health insurance panic

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innocentbride Posts: 195
I have been with Quinn direct (formerly bupa) for nearly 3 years. I had a scan taken which has shown up potential problems with one of my ovaries (I have been TTC). I have been booked in for a lap and possible operation next month. I called them today to check my cover and they asked was it a preexisting condition,I was a bit taken aback by this and asked her what she meant by that (the scan was last year) and she said could the problem have been there before I joined them. I have no idea how long the problem was there for as the whole point of the lap is to see what exactly the problem is and I suppose then the surgeon would be be able to guess how long it was there for. I have suspected Endometrious so I would assume the problem would have been there for a while and possibly over the 3 years since I joined. Now I am really worried as according to their website they dont cover for preexisting conditions regardless if you are aware of them or not :eek :eek( and I only went for the scan as I am ttc) . They dont cover preexisting conditions up to 5 years. I am panicking now as of course I wont know any of this until after the procedure and when they get billed they may refuse to pay!!I could be liable for thousands then!! any advice on what I should do?
Ms4eva Posts: 285
Hi there, I'm not 100% sure but I honestly believe that because the condition has not yet been diagnosed, they might consider it as not pre-existing. Some women have the likes of endometriosis for years (incl myself) and don't find out until they are ttc. I hope that helps. x Best of luck with the op
glowgal Posts: 949
Did you have any scans for this prior to joining Bupa? If your first scan was only last year, then you [u:18ynk1kl]ARE[/u:18ynk1kl] covered. Its not pre-existing unless you had actually been diagnosed prior to joining Bupa three years ago. Do not let them tell your not covered, I would reiterate to them that you only had the scan for the first time last year which was the first you knew of it. Insurance companies will do anything not to pay a claim so make sure you know where you stand. I have worked in hospitals dealing with the claims that go into insurance companies and they will get out of paying a claim where possible, Bupa used to be very good and queried very little but since Quinn took over, Im not so sure about them. Any other questions, pm me.
marianf Posts: 5845
IMO its not a pre-existing condition. To be a pre-existing condition is something that was diagnosed and requiredTREATMENT already before you joined. This clause is to stop people getting health insurance when they realise that something is wrong with them. Hope you arent too stressed out :thnk
innocentbride Posts: 195
thanks so much for your replies, I couldnt sleep last night with worrying about it. I was even considering calling my GP today and trying to get the Lap and any potential op on puplic health, but with my age I really need to get sorted ASAP. I did have a scan about two years before I joined bupa in ireland as I had a bit of pain mid cycle(I now know that is normal!!)I had an ovarian scan and that was clear then,but I also know endo doenst always show up on a scan! fortunately the consultant in the uk gave me these scans so I have the proof yhat my inards looked clear two years before I joined bupa ireland..I was livingin the uk then i had private healthcare insurance in the uk with bupa, (unfortunately they wouldnt "join" up the two policys O:| and I had a break off 7 months from where I left bupa UK and joined bupa ireland(didnt visit any doc in between) I joined bupa ireland june 2005 and had my first dodgy scan where problems clearly showed up dec 06 and jan 07 and next month going for exploratory Lap...but that quesion from quinn yesterday really threw me and I said no the condition wasnt preexisting as I didnt want to leave open any lines of query..I wanted to say how on earth would I know until the Lap was performed..I felt terrible saying that as immediately I felt guilty though I know I shouldnt! I would never be able to omit things I felt were importnat! I even think when I applied for bupa that I said I had the first scan in the uk but it was clear!! so I hope that doesnt go against me. Its really difficult as I really need to know where I stand BEFORE the op and I cant ask quinn in case they try and wriggle out. I feel I would be wasting my consultants time if I ask him beforehand and once I am in hospital it wil be to late!!
NowGone Posts: 8042
It can't be a pre-existing condition until it's been diagnosed. While of course if could have been there for years, it isn't a condition until you know it is. It is extremely important that if Quinn ask you again you say No. Basically, it's to stop people who know thay have (say) cancer, joining, then after paying 2 months contributions deing "diagnosed" and demanding all of their benefits. If you're still only at the investigative stage you;ll be fine.
Bitsy Posts: 111
Hi, I had a lap & dye a couple of months ago and I was only covered for €200.00 with Bupa, I had to pay the balance myself. Perhaps you should check this out with your doctor or Bupa. They told me what I was covered for in the hospital before I had the op. Goodluck with it Bitsy
innocentbride Posts: 195
I have PMed you bitsy , hope you dont mind. I did assume I would be fully convered for the investigative part of the procedure and was more concerend about what would happen if he found something while I was under the anaesthic! thats something I need to find out about ...bloody hell this is a minefield, it is so complicated. When i was in the Uk everything was free on the NHS though long waiting times, and if you had private insurance (that I had) everyting private was free...including consultant visits!!! cant remmeber if medicinces were free, maybe not actually...but still it was so much easier and all those years not a thing wrong with me (thankfully!!) I never had to use any of it!!Back in Ireland, health insurance for nearly 3 years and when things are going wrong theres no peace of mind as its all so complicated O:| O:| O:| !! sorry that turned into a rant there!!
ditzypixie Posts: 1397
[quote="NoZilla":3m9mo1m5]It can't be a pre-existing condition until it's been diagnosed.[/quote:3m9mo1m5] Sadly it can and it's important that we all know that before deciding to go private. A preexisting condition is determined by the appearance of the first symptom and is recorded by the first time that you visited a doctor in relation to it or the length of time that you were suffering symptoms that you mentioned to the doctor. Example: January - You have regular headaches and they bother you but not so much that its taking over your life. Everyone gets headaches right? And work/life is a bit stressful at the moment. Maybe its the amount of chocolate you're eating. March - Take out health insurance. You've been meaning to do it for years. All is well with your health. September - Blurry vision/feeling tired. You visit doctor. "How long have you had these symptoms" s/he says. "About a month now" you say. Doctor asks reams of questions about your recent health. You mention the headaches you had in January. Doctor checks you over and refers you for a scan. October - you have the scan. Scans don't count under pre-existing as are outpatient (paid out depending on centre that you go to). January - bad news. It's a tumour (ok I know I'm dramatic but this happens and I couldn't think of other example). Doctor mentions the initial symptom as being in January last year. Claim rejected as was pre-existing even though it wasn't diagnosed. Claims are always linked back to the original symptom. It doesn't mean that you should mention the pain in your toe when taking out health insurance but it is amazing how symptoms that appear years before diagnosis actually count towards claims. If the scans that you had prior to joining insurance can be used as evidence that this did not exist prior to joining then you will be fine. Have a chat with your consultant and s/he should be able to put your mind at ease. At the end of the day, it's what your consultant puts on the form that counts. Best of luck.
innocentbride Posts: 195
thanks for that ditsy...though now I am worrying again, I cant remember what I said to my consultant though I am nearly sure I told him that I had horrendsous pain on my left side in August 2006 which would have been well over a year since I took out my policy,this could have been a ruptured cyst which is what s appearing on the scans now so I think I will be ok. I will mention my concerns to my consultant and at least I have the orginal scans that are clear so that would all help my case of Quinn start querying it. I am probably worrying over nothing so will try and not think about it until I have spoken to consultant, if there are anydoubts at that stage I will go ahead with Lap and dye but not the laborotomy if its needed if this could cause a problem with my insurance...I know its mad putting this before health but I just wont be able to afford it if Quinn refuse to pay up and I dont want to risk being liable. I could then arrange the op on the public health system. Will know more when I get in. Thanks for all your cmments, very helpful and good to get a balanced view.