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Investigations Unveil Extent of Fraud

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Investigations Unveil Extent of Fraud ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS WWW.ITIJ.CO.UK NOVEMBER 2011 • ISSUE 130 Investigations unveil extent of fraud Kenyan conundrum The summer holiday season has come to an end in the northern hemisphere, and with it has come more dire warnings from travel insurance Travel insurers basing their coverage decisions on companies that fraud is on the up – both from travel advice from government agencies have hit clinics treating travellers, and from travellers the headlines in the UK recently. Mandy Aitchison themselves. Sarah Watson reports on the problem looks into the issue In a recent editorial piece in Insurance Insight, The UK’s Foreign and Commonwealth Offi ce (FCO) Mike Keating of AXA Insurance explained that has advised against ‘all but essential travel to coastal the company noticed ‘a worrying trend over the areas within 150 km of the Kenya-Somalia border’. It summer’, stating that AXA’s claims department further explained: “We advise against all but essential received some excessively high medical bills as part travel to coastal areas within 150 km of the Somali of claims for treatment in Spain, Turkey, Bulgaria, border, following two attacks by armed gangs in small Egypt and sub-Saharan Africa. He added: “There boats against beach resorts in the Lamu area on 11 is evidence of overcharging, overdiagnosis and September and 1 October 2011. This advice will be over-treatment of minor problems and collusion kept under review. Both attacks were on beach-front between clinics and holidaymakers. Travellers need properties, with two Westerners kidnapped and one to be warned of the risks involved in using overseas murdered. Beach-front accommodation in that area travel clinics so that they do not end up with a hefty and boats off the coast are vulnerable.” medical bill to add insult to injury.” He noted several Some customers with holidays booked in the area, examples of bills received by the insurer this summer though, are being told they can’t cancel their holiday that were considered to be fraudulent, including an and claim on their travel insurance policy because of £88,000 bill for treatment of a heart attack in Turkey. a ‘disinclination to travel’, and they must approach “The charge was not only excessive,” said Keating, their tour operator to fi nd an alternative destination “but the clinic also ‘persuaded’ the customer to have if they do not wish to go on their planned holiday. extremely risky surgery overseas when he could While for most holidaymakers, re-booking to an safely have been repatriated and admitted to a UK alternative destination would be acceptable, there hospital.” Further examples given of overtreatment are bound to be customers for whom re-booking is and overcharging include a clinic in the Democratic not an option, and they just wish to cancel and get Republic of Congo, which tried to bill AXA for a CT their money back. scan despite the fact there was no scanner at the The justifi cation for the stance taken by travel hospital, and a rash in Thailand, for which the cost insurers, given by esure continued on p.7 was £10,000. The other problem includes collusion with the patient, which is most commonly seen with alcohol-related illnesses, where the clinic knows that if alcohol is cited as having played a part in the claim, the insurer will not pay the bill. One incident reported by AXA involved a pancreatitis case that was exacerbated by holiday binge drinking. The treating doctor stated that, in his opinion, the holidaymaker was suffering from alcoholic pancreatitis, but changed his diagnosis when the family put pressure on him and he realised that he ran the risk of not getting his bills paid. Furthermore, a recent undercover investigation by a reporter at the UK’s Sunday continued on p.6 4 NEWS ITIJ CONTRIBUTORS Robin Gauldie has been a freelance journalist since 1989, writing for the travel sections of national newspapers including The Sunday Telegraph, The Observer, The Times, The Sunday Mirror, The Guardian and Scotland on Sunday. He is the author of more than 20 travel guidebooks to destinations including Greece, Scotland, France, Portugal, Egypt and IN THIS ISSUE Morocco. David Ing is a freelance journalist covering mainly travel and tourism issues REGULARS in Spain. He writes on air transport for a leading international news agency, as well as News continued 5 contributing special features to Newsweek Editorial rant 6 and writing in-fl ight magazine articles and guidebooks. Company brief 10 Insurance matters 11 David Kernek has, for the past four Health matters 18 years, been in a full-time post editing two Travel matters 20 glossy travel magazines – Holiday Villas and Holiday Cottages. He has since converted it IPMI news 22 into a freelance role having become self- Cross-border