Nightmare abroad: How to handle insurance denials overseas: 'He was in the ER for a month!'

DIABLO, Calif. (KGO) -- Imagine this worst-case scenario: it's the start of your international vacation -- and you land in the OR for emergency surgery. Can your insurer deny you coverage?

That's what happened to an East Bay man battling cancer who was stuck in Portugal for over a month -- only to return home to another battle with his insurance company.

In June 2023, Les and Jessica Serpa, of Diablo, traveled to visit one of Portugal's most iconic festivals: São João.

The streets of Porto were packed with people as lanterns lit up the night sky -- a romantic start to the Serpas' long-awaited vacation. But it quickly turned to chaos.

"He was shaking almost uncontrollably -- so I had to call for an ambulance and rushed him to ER in Porto," his wife, Jessica Serpa said.

Les Serpa was battling prostate cancer, and his doctors used radiation seeds as a part of his treatment. And while his medical team OK'd him to travel, upon arriving in Porto he got a serious infection. Serpa was diagnosed with sepsis, a potentially fatal condition where the body's immune system has an extreme reaction to an infection. Within 24 hours, he went into emergency surgery to remove a large growth.

"His fever was 107 and his blood oxygen was at 80% -- and they said literally if I didn't call, he could've easily died within five to 10 minutes," Jessica said, adding the doctors told her he had no other options. "So he ended up being in the ICU (for two weeks); having multiple surgeries."

Those two weeks turned into more than a month in the hospital -- each day the Serpas only communicating via Portuguese translators.

"It was just chaos," Jessica said. "But the doctors there saved his life."

What's covered when traveling abroad?

The couple was billed $62,000, which included numerous surgeries and the five-week hospital stay.

"Sixty-two-thousand dollars! That's a weekend in a hospital here in America," said attorney Glenn Kantor, who specializes in fighting insurance claim denials.

Kantor says that bill would cost at least $1 million here in the U.S. The Serpas had to pay out of pocket. That's true for any of us traveling internationally because most hospitals abroad won't bill U.S. insurance companies.

So as you pack your bags this summer, remember this: there are some insurance policies that simply won't cover out-of-state or out-of-country treatment -- but Kantor says most will, if it's an emergency.

"For example, you can't pick up and fly to Germany and say to Anthem, 'I got my treatment in Germany, you don't really offer it here, so pay,'" Kantor said.

But if you're playing pickleball in Germany and tear your ACL?

"That's an emergency, they're expected to pay for that," said Kantor.

In other situations, like if you tear your ACL and you need your leg raised, Kantor says insurers would be expected to fly you home first class to adhere to any medical accommodations. A lot of these nuances will vary depending on your policy. For example, one of Kantor's clients who had an appendectomy in Spain got her hospital care covered, but her hotel stay and flights were not. He says the other question that often comes up: how long are insurers expected to pay? If you are injured abroad but are still able to travel home, they expect you to do so. In the Serpas' case, due to the severity of Les's condition, he didn't have that option.

Yet, even a year later, the Serpas said Anthem Blue Cross would not pay out Les's claim -- despite it clearly being covered under his policy. Jessica added their paperwork was "conveniently lost" several times.

"They kept telling me you just need one more thing... We can't find your original claim... Now you need to send everything over again and start over," she said. "This went on for months and months!"

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Kantor says to fight back: send in your claim by certified mail, with return receipt requested. That way insurers can't say "they didn't get it."

"In my experience, insurance companies -- United Health, Anthem, Cigna -- will stonewall people and stonewall people -- just in the hope they go away!," he said. "The lower the bill, the more stonewalling."

Also no phone calls, as it's hard to prove what is said. That's what Jessica tried...

"I just felt so helpless... I figure if my own insurance agent can't help me and this lady is just hanging up on me... what to do?!" she said.

"Then I was like, 'Oh, I'm going to call 7 On Your Side!'"

7 On Your Side reached out to Anthem Blue Cross to get this resolved. The Serpas told us the insurance company apologized and agreed to refund them the $62,000.

"It was immediate, as soon as you sent them whatever message you did -- they contacted me immediately... and it worked!" Jessica said. "It was such a huge relief, like a thousand pounds lifted from my shoulders."

And the other huge relief: her husband.

"As of today he is cancer free -- yes!" Jessica said.

Planning an international trip this summer? Tips before you go

Now, if you're planning a getaway abroad, Kantor has some tips -- depending on where you're headed. If you're going to France, Italy or Switzerland, he says you shouldn't be as worried because you will have access to advanced medicine. But if you have a chronic health condition and are traveling to an exotic location in a remote area, he says you should take into account the risk factors. In those rare cases, where access may be limited, he recommends buying travel insurance. He says most policies will cover air ambulance transport to the nearest hospital offering a comparable level of care to treat your condition.

"You get what you pay for," Kantor said, adding it's often the "grey area" that causes disputes with insurers.

For example, one of his clients had to have emergency surgery in Russia, but the doctors there only wanted to do local anesthesia, and his client wasn't comfortable with that. So he paid for an air ambulance back to the U.S. The insurer fought back, claiming it wasn't necessary to come all the way home -- adding it would've been reasonable to fly to the closest area In Europe offering comparable treatment.

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"It is the very rare person that buys travel insurance and then reads the policy before they go," Kantor. "But I recommend it!"

Lastly, if you find yourself in a situation like the Serpas, legal experts say you can sue your insurer for bad faith if you purchased insurance through the Affordable Care Act in California. But keep in mind, California has a law that expects consumers filing for reimbursement for a serious injury to go to the nearest emergency room. On the other hand, if you purchased your policy through your employer, it's important you have sufficient documented proof that your insurer did not respond to your claim within a timely manner. In those instances, Kantor says it's likely you will have success filing suit in federal court to get your money back.

If you have a medical bill issue with your insurer, you can file a complaint, also known as a grievance, with Anthem or potentially with the California Department of Managed Health Care (DMHC). You can also file an appeal if you disagree with Anthem's decision to deny or modify coverage, and request an independent medical review.

Take a look at more stories and videos by 7 On Your Side.

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