‘What a muddle’: 77-year-old Ontario man denied a $10K insurance claim over a one-time puffer prescription he forgot to disclose — says he called the insurer 100 times but they refused

‘The greatest runaround…in my life’

Hamill says he has made “100 calls” to TD Travel Insurance and Global Excel, a claims management and medical assistance company, trying to deal with the situation.

He told Global News: “Talk about customer avoidance techniques, it was the greatest runaround I’ve been in in my life.”

Valley Hospital had offered to give Hamill a $6,396 discount off the original $10,660 cost, but since it took months for Hamill to find out his insurance claim was denied, the hospital sent the original bill to a collection agency due to non-payment.

Despairing over the mega bill, Hamill reached out to Global News, who reached out to the insurers on his behalf. The companies then reviewed Hamill’s case and agreed to settle the bill with the collection agency.

TD then issued a statement saying it is “committed to supporting its customers and putting the customer first in every decision we make. We have worked with the individual to resolve the claim … We encourage customers who have any questions about their policy to contact us.”

Global News spoke to Michael Camacho, former president of the Travel Health Insurance Association (THIA) about Hamill’s case. Camacho emphasized that any changes in medications or medical conditions that happen from when you purchase the policy to when you depart must be disclosed.

“However small it might appear to be, you’ve got to call the insurance company or your insurance advisor and let him or her know that there has been a change,” Camacho told Global News. In this case, the forgotten puffer was all it took for the case to be denied.

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Know your coverage

Hamill learned the hard way that the information you provide to your insurer must be complete and accurate, but there are other considerations to keep in mind.

Insurance is there to safeguard against life’s unexpected moments, but understanding what you’re covered for is critical to make sure you are protected.

If a medical emergency happens when you’re abroad, your provincial or territorial health plan may not cover the costs — some countries may not even treat you if you don’t have insurance or money to pay the bill.

Also, be aware that benefits will vary depending on the provider. Pay attention to definitions, restrictions and limitations, and carefully review the policy and coverage before you leave the country.

Finally, keep a copy of the insurance information with you and if you need to make a claim, submit original receipts and hold onto any copies for your records. If the claim is denied and you disagree with the decision, you can appeal it or contact the insurer’s ombudsman department.

For Hamill, reaching out to Global News made the difference. “Without your help, I wouldn’t have had a chance,” he told them.

Sources

1. Global News: Why a prescription puffer cost an Ontario man a $10k insurance claim, by Sean O'Shea (Oct 19, 2024)

2. Government of Canada: Trip interruption and travel health insurance

2. Canadian Life and Health Insurance Association: A Guide to Travel Health Insurance