New Brunswick

Dream vacation turns into a Fredericton woman's insurance nightmare

A Fredericton woman is on the hook for nearly $50,000 US in medical bills after falling ill during a trip to Pennsylvania. Sandra White thought she was covered, but a technicality in Blue Cross policy made her claim ineligible.

On hook for $50,000 US in medical bills, Sandra White says Blue Cross travel insurance rules unclear

Sandra White of Fredericton is on the hook for nearly $50,000 US in medical bills in Pennsylvania after her insurance provider declared her claim ineligible. (Catherine Harriop/CBC)

Sandra White was on cloud nine after returning to Canada from a dream vacation to Holland with her son. 

They were in Toronto and ready to part ways when she decided to take a trip into the United States to visit his family at his home in Pennsylvania. 

But White contracted a severe illness soon after and spent a few days in a U.S. hospital, racking up a massive bill. Her son, Matthew White, said they were comforted knowing the costs would be covered by the travel insurance he purchased just before leaving Canada. 

Or so they thought.

The claim was denied, and the 70-year-old retired hairdresser is on the hook for nearly $50,000 US. As the family fights with their insurance provider, they're warning other travellers to read the fine print before taking off.

A Fredericton woman got sick while in Pennsylvania, but when she sent the hospital bill to her insurance company, it denied the claim. Sandra White now owes the hospital $48,000, but she says the insurance company is wrong. 1:23

"I may have to go to a lawyer," Sandra White said. "I'm not sure what I can do. I can't pay it, but I want it to be paid because those people did for me what they needed to keep me alive."

At issue is the definition of a trip, and Sandra and her insurer, Blue Cross, don't see eye to eye.

'I got deathly ill'

Her son surprised her this spring with the trip to Holland — a place on her bucket list. They met in Toronto, flew across the Atlantic and spent a week in the country, starting April 20.

At the last minute, her plans to stay in Toronto for a visit changed, and her son invited her back to his home in Erie, Penn., to visit with her grandson. 

Before they left Toronto Pearson International Airport, Matthew White went on his phone to buy travel insurance for his mom. They drove into the U.S. on April 27, and two days later he was rushing his mother to hospital.

Sandra White says either Blue Cross made an error in denying her claim or the company is looking for an excuse to not pay up. (CBC)

"This time on the 29th, I got deathly ill," Sandra White said. "I had [bacterial] pneumonia and nearly died."

She underwent a myriad of tests, was on oxygen and was told she had chronic obstructive pulmonary disease, or COPD, and spots on her lungs — two conditions yet to be diagnosed in Canada, her son said.

Matthew White said he was in talks with Blue Cross throughout the hospital stay and was given the impression there would be no issue with their coverage.

"So at no time during that entire experience were we thinking about, like, 'Oh God, what if we have to pay for this?'" he said.

Matthew White was under the impression the insurance covered his mother's illness. (Matthew White/Submitted)

Blue Cross requested extensive medical and travel records, which they provided. Then, about two weeks later, Sandra White received a denial letter.

"They're not paying it on the grounds that I did not insure the entire trip from the 20th of April," she said.

The definition of a trip

According to Blue Cross, a trip begins the day a person leaves their province of residence and it ends when they return. The individual must also be covered from start to finish, no interruptions. 

In Sandra White's case, even though the visit in the U.S. was a last-minute trip separate from the Holland adventure, because she had yet to return to New Brunswick, or purchase coverage before leaving the province, that gives the insurer grounds to deny the claim.

Melissa Thibodeau, an agent trainer with Blue Cross, said it comes down to risk exposure.

"It has to be purchased prior to yourself being exposed to the risk," she said. "This is the way we protect ourselves from, of course, fraud and stuff like that. We know that most clients do not intend to [commit] fraud, but we have to put measures to protect ourselves to a certain extent."

Blue Cross says it's clear with consumers about its coverage, but it also encourages buyers to read the rules. (CBC)

Thibodeau said it's a standard rule across most of the insurance industry, though some companies might offer different packages.

The Whites are incredulous. 

"The 20th to the 27th, I had no reason to have insurance with that company for the U.S. Nor did I need it for being in Holland," said Sandra White.

"So, either somebody made a real big booboo, or somebody is trying to get out of paying. I'm not sure which it is."

Is it clear enough?

The Blue Cross online form does ask for your departure date from your province of residence — not from your province of departure.

Matthew White said he believes he put in Ontario, not New Brunswick, because that is where they were starting their trip into the United States. To him, it only made sense.

Thibodeau said Blue Cross is clear with consumers about the province-of-residence wrinkle, but she advised travellers to read the policy to fully understand the coverage.

"We advise them when they go through the process," she said. "We say, 'OK, so we sold you the basics, but go take the time to read all the rules about this purchase, and if you don't agree with any of that, we'll refund you."

A warning that travel insurance must be purchased before departure appears when buying Blue Cross insurance online. (CBC)

The consumer has 10 days to opt out and be refunded, she said.

Thibodeau said if someone disputes a denial, they can send a letter arguing their case that will be reviewed by an in-house revision committee, which has one year after the refusal to consider the case. Upon review, the complainant will receive a formal decision within four months.

"But afterwards, if we maintain a refusal, there is always the opportunity to transfer the client complaint to the ombudsman service," she said.

Buyer beware

Michèle Pelletier, New Brunswick's consumer advocate for insurance, didn't think the province-of-residence issue is made clear to buyers.

"I don't agree with them, because when I did fill in the application, it was just as if I was going to buy some insurance, it was not that clear," she said.

But Pelletier cautioned the public about online insurance buying.

"So when you do book online, nobody helps you, nobody gives you information," she said. "You are the only one. So yes, you have to be more careful because nobody helps you."

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