Important note: I am not a medical provider, not an insurance underwriter, and do not have any official qualifications. I just live with food allergies. All information here is provided as a 'best effort' condensation of the current state of best practice when this was written. Sources mentioned here are not the responsibility of PeanutFreeNYC. As with the rest of this website, discuss with a licensed doctor or insurance provider when you make decisions that involve your health, money or travel plans.
Definitions
Traveling Within the US
International Travel
Using your Insurance Effectively and Next Steps
Some Important Definitions
Pre-Existing Conditions: Pre-existing conditions refer to any medical ailment or condition that an individual has been diagnosed with or has shown symptoms of before purchasing their travel insurance policy. Food allergies fall into this category.
Acute Onset of Pre-Existing Condition: This term refers to the sudden and unexpected onset or exacerbation of a pre-existing condition, which necessitates immediate medical attention. Many travel insurance plans offer some form of coverage for the acute onset of pre-existing conditions. However, they are unlikely to cover food allergies.
Lookback Period: The lookback period is a specific duration of time before the purchase of a travel insurance policy (note, not the trip the policy covers) during which an insurance provider will review a policyholder's medical history. This period is crucial for determining whether a medical condition is considered pre-existing. Depending on the insurer, the lookback period usually ranges from 7 to 180 days. If the condition is found to have changed during the lookback period, coverage will most likely be denied. However, some medical services may not violate the lookback period, such as routine allergist visits.
Primary / Secondary Insurance: Within insurance, policies are distinguished as either primary or secondary coverage. Primary insurance can be claimed before any other existing coverage. Secondary insurance, on the other hand, only pays out after all other insurance policies have contributed or declined coverage, potentially covering remaining eligible expenses not covered by the primary policy. Health insurance through an employer, purchased through the healthcare marketplace, or supplied by the government is always primary insurance, while travel policies can be either primary or secondary insurance.
In-Network / Out of Network: These terms relate to the group of healthcare providers or facilities that have a contracted agreement with the insurance company to offer services at discounted rates. "In-Network" providers are within this approved network and generally result in lower out-of-pocket costs for the insured. Conversely, "Out of Network" refers to providers not contracted with the insurance company, often leading to higher expenses for the individual. However travel insurance healthcare policies pay out regardless of what insurance network the facility may support.
Coinsurance: Coinsurance requires that the policyholder is responsible for paying a certain percentage of the costs for services after their deductible is met. (Glossary) For instance, if an insurance policy has a coinsurance of 20%, the insurer would pay 80% of covered expenses, leaving the policyholder to pay the remaining 20%. Coinsurance rates are typically denoted by metal categories from bronze to platinum, with bronze policies typically reducing the amount you pay by 60%, and platinum policies typically reducing costs by 90%. Coinsurance only applies on specific medical services rendered at a medical office, and not to the visit itself. Visit costs are covered under copayments, and are charged in addition to coinsurance.
Copayment: A copayment (copay) is a fixed fee with a dollar amount that a policyholder must pay for specific medical services or prescriptions under their insurance plan after their deductible is met. This fee is typically required at the time of the service and can vary depending on the type of service received, such as a visit to a doctor's office or obtaining medication. (Glossary) For medical visits requiring specific services or treatment, like an IV, a coinsurance for each medical service will be charged in addition to the copayment to the facility.
Deductible: A deductible is an amount that a policyholder needs to pay out-of-pocket before their insurance begins to cover any specified their medical expenses. (Glossary) Deductibles can vary widely among different insurance plans and can be charged per policy, year, or incident. Choosing a plan with a higher deductible might lower the cost you pay for the plan, but will equate to a much higher bill minimum before coverage takes effect during travel. While traditional healthcare plans have deductibles of thousands of dollars, travel plans usually have deductibles of between $0 and $500 per incident.
Traveling Within the United States
The average cost of a hospital stay after insurance coverage in the United States is about $2500. (Marketwatch) For those without insurance, the this cost may rise to $10,000 for a single day. (US Gov) Such costs highlight the need for thorough preparation and understanding of travel insurance.
If you Have Low-Support Health Insurance or No Insurance
Traveling without insurance, with an Exclusive Provider Organization (EPO) plan or with a High Deductible Health Plan (HDHP), can pose significant financial risk in the event of a hospital visit. In life-threatening emergencies, hospitals are required to provide necessary care regardless of a patient's insurance status. (Cornell Law) Still, given the high costs associated with healthcare in the U.S., carrying travel insurance might be useful for anyone making a long-distance trip from their home where allergen contact can be more likely.
Before receiving treatment at a medical facility, patients without insurance or those intending to pay out of pocket should identify themselves as self-pay patients or express a desire to pay in cash. Doing so can unlock substantial discounts on medical services relative to the stated amount on the bill, as cutting the insurance provider out often saves the hospital some money. (Axios)
If you have local US insurance or bought domestic travel insurance
Before you depart on your adventure, you should find out how comprehensive your health plan's benefits will be in your desired destination. While prioritizing medical care is always the most important, knowing the landscape ahead of time can save thousands of dollars.
