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Old 09-21-2018, 06:12 PM   #1
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Bad Sam Travel Assistance

After a medical crisis, she was hit with fine print
DAVID LAZARUS
Of the many dubious reasons insurers use for denying claims, one of the most bizarre is telling a patient they neglected to obtain prior approval for treatment in the midst of a medical emergency.
Because, of course, the first thing most people think of in a life-or-death situation is phoning some insurance company’s call center and jumping through bureaucratic hoops.
Kathy Mutchler faced this Catch-22 recently — and found herself saddled with a $71,000 air ambulance bill — after being diagnosed with a severe kidney infection in Mammoth Lakes, where she was staying with her wife in an RV park.
Mutchler, 64, who these days calls the open road home, is a member of the Good Sam Club, the world’s largest organization of recreational vehicle owners. You’ve probably seen the stickers on the backs of RVs and campers.
Mutchler pays $89.99 annually for the service’s TravelAssist program, which, among other things, says it covers medical evacuations if suitable care isn’t available locally, as well as any costs involved in returning to your RV.
Last month, she went to a Mammoth Lakes emergency room suffering from chills, shakes and fever. Her potassium level was dangerously low.
“They said it was life-threatening,” Mutchler told me.
She wasn’t in much of a position to take charge of things, let alone interrupt her medical emergency for some chit-chat with a Good Sam service rep.
“I wasn’t in any shape to make a call,” Mutchler said. “I felt like I was hallucinating.”
After diagnosing the kidney infection, the Mammoth Lakes ER staff tried antibiotics, but couldn’t stabilize Mutchler’s condition. The doctor decided to transfer her via air ambulance to a better-equipped facility in Reno.
Mutchler’s wife, Kathy O’Hara, 60, joined her for the trip and contacted Good Sam as soon as they landed in Nevada to let the organization know what was happening. She was given a case number by a service rep.
Mutchler was hospitalized for three nights. Her condition gradually improved, she was released from the Reno medical center, and she and O’Hara rented a car for the return to Mammoth Lakes — an expense they believed that, like the air ambulance, would be covered by the Good Sam coverage.
It was on the drive home that a Good Sam rep called. Mutchler’s claim had been denied. She’d be responsible for the air ambulance and rental car costs.
Her medical costs weren’t a factor. They were covered by Blue Cross. But this was a serious blow.
“If we had to pay $71,000 for the medical evacuation,” Mutchler said, “that would be enough to put us in the poor house.”
The Good Sam rep pointed her to the fine print in her TravelAssist policy , which stipulates that medical-evacuation expenses “will be covered only if we have given our prior approval and if those services are coordinated by us.”
It adds that “we will determine the appropriate method, destination and timing of any evacuation,” and “the destination will be the nearest facility capable of providing appropriate care as determined by us.”
Mutchler appealed the decision, noting she was in no condition to seek prior approval while drifting in and out of consciousness in Mammoth Lakes.
She emphasized that O’Hara didn’t join her until she was being driven to the airport, and once they landed in Reno, O’Hara immediately contacted Good Sam.
Mutchler still hadn’t heard anything back by this week, so she got in touch with me.
Many travel-related insurance policies contain language exempting people from the need for prior approval in the event of an emergency — a so-called extenuating circumstances provision.
Good Sam’s policy contains no such language. There is, however, a passage that says “if the condition is an emergency, you should call 911 or go immediately to the nearest physician or hospital without delay and then contact TravelAssist.”
This at least suggests an awareness on Good Sam’s part that there will be occasions when a medical emergency tops the need for prior approval.
I reached out via email and Twitter to Marcus Lemonis, chief executive of Good Sam Enterprises and star of the CNBC reality show “The Profit.” That resulted a couple of days later in a call from Tom Wolfe, Good Sam’s chief financial officer.
