Pregnant Woman’s Insurance Denial a Lesson

Maui, HIThe tale of a Canadian woman who gave birth in Hawaii and had her insurance claim denied is a cautionary tale for all insurance policyholders. Despite the woman and her husband thinking they were following the rules and properly covered, they reportedly wound up with a bill of $950,000, a bill their insurance company - Blue Cross - has so far refused to pick up. The family was finally able to return home with their newborn daughter, but the costs associated with having their insurance claim denied have followed them.

The ordeal began in October 2013 when Jennifer Huculak and her husband, Darren Kimmel, went to Hawaii. Prior to going to Hawaii, Huculak saw her doctor and obtained permission to travel to Hawaii. Huculak had previously been treated for a bladder infection, which caused some bleeding, but her doctor said the infection was not a factor in Huculak giving birth early.

After obtaining permission to travel, Huculak took out a travel insurance policy from Blue Cross. She and Kimmel then flew to Maui where, two days into her vacation, Huculak’s water broke. She was taken to the hospital in Honolulu, put on bed rest for six weeks and gave birth to her daughter, Reece, nine weeks early. The newborn then required two months in the NICU, at a charge of $10,000 to $15,000 per day, according to the Toronto Sun (11/18/14).

Blue Cross has refused to cover the cost of the hospital stay because it deemed Huculak’s pregnancy “high risk” due to her bladder infection, despite a doctor having told Blue Cross that the bladder infection was not linked to the early birth, Huffington Post (11/19/14) writes. That leaves the family with a $950,000 hospital bill, which they say they cannot afford. As a result, they are now considering filing bankruptcy.

Regardless of the debate over travel while pregnant, in this case an insurance company is overruling the opinion of a doctor by stating that Huculak’s pregnancy was high risk when her doctor said it was not. In the end, however, it may come down to the fine print in the insurance contract. Travel insurance usually excludes coverage linked to pre-existing conditions, and companies may view trips to the doctor’s office in the three months prior to travel as a sign that the patient was not medically stable for travel.

In other words, sometimes the details included in a policy’s fine print can be used to deny what appears to be a legitimate claim.