Nearly every health plan issued in the US comes as part of a network, including travel plans. Medical providers in the plan's network have contracts with the insurance company to provide services, often at reduced rates. (Glossary) All other medical providers are considered 'out-of-network', and plan coverage of these medical services can vary: some out of network providers may not be covered whatsoever. (If you have local...)
All that to say, if you're in the middle of an allergic reaction in the US, know that you don't worry about in-network vs out-of-network hospitals. Just get to the closest medical facility which can treat you. The No Surprises Act enforces protections against out-of-network charges for emergency (e.g. life threatening) services, meaning you'll always pay the in-network rates in emergency situations, and you should push back if the hospital tries to charge you more. (Cornell Law)
For those who find themselves with substantial medical costs even after insurance contributions, always try to apply for uncompensated care. (CFPB) This is a form of financial assistance meant to help individuals burdened by medical expenses they are unable to afford. If approved, the hospital will waive costs, typically those not covered by insurance deductibles. While the application process and eligibility requirements can vary by healthcare provider, you often have to call the billing department and ask for it.
Now we get to the complicated part: international travel.
International Travel
Get appropriate medical insurance. Do it.
If you are taking an international trip with severe food allergies, not having travel insurance can be extremely risky. (Sydney Morning Herald) Similarly, you really don't want to find out that travel insurance doesn't cover food allergies after you've purchased it. Some destinations even require travelers have insurance. The process of obtaining this insurance requires careful consideration of the coverage options, understanding the terms and conditions, and ensuring that the insurance plan addresses the specific health needs of the traveler. Just think of it as a similar step to safety, like having epinephrine with you at all times.
Collecting Information about Your Trip
When applying for travel medical insurance, you'll often need to provide detailed information to ensure your policy is accurately tailored to your needs. This information often includes destinations, dates, traveler information, the total non-refundable trip cost, and other specifics. However, this doesn't mean that you should wait until the last minute when everything is confirmed; try to book your travel insurance on the same day as you buy your flights and/or hotel room, whichever comes first. This will be important for securing a pre-existing conditions waiver so food allergies will be covered under the plan's travel medical insurance.
The Pre-Existing Condition Waiver
Unfortunately, regardless of what travel insurance policy you purchase, just waving your policy papers around during your trip will not get you coverage for anything related to food allergies. Because the traveler knows about their food allergy before they purchase coverage, it is generally considered a pre-existing condition. Coverage for a pre-existing condition requires significantly more work and confirmation with the insurance provider than coverage for undiagnosed issues. (InternationalInsurance, AllergyBites)
While insurance providers will rarely cover pre-existing conditions without any extra work, nearly all providers that offer the service will allow you to complete a free pre-existing conditions waiver. This waiver will grant medical coverage for all the conditions specified in the waiver.
Acute Onset of Pre-Existing Conditions, and Why it May Not Apply
While reading insurance policy documentation, you may come across language about the 'Acute Onset of Pre-Existing Conditions'. Unlike regular pre-existing conditions, which require a waiver to be covered, Acute Onset conditions, are typically covered by most policies without additional paperwork. However, you probably do not want to rely on these protections alone for life threatening food allergies.
While it may intuitively seem like food allergy reactions are covered under acute onset clauses, since they require emergency treatment within 24 hours, many insurance policies include language like the following:
An Acute Onset of Pre-Existing Condition does not include any condition...the Insured Person (i) knew or reasonably foresaw he/she would receive, (ii) knew he/she should receive, (iii) had scheduled, or (iv) were told that he/she must or should receive, any medical care, drugs or treatment.
- Insubuy
While the interpretation of such language varies by provider and even the person interpreting a food allergy case, the increased risk of requiring medical care from eating in an unfamiliar environment seems unlikely to be classified as unforseeable. However, depending on preventative actions you took to protect yourself or the covered individual with food allergies, you may be able to successfully negotiate coverage. On the other hand, some policies explicitly name food allergies as not eligible for pre-existing condition coverage:
The acute onset coverage benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatment existent or necessary prior to the effective date of coverage. An example of this might be someone who has a food allergy or bee allergy and is unknowingly exposed to their allergen and requires immediate medical attention.
So while you might be able to classify a food allergy reaction as an unforseen acute onset, it's probably not worth chancing, particularly since plans with pre-existing condition coverage waivers are not much more expensive, and many pre-existing condition waivers are free.
Typical Requirements for a Successful Pre-Existing Conditions Waiver for Food Allergies
While exact requirements for a successful waiver vary by insurance provider and plan, you may want to use these requirements as a general guide. Always listen to your selected insurance provider about how to fill out their specific waiver.
a. Do not have a significant change in the allergic person's allergy condition during the insurance plan’s look-back period before purchasing insurance. This could range from 7 to 180 days. What qualifies as a 'significant change' can vary between insurance providers, but often includes any active treatment like a hospital visit, new diagnosis, or a change in treatment. Some insurers may also deny coverage for simply visiting an allergist. Note that you do not need an official diagnosis for a condition to be considered as pre-existing - any relevant medical treatement will be considered by the insurance provider.
b. Obtain a letter from your primary care doctor (not your allergist, unless told otherwise) supporting your fitness to travel on the day you purchase insurance.
