Despite travel insurance, $140,000 claim denied
Published Monday, October 29, 2012 5:37PM PDT Last Updated Wednesday, October 31, 2012 9:38AM PDT
A Las Vegas vacation turned into a financial disaster for a Sunshine Coast couple after one of them was hospitalized and their travel insurance company left them on the hook for $140,000 in medical expenses. Mike Gojevic is now on the lung transplant list.
Gojevic came down with what he thought was a bad cold just days before heading to Las Vegas to celebrate his wife Arleatha’s birthday in February.
An X-ray suggested he might have pneumonia, so an emergency doctor prescribed him a 10-day course of antibiotics. The doctor said he was good to go on vacation.
"[He told me] I can stay at home and feel like crap at home or I can go down and feel like crap by the pool in Las Vegas,” Gojevic told CTV’s Steele on Your Side.
But the 53-year-old started having difficulty breathing on the plane as the Las Vegas strip came into sight. He was administered oxygen on the plane and was met on the jet runway by paramedics.
He was rushed to Desert Springs hospital in Las Vegas. Gojevic, an insurance adjustor by trade, gave his wife some breathless instructions to make sure that the company they bought travel insurance with, One World Assist, knew they would be in the hospital.
"I gave her the book and I said ‘you better call the travel insurance company, make sure we're all on board on this anyway,’" he said.
Gojevic spent the next 10 days in hospital. Despite efforts of several doctors who saw him, his condition remained undiagnosed during the stay.
One World Assist sent a fax to the hospital confirming his coverage, stating that: "The above mentioned patient has a policy with our company that provides coverage for medical emergencies that he might encounter while outside of Canada.”
The Gojevics said it never occurred to them that there would be any problem with medical coverage.
"They certainly didn't allude to that all,” Mike Gojevic said.
After the couple was flown home via B.C. Air Ambulance they received a double whammy of horrible news: Mike was not suffering from pneumonia, but a life-threatening lung disease called pulmonary fibrosis. He was put on the list for a double lung transplant.
Then One World Assist denied the travel insurance claim, saying he was on the hook for $140,000 in medical expenses.
The company said he didn't qualify because he was treated stateside for a "pre-existing condition.”
In its denial letter, One World Assist told the couple it had saved them money. “If we had not arranged for your return to Canada via air ambulance, your medical expenses in the U.S. would have been significantly higher,” a claims representative wrote.
But Mike Gojevic argued that it was the pulmonary fibrosis that was the health problem that kept him in hospital, and he hadn’t been diagnosed with the serious lung condition at the time. He had only been diagnosed with pneumonia -- a condition considered minor by the insurance company.
"The reality is it wasn't pneumonia that caused the problem -- it's the pulmonary fibrosis which caused the issue -- and that was not a pre-existing condition,” he said.
"It's like I went to sleep and woke up and my whole life has just been ripped apart…it's just devastating,” Artletha Gojevic added.
The Gojevics appealed the decision with One World Assist but the company denied that as well.
Steele on Your Side contacted the company after months of it refusing to reconsider the couple’s claim, and it suddenly had a change of heart.
One World Assist Managing Director Mike Starko said despite being initially denied – twice – it will now pay the claim. Starko said the company stands behind its decision to deny the claim, but understands that the ordeal has been “understandably difficult” for the couple.
"We don’t believe the claim is actually payable, but we're doing it on compassionate grounds,” he said.
One World Assist says it didn't have to pay the claim because Gojevic went to more than one doctor before leaving for his trip, and required medication and a follow-up visit.
Starko said the lengthy timeline of the dispute resolution factored into the company’s decision to forgive the outstanding bills.
“I coupled that with just the situation that they're going through right now. That's when it just became obvious to me that we needed to make this exception on a compassionate basis,” he said.
The couple is beyond relieved.
"What a huge weight off our shoulders,” Mike Gojevic said.
Shortly after our interview, Gojevic’s health took a turn for the worse and he was admitted into St. Paul’s hospital. He remains in treatment and is waiting for lungs to become available for a transplant.
His wife, a home care nurse, travels back to the Sunshine Coast twice a week to see patients.
The family has set up a donation website, http://www.mikeslungs.com, in an effort to provide financial assistance to Mike and his wife while they are awaiting a transplant.