Travel insurance and ITP as pre-exisintg condition

Hi all,

I searched for this topic and found some stuff but a lot was pretty old posts or dealt mostly with short term travel (only a week or two). Before being disagnosed with ITP one month ago (did 3.5 weeks pred and just switched over to a pulse of dex) my plan was to get on a flight July 27th for a year of backpacking around southeast asia and australia (with a lot of that being off the beaten path -jungle trekking/mountain climbing).

I am slowly admiting that I need to cancel my trip, but am staying positive and hope to do it down the road. I have been researching travelling with ITP and specifically travel insurance. The information has been difficult to find, with most of the info I find coming from UK travel insurers, which doesn't help me as I live in Canada. I have several general questions and any input/advice/answers are trememdously appreciated. Thank you:

1. Has anyone taken any long term trips with ITP (i.e. several months or more)? Specifically, backpacking type trips?

2. When you do travel, do you disclose your ITP to your travel insurance or just take along some pred/dex in case?

3. Have you had trouble finding travel insurance companies that will cover you? What are their policies regarding pre-existing conditions?

4. Can you recommend any travel insurance providers (short or long term travel) that have been accomdating when it comes to pre-existing conditions? What time frame did they use as a pre-existing condition?

5. Any other personal anecdotes/insights are welcomed with open arms. THANK YOU

My daughter was diagnosed with ITP 6/08. Through school she was planning to take a trip 12/08. We signed up for the trip, paid the money, but took travel insurance at the same time. The insurance we took had a provision that they would waive the pre-existing clause if you took the insurance so many days after you booked the trip. Well, sure enough, her platelets were at 16,000 and she couldn't go on the trip. It was to Mexico on an archeological tour. As it would happen, half of the kids that went ended up in a hospital with food poisoning. We did get a refund, but it took a lot of time and paper work. We recently had a 4 day trip planned to DC. Again, her platelets were at 1,000 - had to cancel, but hadn't taken trip insurance. We lost about $800. Bummer, but better safe than sorry. You don't want to be far away from home with an emergency. She has now missed 3 trips due to the ITP.

Gay

Andrew:

I can't help you with most of your questions, but I will say that you should always disclose any conditions or health issues that you have. You could lose coverage if they find out and you didn't disclose it.

Have you looked into Rituxan? It's a treatment that could give you a year or more of remission.

I wonder if Andrew is talking about medical travel insurance to cover him for medical purposes not travel insurance so he is reimbursed if he has to cancel a trip - is that right Andrew?

I probably have this all wrong but I remember where my folks lived in Florida there were many Canadians - they could only stay there for a certain length of time and then had to get back to Canada so that their medical insurance would stay intact. So judging from the folks Canadian neighbors they couldn't be gone from Canada for a year [as Andrew plans to be] and keep their medical.

As I said - may have this all wrong but that is what popped into my head when I read Andrew's post.

I think that Andrew is talking about insurance to cover any medical costs he might have while traveling. The Canadian government will not pay for health care in other countries, so it's common for Canadians who travel to buy insurance to cover these costs. There are stories about Canadians who become ill while on vacation and then incur huge costs for their medical care.

I haven't had to use this insurance for a while because I get travel insurance through my employer. I'm sure that ITP would be an issue otherwise. I tend not to worry about it to much, but I've had ITP long enough to know that I respond well to prednisone, so I just take some extra pred along. I also have not done backpacking in other countries. I think that would be an issue because you might be far away from medical help in any case. For example, I don't know that I would want to backpack in remote parts of Canada, if I were worried about low counts.

Anyhow, perhaps some other Canadians can chime in with their experience. It's too bad that you had to cancel your trip. It sounds like a lot of fun.

Lily

That's what I thought Lily, thanks.

My HMO will reimburse me for medical expenses when I travel, so I can't speak to the insurance issue that Andrew raises.

I have traveled quite a bit since being diagnosed with ITP in 2000, but I am too old and arthritic to backpack now, so I can't speak to that either!

