In late May, I dislocated my elbow at a queer wrestling event in Portland, OR. I've been trying to stay more active: bouldering, salsa dancing, acro yoga. But wrestling was a bad idea. I didn't have any experience, and the organizers gave only a basic safety briefing. Before I knew it I'd been thrown to the mat at a weird angle, and my right forearm was dangling awkwardly by my side.

I wasn't in much pain yet, so my first thought was simply that I’d go to an urgent care, get it put back in place, and carry on with my life. I had articles to write, a catsit to get back to, a friend’s wedding coming up, and non-refundable plane tickets to my next destination in just over a week.

But the urgent care referred me to the ER, where the doctor told me that they’d have to put me under anesthesia to relocate the elbow; it would only take a few minutes, and wouldn’t require surgery, but my muscles would resist if I were conscious. Afterwards, they’d put me in a splint for a week.

I’d never had anesthesia, or even been to the emergency room before, but I felt comfortable knowing that I had Genki travel insurance with up to €1,000,000 of coverage in “Every country. Any doctor or hospital,” including repatriation to my home country, Australia. I’d even paid extra for full coverage in the U.S.

What I didn’t realize was how much of my recovery would be spent trying to get them to honor that coverage – and why a second type of insurance that I hadn’t even realized I had ended up covering me instead.

I made it back to my catsit around midnight, and a friend helped me get settled in. I could still use my left hand, but my right arm was in a splint, so I couldn’t easily get dressed, brush my teeth, or cook for myself. I could still type, though!

At this point, I was optimistic that I’d be able to take the splint off in a week and wouldn’t have to cancel the remainder of my trip. But the doctor had warned me that the X-rays showed a slight fracture, so the best course of action would be to see an orthopedist who would make sure it was healing properly.

The next day, I reached out to Genki to find out what I needed to do to ensure coverage, and this is where the cracks started to show. Genki doesn’t process claims directly, but through one of two entities: MCI Assist provides a 24/7 hotline for emergency care, while Squarelife provides compensation for outpatient care and doesn’t have a phone number for Genki customers.

I contacted MCI Assist to get some guidance on how to proceed:

Following our phone conversation regarding your recent emergency room visit in the United States, I am writing to provide further clarification on the procedures for handling your medical expenses. Regarding outpatient treatments, please note that these are generally handled on a pay-and-claim basis. This means you would typically settle the costs upfront and subsequently submit a reimbursement request through the Genki application portal, ensuring that both the invoice and the corresponding medical report are attached.
All outpatient treatments are subject to policy terms and conditions, as well as final assessment by the insurer. However, as the costs in your specific situation exceed €1,000, please be advised that you must contact Squarelife directly. When reaching out to them, please specify that this is a request for coverage and not a reimbursement claim.

I immediately sent an email to Squarelife explaining the situation. Aside from the impracticality of fronting the money for an ER visit in the U.S., I noticed this line of fine print in the insurance conditions:

For costs of at least €1,000, you must send an itemized cost estimate at least 5 days before starting the treatment or otherwise incurring the costs.[…].If you do not do this, only 50% of what would otherwise be covered will be reimbursed.

By now, the reality of my situation had hit me. If I were back in Australia, I needn’t have worried: as a permanent resident, I have access to Medicare, the country’s universal healthcare system, which would cover almost everything I needed, from surgery to physiotherapy. But here, I was at the mercy of an insurance company that may or may not approve my treatments.

I didn’t hear back from Squarelife for a few days, so I contacted Genki directly, who told me there was nothing they could do to speed it up:

Genki Support cannot confirm in advance whether a treatment will be covered. Only the insurer’s claims team can make that decision after reviewing your documentation.
For Outpatient medical emergencies, where you don't have knowledge of the costs more than 5 days in advance but you know they'll exceed €1.000, you can instead contact the Emergency Assistance directly for faster confirmation. You can find the contacts in the Member Center under "Help".

The Help page had the same phone number for MCI Assist that I’d called before, and the same email address for Squarelife.

Finally, after 5 days, I got an email from Squarelife. It was all business, asking for more information to “proceed with the assessment”.

Elbow dislocations can heal quickly, but they need to be properly managed: keep the elbow immobilized for too long and it can stiffen up and lose its full range of motion. I’d asked them about the prospect of physiotherapy, which my policy allegedly covered:

Regarding physiotherapy, please note that your policy covers up to 6 prescribed physiotherapy sessions per insurance case. If physiotherapy has been recommended as part of your treatment plan, we will be able to assess this once we receive the complete medical documentation.

