A woman from India found herself hospitalized in Brampton, Ontario, due to hypoxic respiratory failure, resulting in a substantial medical bill.
Joseph Christy was thrilled that his 88-year-old mother, Alice John, could visit from India for six months on a ‘super visa.’ This visa permits parents and grandparents to remain in Canada for an extended duration. However, shortly after her arrival in January 2024, John began to experience health issues.
“She started exhibiting symptoms such as a cough, shortness of breath, and fever,” Christy, a Brampton resident, reported.
At the time, John was visiting her daughter in Hamilton and was subsequently admitted to Hamilton General Hospital. She spent nearly three weeks in the hospital and required a ventilator for assistance with her breathing.
The family had obtained a basic super visa travel insurance policy from Manulife, which provided coverage up to $100,000. However, after her treatment, it was revealed that she had a pre-existing condition, leading to the denial of their claim.
“You are not eligible for coverage under this policy if you have ever been diagnosed with congestive heart failure,” the family was informed.
Christy expressed his shock at this revelation, noting that the term congestive heart failure had never appeared in any of her prescriptions over the past three years.
Without insurance coverage, the family was left to cover the medical expenses, which amounted to $96,311.
“We felt extremely disappointed and let down,” Christy stated.
The family acquired a basic insurance policy, which does not require a questionnaire.
Typically, the insurance provider poses questions only after an individual seeks medical treatment.
Martin Firestone, the president of Travel Secure Inc., a travel insurance firm, informed that although the basic plan lacks medical inquiries, the underwriting process commences only when a claim is made. This means that any stipulation regarding the exclusion of pre-existing conditions could lead to significant complications.
“It is crucial to recognize that if the policy states no coverage for pre-existing conditions, any issue found in their records may be deemed a problem and ultimately not covered in Canada,” Firestone explained.
However, the family believed there was a misunderstanding, as they were unaware that their mother had a heart condition.
When contacted Manulife on behalf of the family, a representative issued a statement: “Occasionally, unique circumstances arise where the interpretation of the medical file does not correspond with the contract. We have reviewed the situation more closely and, considering the circumstances, will approve the claim. We have informed the necessary parties and are now beginning the payment process.”
Despite the initial denial of the claim, Manulife has now consented to cover the medical expenses in full.
“We appreciate your assistance in sharing our story and helping us reach this resolution,” Christy stated.
“When obtaining coverage for yourself or a loved one, it is essential to be aware of and clearly communicate all known health information to ensure appropriate coverage,” Manulife advised.
“We recognize that completing medical questionnaires can be difficult for some individuals. If there are any doubts, we encourage customers to consult their physician for the necessary clarity.”