This letter should confirm that you are currently fit to travel and detail the nature of your allergies. Insurance providers might require this documentation as proof that you are aware of and have taken preliminary measures to manage your allergies effectively during your travel. Moreover, it may assist medical professionals in your destination to better understand your condition in case of an emergency. Ask the doctor to include information on anaphylaxis treatment - ideally both in English and in the national language of the country you will be visiting.
c. Contact travel insurance providers offering pre-existing condition coverage in your price range, ideally in writing, before buying a policy. These policies will often be found exclusively as part of per-trip insurance packages, though some providers may offer annual plans with the coverage. Ask what policy options are available which cover pre-existing conditions. If the agent is unsure if the plan will cover food allergy reactions, choose another policy or ask to talk directly with the underwriter. Keep documentation of these conversations for later, in the event that insurance attempts to deny your food allergy claim. Download and read the policy quote in full before buying an insurance plan.
d. Purchase travel insurance for all non-reimbursable costs shortly after making the first deposit towards your trip, typically within two weeks. This timing is crucial; some insurance companies mandate that any waiver of pre-existing conditions will be void if insurance is purchased 'separately' from your deposit from the trip. Many waivers for pre-existing conditions also require coverage for your entire trip. These costs can include, but are not limited to, prepaid reservations, flights, and any deposits made for accommodations or activities that cannot easily be refunded. If these costs exceed a certain dollar value, usually over $10,000, you may not be able to apply for a pre-existing condition waiver.
Backup Methods of Medical / Financial Support
Depending on your health insurance in the US, America-based international travelers may be able to find some financial support from their primary health insurance. Holders of some Cigna, Kaiser Permanente, and Aetna healthcare plans may be able to receive some out-of-network support for life-threatening services in some foreign countries. (United Healthcare and US government-issued plans reportedly do not offer any international support) (Forbes) Still, this coverage may be minimal, varies depending on the specific health plan you have, and will likely not cover food allergies as a pre-existing condition. Even if your US health plan does cover international emergencies, purchasing a separate travel health insurance plan will likely be a better value, particularly during the kind of extreme medical cases arising from food allergies.
Certain travel-focused credit cards (usually with high annual fees) may also offer some support for emergency medical situations, though their coverage will rarely extend to pre-existing conditions like food allergies since they offer perpetual and not per-trip coverage. For example, the American Express Platinum card specifically excludes all coverage for any pre-existing conditions. (Terms) However, you may wish to use such credit cards to supplement or replace services covered by traditional travel insurance unrelated to food allergies. They also offer additional benefits which may be useful, like lounge access, trip delay insurance, emergency medical evacuation and concierge services.
Using your Travel Insurance Effectively and Follow-Up Steps
Contact your Insurer Immediately
It's essential to utilize the resources provided by your insurer as soon as possible in the event of a hospital visit for the highest chance of a favorable outcome. While receiving appropriate care must always be a priority, many insurance providers require that you involve them in the medical process as soon as possible. (Insubuy) Most travel insurance cards list a 24/7 contact number on the back; call this number as soon as your condition is not life-threatening, and/or tell the medical facility to call the insurance company for you. These representatives may also be able to interact with hospital staff in the local language, plan emergency evacuation services, coordinate payment, and authorize prescriptions (Forbes).
If you find yourself needing to visit a hospital, always ask for an itemized bill, send it to your insurance provider as part of your claim, and take the time to review it before making any payments. (GoodBill) Hospital bills, particularly in the US, are notorious for having errors which will not be corrected unless you or your insurance provider points them out. (CMS) Many providers are used to negotiating, so do not hesitate to inquire about possible discounts or lesser charges. (Health.com) Some providers will even just waive costs if you just ask for an itemized bill.
Paying for Medical Bills
Because travel insurance often pays out weeks or months after a trip, the traveler is typically responsible for fronting the costs to the medical provider. While you may be tempted to pay in cash or debit, using a credit card for a payment plan has significant advantages, notably since you get more time for the insurance company to reimburse you for what is likely a high-value purchase. You also typically recieve some nice rewards and payment protection from blatant billing errors. If you do this, just make sure your debit or credit card has no foreign transaction fees, which add a ~3% fee to all international purchases.
Track and Keep Receipts for All Expenses
Travel insurance will often reimburse associated costs for delays and nonrefundable expenses associated with an approved medical claim. These may include supplementary food, lodging, travel. However, insurance companies will push back against these expenses if they are not recorded - keeping paper / scanned /email receipts is ideal. If you cannot get a receipt or lost the physical copy, a credit / debit card statement may suffice. Make sure each receipt has a date connecting it with your trip, and ideally, the reason the expense is necessary due to your medical claim.
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