I felt defeated. I could barely move my right arm, hadn’t gotten any sleep since the incident, and was struggling to find an orthopedist with any availability within the next week. My catsit had ended, and I was on the pull-out bed in my best friend's living room, while he and his partner cared for their newborn baby.

Squarelife was treating this like a paperwork issue, not a medical emergency.

But at least their email signature included their phone number, country code Leichtenstein. I called them up and got their answering machine: Press 1 for German, 2 for English. Try again during European business hours.

When I finally managed to get someone on the phone to ask about my case, she had trouble understanding me. “Do you speak German?” she asked.

It was clear that Squarelife wasn't prepared to handle a case like mine, wasn't prepared to navigate the complexity of the U.S. healthcare system.

The travel insurance that cost me €100+ per month was useless.

Frustrated, I considered a back-up option: credit card insurance. My Australian credit card – a bare-bones one that doesn’t earn me any points and for which I don’t even pay an annual fee – provided three months of international travel insurance, including medical care and unused travel expenses.

It seemed like a long shot: would insurance coverage that I hadn’t even paid for come through before the one that I had? But it was offered by Allianz, a global company with a 24/7 emergency hotline. I called them up right away.

The agent I spoke to couldn’t confirm whether or not I would be covered, but I could file my claim over the phone and send through the documentation later. They treated me as a patient first, a customer second. Their follow-up emails always started with a check-in on my progress:

First and foremost, we wanted to check in on how you are holding up. We understand that navigating an injury like this while overseas can be incredibly stressful, and our medical team is here to support you.
How are you feeling today? Are you experiencing any changes in your pain levels, swelling, or the spasms you previously mentioned?
Please ensure you keep your right arm securely immobilised in your splint and sling as directed by the Emergency Department until the orthopaedic specialist formally reviews your injury.

A few days later, I was finally able to see an orthopedist, who recommend that I keep my right arm immobilized until I got a CT scan: there was a risk that a bone fragment could become lodged in the joint, and if so, they suggested I fly back to Australia for surgery. I sent the update to Allianz, and they followed up:

First and foremost, from a clinical perspective, we are very pleased to hear that you are feeling much better and that the orthopaedic specialist was able to place your right arm into a more comfortable brace. It is also excellent to hear that you have discussed a clear plan forward, including a CT scan and the option of returning home to Australia should surgery be required.
If your condition changes or you need to speak with us urgently, our medical team is made up of case managers and registered nurses, and we are here to help 24/7.

The next few days were a blur of phone calls and appointments. Most of the CT clinics I contacted were booked out days or weeks in advance, but one of them had an opening in just over an hour if I could get there in time. I took a Lyft, cradling my right arm on the bumpy ride to the clinic, and again as the CT technician helped me out of my brace so he could get an unobstructed image.

The idea of getting "preapproval" from Genki for a last-minute booking outside of European business hours was absurd. Getting them to cover surgery if I needed it, or physiotherapy if I didn't, seemed impossible too.

Allianz hadn't confirmed coverage yet, but at least they kept things moving: one day, I got a call from their investigations team to check on some details of the incident. They needed a witness statement from the organizer of the event to confirm I hadn't been compensated for it.

Eventually, they confirmed coverage for "conservative management of elbow dislocation and CT," even offering to book me a flight back to Australia:

Our agent has located the flight option below for you. Additionally, we will be arranging an extra lateral economy class seat to ensure your comfort due to your injury. Could you please confirm if the proposed flights are acceptable so we can proceed further?

This was what I'd expected Genki to do.

Around two weeks after the injury, I finally made it back to Melbourne, where I was given the all-clear to take off the brace and start physiotherapy. No surgery needed, although it remains to be seen whether I’ll need further manipulation under anesthesia to regain my full range of motion.

Allianz has yet to reimburse me for my out-of-pocket expenses, so this isn’t a full-throated endorsement. But even if they don't fully reimburse me, they gave me the support I needed during a difficult time in a way that Genki utterly failed to do.

Genki might be sufficient for non-urgent care in low-cost destinations, but it's clear that their U.S. add-on is not what it claims to be, and I would think twice before relying on them for emergency coverage anywhere.