Definition/exclusions of acute onset of pre-existing condition

[ramants17]

Is gallstone pain covered?

Hello,
Please help answer this.

My aunt is visiting USA and she had sharp abdominal pain which was unbearable and we went to urgent care first and then were referred to ER by the doctor at urgent care.

It was diagnosed that the pain was due to gallstones and she was let go after pain medication and radiology tests. It was also recommend to to follow up with a surgeon and advised to return back to ER if pain reoccurs.

Now as we understand this was probably preexisting and this was just the outburst.
I saw a post on the forum which said kidney stone related pain was covered.

We have the Atlas America plan which covers acute onset of a pre existing condition.

Will this be covered?
Will any follow-up with the physician or surgeon or any surgery done to address the gallstone situation be covered?

At this point we are in dillema weather to let her continue the trip and follow up with a physician here, or suggest her to go back while the pain is contained. Please suggest.

[insubuy]

ramants17,

As I have clarified before, simply based on the posts here, it is not possible to make determinations whether a particular scenario would be covered or not. It would be determined based on the medical records including attending physician report. And that can happen only after the treatment has already occurred and all medical records are submitted to the claims department and reviewed by them.

Whether she should stay here or return to her home country sooner is the decision she and her family member would have to judge and make.

[ramants17]

ramants17,

As I have clarified before, simply based on the posts here, it is not possible to make determinations whether a particular scenario would be covered or not. It would be determined based on the medical records including attending physician report. And that can happen only after the treatment has already occurred and all medical records are submitted to the claims department and reviewed by them.

Whether she should stay here or return to her home country sooner is the decision she and her family member would have to judge and make.

While I understand this is complex. These kind of answers by insurance makes it impossible for the insured to seek medical help in united states, specially if the condition\problem falls under this "pre-existing" category.
We buy insurance for peace of mind and if I can't be sure that insurance will cover me if I seek medical help, what would one do when in problem?
I know it's family's decision, but these kind on answers don't leave a choice for insured, but to run back. Specially if they can't afford to pay for the cost of medical expenses out of their pocket.

You should take this as a feedback and at least answer these questions to physician's office. A physician can explain the problem and you can take a call weather you're going to cover it or not.
No one wants to go for a surgery\procedure here, not knowing their coverage and only to be under a huge debt burden afterwards.

Also, these visitors are here on their once in a lifetime trip to the US and cutting the trip short is not that easy a decision as it may sound and your answers don't leave a choice.

[insubuy]

We understand your situation.

However, the answer I provided is the best and the most accurate answer that is possible. It is not possible to answer in advance whether something will be covered for sure or not. There is simply not enough information in advance to make such determination.

When we invite elderly parents to visit the US, we all take the risk that some medical conditions that they may run into may not be covered. By purchasing the insurance, it is possible to offload some risk to the insurance companies, but not all.

Please note that your situation is not too different from my own, including hundreds of thousands of others.

Therefore, it is very important to carefully think about you are willing to do or bear before inviting them.