Beware Vacationguard Timeshare Insurance

Anyone who has seen the advertisements on this web site or in Timesharing Today regarding Vacationguard Insurance being a good policy is being is being mis- informed. I have submitted a claim for a week in July with a substantial amount of paperwork.After they asked for more paperwork which we complied with, they just denied my claim. We were at the urgent care center twice with x-rays being taken and copies of prescriptions and an explanation from the physician explaining my issues. The urgent care center was in New York and was not my primary care physician in Florida. This insurance gladly accepted my premiums of $199 per year for two consecutive years but refuses to pay a legitimate claim for about $450. This will be our last year of paying for so called insurance where they look to get out of paying legitimate claims.

DO NOT BUY VACATIONGUARD INSURANCE

Thanks for the tip!

I was thinking about using them, but now I won't bother :annoyed:

I'm getting tired of having to submit tons of paper work, and jumbing through several hoops.
Marsha

ira g said:

Anyone who has seen the advertisements on this web site or in Timesharing Today regarding Vacationguard Insurance being a good policy is being is being mis- informed. I have submitted a claim for a week in July with a substantial amount of paperwork.After they asked for more paperwork which we complied with, they just denied my claim. We were at the urgent care center twice with x-rays being taken and copies of prescriptions and an explanation from the physician explaining my issues. The urgent care center was in New York and was not my primary care physician in Florida. This insurance gladly accepted my premiums of $199 per year for two consecutive years but refuses to pay a legitimate claim for about $450. This will be our last year of paying for so called insurance where they look to get out of paying legitimate claims.

DO NOT BUY VACATIONGUARD INSURANCE

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could we have some more information regarding the situation?

ira g said:

Anyone who has seen the advertisements on this web site or in Timesharing Today regarding Vacationguard Insurance being a good policy is being is being mis- informed. I have submitted a claim for a week in July with a substantial amount of paperwork.After they asked for more paperwork which we complied with, they just denied my claim. We were at the urgent care center twice with x-rays being taken and copies of prescriptions and an explanation from the physician explaining my issues. The urgent care center was in New York and was not my primary care physician in Florida. This insurance gladly accepted my premiums of $199 per year for two consecutive years but refuses to pay a legitimate claim for about $450. This will be our last year of paying for so called insurance where they look to get out of paying legitimate claims.

DO NOT BUY VACATIONGUARD INSURANCE

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marsha77 said:

I was thinking about using them, but now I won't bother :annoyed:

I'm getting tired of having to submit tons of paper work, and jumbing through several hoops.
Marsha

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TUG Improvements! said:

could we have some more information regarding the situation?

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There is not enough information given by the OP to make a determination/decision either way.

TUG Improvements! said:

could we have some more information regarding the situation?

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We had a 3 week vacation planned with a week at a timeshare in Vermont, a week in the NYC area in a hotel, following with the final week in another timeshare in Vermont. During the latter part of the first week in Vermont I developed severe headaches. We went down to NYC where I went to an Urgent Care center since we reside in Florida. At that time they took blood work and prescribed antibiotics. During the latter part of the second week the headaches were not improving, so I went back to the physician's office where they proceeded to take x-rays and prescribed another antibiotic. At this point we felt it was not appropriate to continue our trip for the third week of our trip in the timeshare in Vermont, being diabetic and desiring to be closer to our own doctors. I was unable to help my wife with any of the driving responsibilities in returning to Florida. Yet the claims department of this insurance policy is looking to weasel out on a legitimate claim. WHY?

Have you asked what the reason is for the denial? And have they given you a reason?

yes indeed...what was the reason they gave for denying your claim?

TUG Improvements! said:

yes indeed...what was the reason they gave for denying your claim?

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Since the OP has an on going medical condition, diabetes, they may be using the
"pre-existing condition" loophole. Just a guess. Reread your policy carefully and best wishes. I hope you prevail.

Phil

Dave M said:

Have you asked what the reason is for the denial? And have they given you a reason?

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The verbal reason they have given me is that the doctor didn't mandate a stop of the trip in a written letter to them. I had on 2 occasions provided to them from the urgent care physician a letter describing my conditions and the fact that the original antibiotics did not work and that they were prescribing a new antibiotic. To me, who was sick this just appears to be an arbitrary denial and a means not to pay a valid claim. I told them, and have signed a letter indicating that, they could obtain any medical documents from this physician yet they refuse to contact them. I have taken out many travel insurance policies on major trips and have never had to use any. This Vacationguard insurance promises timeshare coverage but to me they are less than credible. They remind me of an up front timeshare company who promises everything and doesn't deliver on their claim.