However, I think once you become used to dealing with your ITP, Andrew, you'll be able to work travel--and backpacking--back into your life. It often takes a year or two to become comfortable with the condition. Before my trips (the longest have been 5-6 weeks and have involved some fairly rustic environments, like rafting down the Colorado, and travel to New Zealand and Central America), I have a CBC, and my hematologist tells me what a safe dose of prednisone is for the time I'm gone. I pack extra pred with me in the eventuality of my having scary symptoms (this has never happened). It has never occurred to me or my hematologist that I would cancel a trip. When I have had to pack bigger doses of pred, I pack sleeping pills too since the main negative side-effect I have from prednisone is insomnia.

Thanks everyone for the insights, it's helpful and encouraging to hear people like karenr who've been able to keep the travel bug alive with ITP.

Melinda, yes I am more concerned about the travel medical insurance in the event that ITP returns while I am traveling. It is true that as Canadians we can only be out of the country for 7 months of the year and keep our public health coverage (though they make exceptions for citizens working or studying abroad). Pre-ITP diagnosis, I was going to do what many long term travelers do and that is when I returned to Canada, take private insurance for 3 months, which is the time period you have to wait after you're gone for 7 months for your public coverage to kick in again.

I talked to some travel insurance companies today. Unfortunately, many of the companies geared towards backpackers won't come near you if you have a pre-existing condition. Others require you to be stable for 3 months prior to the trip in order to qualify. Apparently "stable" means no new treatments. So if I my ITP goes into remission, I delay my trip by say 6 months, but it returns 1 week before I leave, that would count as a pre-exisiting condition and any medical costs incurred as a result of my ITP while traveling would not be covered. Though if my ITP came back the day after I left on my trip, I would be covered. Frustrating. I would definitely take along pred/dex for emergencies, though ideally I want to be in a situation where I can get further treatment without needing to fly home.

Thanks everyone. It is really encouraging to hear how everyone has been able to keep up their daily lives/plans while having ITP. I think I'm just going to have to slow things down for a bit and continue researching different travel policies. Thanks again.

Since my ITP flared up in my life, I have not felt much like traveling. So I have not felt much like traveling, because I fall into the group hta is tired, achy, and lack energy. It really inhibits my wander lust gene

But I have thought about what planning I would need to d, before I went on a long extended trip.

1.) Before I planned to go somewhere specific, I would want to make sure there are Medical facilities that I could get to in a reasonable time frame. The right doctors, hospitals that could treat me if things went bad.

2.) Is there any thing I can carry with me to allow me to extend my time without receiving treatment.

3.) Does the foreign country I want to am traveling to have low cost medicines and treatment if I have to seek out help for ITP. Then do I need medical insurance in that country. So check out what the situation is in Australia.

Andrew, the problems that I can foresee are:

1. Do you respond well to steroids? You'd need to have an idea of what dose gets you to what count.

2. You'd need to know where to get a count done within a reasonable period of time if symptoms began. I have heard of a few people over the years that were in a different country when low counts hit and ended up trapped there because the hospital would not let them leave. I found that to be preposterous since low counts do not always = dire situation. However, it is true.

You'll figure it out. There are always ways to work around it if you really want to.

Karen,
I was wondering if you were refering to Medicare and supplemental insurance when you travel. Right now I have an HMO (HealthNet--not sure if they would cover me while traveling outside the country--need to check on it). But, in a few years I will have Medicare and supplemental insurance. Do they cover you while traveling in another country? All my family came from Italy, and one day I would like to travel there to look up some of the relatives--but I do worry about the insurance issue, too.

I was thinking like Andrew--that we would have to purchase special insurance. You could come home really broke if you had a bout of ITP and ended up in the hospital without insurance.