care 24 employed and now has regular commissions in Air ambulance news 26 consumer, trade or B2B publishing. Profile 42 Service directory 43 Milan Korcok is an award-winning freelance health policy and economics writer Grapevine 50 who covers travel insurance, public health, On the move 51 and medical education issues in Canada and the US. He has been writing about health fi nancing and policy issues in these countries since the 1960s, and is a frequent contributor FEATURES to leading North American professional journals and consumer media. Feature: No place like home 30 ITIJ examines whether the growth of domestic tourism offers opportunities for insurance companies to create and market new products Feature: US health costs spike: insurers put under pressure 32 If insurers were looking for relief from soaring fees and prices for hospital and doctors’ services, they best put their hopes on hold Assistance & Healthcare World Markets: Czech Republic 36 If in doubt, go public – is the overriding theme of the feature, which describes the evolution of public and private healthcare facilities in this former Soviet bloc country ITIJ TEAM Editor-in-chief: Ian Cameron ITIJ Published on behalf of: Voyageur Publishing & Events Ltd, Editor: Sarah Watson Voyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK Title editor: Mandy Aitchison The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the Copy editor: James Paul Wallis Telephone: +44 (0)117 922 6600 publisher nor Voyageur Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or Editorial assistant: Sophie Cameron-Davies editorial dept: Ext. 3 other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of Conference manager: Denise Clements advertising dept: Ext. 1 the trade of any company, individual or fi rm mentioned is hereby excluded. The views expressed do not necessarily refl ect those of the publisher. Production: Kirsty Diclaudio subscriptions dept: Ext. 209 Helen Watts accounts dept: Ext. 4 Printed by Pensord Press, South Wales, United Kingdom Subscriptions: Kate Knowles Copyright © Voyageur Publishing 2011. Materials in this publication may not fax: +44 (0)117 929 2023 Advertising sales: David Fitzpatrick be reproduced in any form without permission James Miller email: [email protected] web: www.itij.co.uk INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522 Finance: Elspeth Reid Louise Goddard Would you like to make a comment? Design: V Creative Design WOULD YOU LIKE TO SUBSCRIBE? Please get in touch with Ian Cameron, vcreativedesign.co.uk VISIT www.itij.co.uk Editor-in-Chief of ITIJ on +44 (0)117 922 6600 ext205 International Travel Insurance Journal NEWS 5 Brits uncovered Companies ill One in five UK travellers are still running the risk to reverse FSA regulation as part prepared of sky-high medical bills when travelling abroad of its war on red tape. through not taking out travel insurance, in spite of The ABTA survey also revealed In a recent survey of security and risk recent high-profile cases highlighting the significant that ‘financial protection’ is the managers conducted by Travel Guard risks of doing so to both health and finances, second-highest rated consideration North America, less than a quarter of according to the 2011 ABTA Consumer Trends survey. for British holidaymakers, following those surveyed felt that the company This fact may be partly explained by 21 per cent ‘safe and secure accommodation’ they worked for was ‘very prepared’ to of respondents mistakenly believing that the UK in first place. Mark Tanzer, chief handle emergencies involving employees Government will cover their bills in the event that executive of the organisation, travelling internationally. According to something goes wrong – one in four 15 to 24-year- said: “Even in a year when the survey, general street crimes are olds think that this is the case. customers are tightening their of most concern to travellers, followed Seventeen per cent of survey respondents also belts, the lowest cost is not their by terrorism, kidnappings, identity theft believe that travel insurance is unnecessary when number-one consideration. The and illness/hospitalisation. While 32 per travelling in Europe if they have a European Health message from our customers cent of those surveyed reported that Insurance Card (EHIC), which provides access to is clear: financial protection is a their companies were engaging in more basic state medical care; and a further 26 per cent top consideration when booking their holidays.” The business travel this year as compared to 2010, and mistakenly believe that an EHIC will cover their survey asked consumers which booking elements Grey gappers travel 66 per cent of those surveyed have a travel safety repatriation costs if they fall ill or have an accident are essential or important to them, and the top 10 and security programme in place, a considerable and have to be flown back to the UK.
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