Phil

Ira says this was the second year.

Nationwide says all pre existing conditions are allowed after the first year:

"...Renewing members have the added bonus of having the medical pre-existing exclusion eliminated upon each renewal, plus access to insurance discounts on personal insurance needs..."

KenK said:

Phil

Ira says this was the second year.

Nationwide says all pre existing conditions are allowed after the first year:

"...Renewing members have the added bonus of having the medical pre-existing exclusion eliminated upon each renewal, plus access to insurance discounts on personal insurance needs..."

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It wasn't clear to me whether he was in the 1st or 2nd year. But now we know the real reason (see post #9 above).

Yes...the real reason according to the Ins Co.......

I still think Ira has a gripe....

Provide all the information to the Attorney Genera's Office of Consumer Affairs in the State where the "insurance" company is located. Request a paper copy of the reason for denial and don't rely on any verbal reasons. Took me a year to get reimbursed for an Rx claim in Hawaii. Just don't quit. That's what they are counting on.

Sterling

Kauai Kid said:

Provide all the information to the Attorney Genera's Office of Consumer Affairs in the State where the "insurance" company is located. Request a paper copy of the reason for denial and don't rely on any verbal reasons. Took me a year to get reimbursed for an Rx claim in Hawaii. Just don't quit. That's what they are counting on.

Sterling

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Thanks Sterling- Once I receive the written denial I am going to contact both the NYS and Florida's Department of Insurance as well as the Attorney General's Offices in both states. By posting here I was trying to alert our TUG community of the questionable practices of the Vanguard Insurance that is supposed to protect our members

I guess the problem depends on their coverage and their definition of medically necessary to stop the trip. This is the problem with so-called vacation/travel insurance.

Clearly, if you had been put in traction or had a heart attack or had something like a death in your immediate family, I assume the insurance would kick in, but from their POV, they are looking at your claim as if you didn't want go on with the trip because of headaches for which antibiotics were prescribed. Apparently, they want you to provide a note from the doctor saying that he advised you to cancel the rest of your trip for medical reasons, and not going because you wanted to be closer to home to treat the problem which may not be covered by your policy.

What is the exact wording in the policy that triggers coverage in a case like this? A lot of insurers simply deny claims when it's not a cut and dry case. Your recourse is usually to appeal the denial, find out what additional information they would need to approve the claim and provide that information.

-David

Look for another resolution

Couldn't agree more with David - great advice so not sure it's time to throw them under the bus.

Worked with loss adjusters my whole life, and most want to at least learn of your position in more detail. They may not have understand it at first blush, and /or your claim may lie in the "gray area" of coverage. This sounds a bit like that. With a doctors note from the urgent care, this seems pretty clear and simple - without one, what's the trigger they pay on?

It's worth your time to ask for reconsideration, as it might save you a lot of time, but at least you'll have some facts to work from.

You'd be surprised how many things can get worked out when someone works nicely with an adjuster, who is just trying to get things right while they have to document everything for the carrier and regulators.

ira g said:

The verbal reason they have given me is that the doctor didn't mandate a stop of the trip in a written letter to them. I had on 2 occasions provided to them from the urgent care physician a letter describing my conditions and the fact that the original antibiotics did not work and that they were prescribing a new antibiotic. To me, who was sick this just appears to be an arbitrary denial and a means not to pay a valid claim. I told them, and have signed a letter indicating that, they could obtain any medical documents from this physician yet they refuse to contact them. I have taken out many travel insurance policies on major trips and have never had to use any. This Vacationguard insurance promises timeshare coverage but to me they are less than credible. They remind me of an up front timeshare company who promises everything and doesn't deliver on their claim.

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I think the key here might be that the physician did not specifically state you "were medically advised to stop the trip". A lot travel policies require this specific statement from the doc. So you might get a better response to your claim if you contact the doctor you saw in urgent care and request that another letter be written that adds this statement.

Lots of speculation going on here. We don't have all the facts so let's not jump to conclusions.

Phil

philemer said:

Lots of speculation going on here. We don't have all the facts so let's not jump to conclusions.