DeeDee, I wasn't referring to Medicare and supplemental insurance because our HMO (Kaiser) covers us. (They use our Medicare, I guess, because we are in the "senior advantage" program.) Whenever we've had to get medical help in another state (Kaiser isn't in a lot of states) or country, we've saved all our paper stuff, and Kaiser has reimbursed us--without question. We've not had anything extravagant though. It does sound wise to check with your HMO to see if they will do that.

And it would be good to check on the health care provided in another country you're going to visit. I think some other countries have much cheaper care, even for visitors.

Thanks, Karen. We did travel to another country once--and I didn't worry about my ITP too much. But, after this last bout (platelets going to 1000), I do worry about traveling out side the U.S. It will be a while before we travel to another country; before we do, I will definitely do some checking up on the healthcare coverage.

I used to have Kaiser, too. But, they did reimburse you while traveling outside the U.S.? I know they will reimburse you when you have a medical emergency in another state--but wasn't sure if they did outside the U.S.

Thanks for your reply and information.
DeeDee

Hi Andrew,
I can't answer about your travel insurance but only my advice regarding traveling with ITP.

I would cancel your trip at this time due to the many unknowns right now. I have had ITP requiring treatment for the last 3 years. I have done IVIG, prednisone, Rituxan, pulse dex and have beed on Promacta for the last year. I am completely stable on the Promacta now! The lowest my platelets have ever been is 19000 and I have only been hospitalized once. Obviously there are different degrees of of ITP. Based on the info you have given in your message, it seems that you don't have enough information to know how you respond/react long term to different treatments. Unfortunatel, this takes time. 1-2 weeks after my pulse dex treatment I became so ill that I had difficulty breathing, sleeping, walking (severe dizziness). I was unable to drive a car for a month. Needless to say, while it did bring up my counts for a significant amount of time from the one treatment, as a long term treament that method method was not for me. Due to the nature of your trip and the dangerous terrain you most likely will traverse while hiking, I would recommend postponing your trip until you have discovered a reliable treatment with manageable and known side effects.

I am traveling outside of the country (for the first time since my diagnosis) to Paris and London in less than a week. My counts were 114000 yesterday. I am finally not worried at all about my platelets crashing. However, in addition to my Promacta, I am also travelling with a course of antibiotics and some prednisone with me in case I come down with a bug while I'm gone. A cold virus put me in the hospital before. But my doctor and I are comfortable enough now with my knowledge of the disease, my body's response to certain treatments that I will "self medicate" if needed until I return. She also knows a hematologist in Paris that would see me if needed.

I hope my experience is helpful.
Hopefully, Andrew, you will find a treatment that works for you long term with minimal side effects. As I am sure you have read before, sometimes the treatment is worse than the disease! I have no doubt that you will be making your trip soon enough and not worrying the whole time about your counts!

kjones, thank you for sharing your experience. I have pretty much decided to cancel my trip for the time being. I think I've known for a few weeks that I needed to cancel but I've just been in denial stage. It's been a week since my first pulse of dex and get another blood test in a couple of days and no new bruises or petechia so fingers crossed! Thanks again for sharing and good luck with your trip. I think its great that you have the name of hema in paris in case. Safe travels!

Hi Andrew,I hope those Dex pulses work for you. I know they have worked for me in the past. After the first Dex pulses, I made it 4 years (and was able to travel outside the US for over 2 weeks without really worrying). I had to do Dex pulses again this time and have done good so far (have had good platelets since last August). And, just like Kjones said--I know they are hard on you--but you just have to go with your gut feelings (plus research) and do what you think is right. You will get to the point where you can do some traveling; you just need to be patient until you get there. Good luck with your platelets. Sounds like you are doing better.

DeeDee, yes Kaiser did reimburse us for medical expenses outside the country. This was in ChristChurch, New Zealand. They even figured out the exchange rate--to our advantage. We have to pay a $10 co-pay, so they did subtract that.

Thanks, Karen, for the information about your reimbursement. It makes me feel a little more at peace to know if we do travel we will most likely get reimbursed. I will still call my insurance company to check on my HMO. Thank you!