He was already familiar with the situation. I related what I’d learned from Mutchler and he said: “You’ve got the general facts correct.”
The problem, Wolfe said, is that TravelAssist “isn’t a reimbursement plan.” In other words, the coverage is based on TravelAssist making all the arrangements on a Good Sam member’s behalf, rather than paying the member back for any expenses incurred.
“Everything needs to be approved upfront,” Wolfe said.
All well and good, I replied, but what if the member is incapacitated? How is he or she expected to get that upfront approval?
Wolfe said the terms of the contract are the terms of the contract, although it’s possible Good Sam would waive the preapproval requirement on a case-by-case basis, even though it’s not contractually obligated to do so.
He said Mutchler’s appeal is still pending as Good Sam continues to review her case.
Amy Bach, executive director of the advocacy group United Policyholders, said she thinks Mutchler — and anyone in a similar position — should consider a lawsuit in the event of a denied claim.
“It’s just common sense,” she said. “You can’t seek prior consent if you’re incapable of doing so. I cannot imagine any court disagreeing with that.”
Wolfe described TravelAssist not as insurance, but as “an advocacy service” that helps coordinate care for Good Sam members if they run into trouble on the road.
In that case, however, they shouldn’t offer what appear to be valuable benefits that could turn out to be worthless in real-world situations.
The website for TravelAssist has a little image of a helicopter and promises “emergency medical transportation — to get you the care you need.”
If that’s not a pledge that can be fulfilled in a reasonable manner, don’t offer it.
Anyway, this story appears to have a happy ending, no thanks to Good Sam.
As Mutchler was gathering extra documents this week as part of her TravelAssist appeal, she called Blue Cross to get a copy
of the explanation of benefits for her Reno hospital stay.
In speaking with a company rep, it turned out that the claim for her treatment hadn’t been processed correctly, and the insurer probably would cover both the hospitalization and the air ambulance.
Mutchler said Thursday she was hopeful her health insurer would come through.
If so, I can say something unusual for me: Good for you, Blue Cross.
As for you, Good Sam: Bad form.
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Old 09-21-2018, 06:18 PM   #2
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If I may ask...
Where do you fit into this long, sad tale?
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Old 09-21-2018, 06:38 PM   #3
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Lesson learned here...read contracts before you sign and agree to them, and follow guidelines. Blue Cross is a real insurance company...Good Sam is only a 3rd Party commission maker. Someone had to sign authorizing the airlift...I bet that's what made her start looking for someone else to cover it.
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Old 09-21-2018, 08:45 PM   #4
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Yikes, don't know that I'd trust Good Sam's to determine where, when and how I should receive medical care. That may not be a very speedy process. You could die waiting for them to approve and "coordinate" every detail. Really think that should be up to the physician and hospital.
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Old 09-21-2018, 09:07 PM   #5
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That's their out!
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Old 09-22-2018, 04:00 PM   #6
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That's their out!
Agreed. An it's too bad they write this and you need a lawyer to figure out what they will pay for...later.
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Old 09-23-2018, 12:32 AM   #7
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It appears you pulled this from a news article. In this case, it seems that a reasonable person would assume they were covered. If you ever get into a sticky situation with insurance, contact your state insurance commissioner and get them involved asap. Then start interviewing attorneys.

