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3-day stay in the cruise infirmary costs Bay-area couple $28K

Travel experts say their situation is a perfect example as to why travel insurance is a must.

TEMPLE TERRACE, Fla. — If you have a question about a cruise, Mike and Sandra Johnston, who have been on more than 70 cruises, will have your answer.

 “We’re the cruise critics in our church and for all of our friends,” said Sandra Johnston.

They were loving their time on a ship in Mexico back in January. They had even booked an excursion in Puerto Vallarta. While on the excursion, Mike fell. It wasn’t serious, and the two were planning to head to dinner when Mike became ill.

“They put me in a bed for the night and pumped me full of antibiotics,” said Mike Johnston.

It was two nights and one full day for Mike, and then Sandra spent one night in the infirmary after feeling nauseous too.

“I think it was Montezuma’s revenge. We had a drink and that might have been our mistake was the ice,” said Sandra Johnston.

They got better, but then they received the bill for infirmary care: $28,000 for the both of them.

But since they are veteran cruisers, they knew to have travel insurance. They knew their medical insurance would not cover international waters or land, so that’s why they purchased the trip insurance when they booked the trip.

“They gave us a number to call. We had to use the ship’s phone, and we started a claim,” said Johnston.

But five months later, the travel insurance company has not reimbursed them for their medical claims. They said first they had to get a denial from Medicare, and then were told to get a denial from their secondary insurance as well. But they didn’t have the proper code on any paperwork which meant more phone calls for answers.

The Johnstons maxed out two of their credit cards to cover the bills. 10 Investigates reached out to the travel insurance company the couple used to purchase the insurance to help the couple get answers. The company got back to us saying:

“The team has indicated that additional documentation is required to finalize Mr. Johnston’s claim. The team will reach out to him again to explain the necessary documentation, which is a response from his supplemental medical insurance carrier.

If medical benefits are defined as secondary or "in excess" to any other medical insurance the customer has, then those benefits are intended to help reimburse the customer for covered expenses that their primary and/or supplemental medical insurance will not pay. An Explanation of Benefits from their supplemental healthcare insurance is necessary to finalize this type of travel insurance claim."

We emailed again to ask why the couple needed the denials since their health insurance won’t cover international waters, and they told us,

“If any insurance policy has excess coverage, the underlying policy has to first process the claim and determine the outcome before the excess coverage can proceed. While Medicare may not provide coverage internationally, the supplemental policy needs to confirm whether or not any coverage applies. From there, the travel insurance medical benefit claim can be processed.”

We spoke with a travel lawyer and an insurance expert who both say once their paperwork is in order, the couple should be able to get their claims finalized.

“I always advise my friends and family that cruise, make sure you have travel insurance. Anything beyond sea sickness, have a medical transport,” said Tonya Meister, a maritime attorney in Miami.

“Make sure when ready to purchase, you understand what you are purchasing. Understand the exclusions and what triggers the coverage because you don’t want to be surprised after being treated on a cruise ship,” said Mark Friedlander with the Insurance Information Institute.

The Johnstons say their secondary insurer is going to get them the necessary paperwork even though they have been unable to get the required code from the cruise company. That should help expedite getting the travel insurer to reimburse them.

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