations in Hong Kong have been ongoing since June 2019.  From 5 August 2019, these demonstrations have led to flight cancellations and disruption to scheduled transport services. News of disruption … Read More

Compulsory Travel Insurance:  Which countries?
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Compulsory travel insurance is becoming more common these days with some countries denying entry in cases where the traveller is uninsured. It can be a little tricky too as some … Read More

Cancellation Cover: Do you really need it?
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Most travel insurance policies include Cancellation cover but how do you know if you need it? To decide, it’s important to make sure you understand what the Cancellation section covers and … Read More

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