My late father would say, "The large print giveth, and the small print taketh away!"

Reading your contracts before problems arise would save a lot of frustration, but few people seem to do that. I have told clients that if they can't sleep some night, get out their insurance contracts and start reading. Bet it will put you right out!
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Old 09-23-2018, 01:10 AM   #8
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Good Sams and Camping World are the Bernie Madoff's of the recreation industry. They are a couple of companies run by a crook. I really wish the government would do something about them.
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Old 09-23-2018, 01:34 AM   #9
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being in charge of some multi state business, any insurance claims of any value will generally require legal assistance to get the insurance company to pay, insurance companies will usually settle before court and juries do not take crap from the big bad insurance company and along the way hospitals and doctors will drop there bill to get paid faster ( match the out of court settlement) then have the amount held up in a court fight.
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Old 09-23-2018, 05:30 AM   #10
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Newspaper article.
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Old 09-24-2018, 02:42 PM   #11
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Thanks for sharing this.

Does anyone know if there a better program for Travel Assist that isn't as difficult to navigate as the Good Sam program?
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Old 09-24-2018, 02:54 PM   #12
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After reading that the OP was a copy/paste from media, I lost any credibility in the actual facts. It's a "he said-she said-they said" scenario. There are so many unknown facts...were the payments past due?? Was there any per-existing condition exclusions?? Did they opt out of going to another medical facility (Fresno) that may have been closer? Who knows. If I were looking into Good Sam Travel Assist or any other 3rd part funded, insurance based program I would take a copy of the policy to my insurance agent/advisor for their review and advice.
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Old 10-16-2018, 01:35 AM   #13
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After reading that the OP was a copy/paste from media, I lost any credibility in the actual facts. It's a "he said-she said-they said" scenario. There are so many unknown facts...were the payments past due?? Was there any per-existing condition exclusions?? Did they opt out of going to another medical facility (Fresno) that may have been closer? Who knows. If I were looking into Good Sam Travel Assist or any other 3rd part funded, insurance based program I would take a copy of the policy to my insurance agent/advisor for their review and advice.
Well, as far as the medical part goes, I made up a record of Name, Add, DOB, SS#, Spouse, blood type, insurances and the names of my surgeries, month, yr, place & doctor. Made up my Spouse's too, made copies and put them in a Cash bag inside my car, truck & RV. I don't have time to remember all this stuff and a record is easier to carry with less conflict.
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Old 10-16-2018, 01:39 AM   #14
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Well, as far as the medical part goes, I made up a record of Name, Add, DOB, SS#, Spouse, blood type, insurances and the names of my surgeries, month, yr, place & doctor. Made up my Spouse's too, made copies and put them in a Cash bag inside my car, truck & RV. I don't have time to remember all this stuff and a record is easier to carry with less conflict.
Oh yeah, the preferred names of the disabilities are in the International Classification of Diseases, which every Doctor and Nurse knows. In the beginning it was hard to find the info but now? Piece of cake.
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Old 10-16-2018, 02:26 AM   #15
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i get these papers in mail every couple months. i throw it in garbage .good sam is a racket plain and simple but some people just don't get it.
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Old 10-17-2018, 04:43 PM   #16
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i get these papers in mail every couple months. i throw it in garbage .good sam is a racket plain and simple but some people just don't get it.
True, a Racket, plain and simple.
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Old 10-24-2018, 03:45 PM   #17
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Good Sam racket

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True, a Racket, plain and simple.
Curious as to what makes Good Sam a racket. I find their discounts save me money every time I go on the road. Discounts at RV parks, gas purchases, items purchased on line at Camping World, Gander Outdoors, and Overton's. They are also the only company that has a systematic rating system I can use so that I have a good idea where to actually take my rig.
What is the racket you are talking about?
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Old 10-24-2018, 03:51 PM   #18
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Curious as to what makes Good Sam a racket. I find their discounts save me money every time I go on the road. Discounts at RV parks, gas purchases, items purchased on line at Camping World, Gander Outdoors, and Overton's. They are also the only company that has a systematic rating system I can use so that I have a good idea where to actually take my rig.
What is the racket you are talking about?
My experience with them and a few others I have talked with. Rather than elaborate, I'll just say experience is a good school, but the fees are high. It's an old saying though.
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Old 10-24-2018, 05:09 PM   #19
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bruno...everything you mentioned is cash discounts and we all like those, which is good...the issues with GS is when they try to play like an insurance company or when you chose to purchase anything from them other than membership. They "3rd Party" everything out and the "middle man" (you) gets caught in the middle.
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Old 10-24-2018, 06:24 PM   #20
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To me, the racket starts at Camping World. CW sells Good Sam assistance packages when they sell new RVs. However, they fail to mention that GS is part of CW. There is no disclosure of the relationship. I know the consumer is supposed to research their purchases but businesses should not hide relationships to generate income. As to the stores they own, I have yet to find anything at CW or GM that is not available online or at other local merchants for lower prices. That's not saying they don't have good sales, but I don't shop, I buy and I only buy when I have a need. I can't speak for Overton's.
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