Phil

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I don't think anybody is jumping to conclusions. We're certainly speculating, because we don't have all the information available. Specifically, we don't know the terms of that policy and when coverage is supposed to kick in.

In no way was I implying that Ira should have gone on his trip or that it wasn't medically necessary to cancel it. Ira's the only one that can make the determination if he should have canceled the trip or not, regardless of insurance coverage. And, from what I gather, he decided (rightly so, IMO) that he should stay closer to home. But that doesn't mean that the cancellation was or wasn't a covered incident.

-David

Ira:
You mean Vacation Guard underwritten by Nationwide Mutual?

ira g said:

By posting here I was trying to alert our TUG community of the questionable practices of the Vanguard Insurance that is supposed to protect our members

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Here is the wording from the VacationGuard policy:

Emergency Accident & Sickness Medical Expense – The Insurer will pay benefits up to the maximum benefit shown per reservation, for You, Your Family Members and Traveling Companions traveling with You during Your scheduled Timeshare Trip, for Covered Medical Expenses as a result of Emergency Treatment of an Accidental Injury or Sickness which first manifests itself during the Timeshare Trip.

Emergency Treatment means necessary medical treatment, including services and supplies, which must be performed during the covered Timeshare Trip due to the serious and acute nature of the Accidental Injury or Sickness.

Covered Medical Expenses are necessary services and supplies which are recommended by the attending Physician. They include the services of a legally qualified Physician, surgeon, graduate nurse, dentist, or osteopath; charges for hospital confinement and use of operating rooms; charges for treatments and laboratory tests; ambulance service, drugs, medicines, and therapeutic services and supplies. The Insurer will not pay benefits in excess of the reasonable and customary charges commonly used by providers of medical care in the locality in which the care is furnished.

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Some delay in processing is understandable. The medical coverage is secondary, requiring a formal denial by other medical coverage:

Obtain receipts from the providers of service, etc., stating the amount paid and listing the diagnosis and treatment; submit these first to other medical plans. Provide a copy of their final disposition of Your claim.

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One of the major exclusions is for:

Any non-emergency treatment

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Thus, speculating ( ), it may be that since the doc didn't recommend terminating the vacation, the insurance company might have decided that the headaches were not an emergency.

KenK said:

Ira:
You mean Vacation Guard underwritten by Nationwide Mutual?

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Yes, Ken I meant Vacation Guard underwritten by Nationwide Mutual

Dave M said:

Here is the wording from the VacationGuard policy:Some delay in processing is understandable. The medical coverage is secondary, requiring a formal denial by other medical coverage:One of the major exclusions is for:Thus, speculating ( ), it may be that since the doc didn't recommend terminating the vacation, the insurance company might have decided that the headaches were not an emergency.

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Dave- I submitted the claims to my primary insurance company and they paid it in full except for the small coinsurance which I submitted to Vacation Guard, which they also denied. How could they deny the medical coverage as well? It appears they are acting in bad faith. I will appeal their decisions and if I get no satisfaction I will bring it before the appropriate regulatory agencies in both Florida and New York.

Ira -

Please note that I'm on your side.

I'm not sure they are acting in other than good faith. Although I'm sure your headaches were severe and debilitating, there isn't enough info from what you have posted that makes it clear that the attending physician made it clear to VacationGuard that he deemed your visit and treatment to be of an emergency nature that could not have been handled by taking an over-the-counter medication and waiting until you returned home for treatment. Many travel insurance policies require a very high level of need to reach the "emergency" level. It's not clear what VacationGuard's threshold is.

However, the fact that VacationGuard noted that your doc didn't recommend terminating your vacation suggests a possibility that they consider your expenses as other than an "emergency", as defined by their policy. But it seems as though VacationGuard didn't actually say that to you.

Thus, it's not at all clear to me what provision of the policy VacationGuard is relying upon to deny your claim. I think you'll have to focus on that and find the language (or ask them) before you'll have any realistic chance in prevailing with a complaint to a regulator.

It's also of note that although many here have used VacationGuard, yours is the first complaint I can recall or find on these forums. That might mean that there is a legitimate dispute or a simple miscommunication tracing back to the physician's report rather than the insurance company acting in bad faith.

I actually read the policy, and I assume you are looking for coverage under Part A1? They don't have a good definition of "sickness" as it pertains to that portion of the policy as far as I could tell from that file.

You said you had the policy for 2 years (or more than 1 year) so the pre-existing conditions clause doesn't apply.

-David