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health insurance and tonsillectomy

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  • 04-12-2014 12:19am
    #1
    mar90
    Closed Accounts Posts: 19 ✭


    Hi apologies if this is in the wrong forum. Need advice regarding my toddler having a tonsillectomy.
    Had appointment with private consultant who is going ahead and removing them in 2 weeks all going well.
    We have very good health insurance now but my question is because we only have the insurance a couple of months and babs has suffered from this before we got the health insurance will this affect this meaning will health insurance refuse to cover costs because he's not been covered too long and has suffered beffort hand.
    as really never thought he would of needed them out but affecting breathing so no other option.
    Any advicewould be greatly appreciated as insurance company wouldn't say until after consultation..
    Thank u


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    #2
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    mar90 wrote: »
    Hi apologies if this is in the wrong forum. Need advice regarding my toddler having a tonsillectomy.
    Had appointment with private consultant who is going ahead and removing them in 2 weeks all going well.
    We have very good health insurance now but my question is because we only have the insurance a couple of months and babs has suffered from this before we got the health insurance will this affect this meaning will health insurance refuse to cover costs because he's not been covered too long and has suffered beffort hand.
    as really never thought he would of needed them out but affecting breathing so no other option.
    Any advicewould be greatly appreciated as insurance company wouldn't say until after consultation..
    Thank u

    It depends...
    Most insurance companies have a rule against covering pre-existing conditions so if you know of the need for surgery and then got the insurance- you may wait up to 5 years to have the procedure covered!!
    If the problem and need for surgery was not pre-existing (you discovered the need for treatment a few days or weeks after taking out cover) and you took out a new insurance policy- you may have to wait 6 months before the surgery is covered... Some insurers wave this 6 month wait...
    If you have insurance for years then it is covered.....

    If you are being honest here, I would expect that it would be classed as a pre-existing problem and not covered, sounds like you have already told them this anyway...

    Clear this up before the procedure as if the job is done and the insurance won't pay... you may get a big bill in the post....


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    #3
    okiss
    Registered Users Posts: 698 ✭✭✭okiss


    I worked in the health insurance area. All procedures be it day case or major heart surgery have a procedure number with each health insurance company.

    I would ask your consultant the procedure number with ( health insurance company name) as you need to check if your child is covered.

    Once you get this number you need to ring the health insurance company & ask them is my son covered for procedure number 123 with such a consultant in hospital name.
    If he is covered get them to email you and say child's named is covered for procedure no 123 with consultant & hospital name.

    If your child is not covered for the operation as a private patient you need to speak to the consultant. Ask them which public hospital can do this & can they put your child on this list.
    In some cases your child can get treated quicker as a public patient. Also in regards to health insurance in a child's name - they are generally only treated in public or children's hospital. Some private hospitals may operate on a child but the like of the mater private ect don't treat children so you don't need to pay for this type of cover for a child.
    I hope this helps you.


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