VHI

JayJay10

Hi All

I am posting on behalf of my partner she is really stressed at the moment and doesn't know what to do.

She joined the VHI in June 2006 through a work(group plan) she was admitted to hospital in July 2006 and a few times after that in the same year. When being admitted to hospital she was asked did she have health insurance to which she said yes VHI as she had taken out a policy.
Over the past few years she has been quite ill in and out of hospital and in 2008 was diagnosed with Crohns disease.
As far as she was concerned she was covered by VHI the whole time apart from doc or a&e fees.
In June 2009 she received a letter from VHI looking for some medical history from her GP to which she did not act on as she went into have our baby the same week.
In Novemeber 2009 she received another letter stating information was required to which she got her gp to fill out the form and send it back.Now since January 2010 she has so far received 4 hospital bills adding to over €1000 and has been informed there is more to come.
The Vhi are saying that because she may have had an underlying illness and did not inform them of this that is why claims are being rejected.
Is this right can they do this she did not know untill 2008 that she had crohns.
We don't know what is the next step is there anyone that can shed some light for us.
Sorry for the long post

GerardKeating

JayJay10 wrote: »

Hi All

I am posting on behalf of my partner she is really stressed at the moment and doesn't know what to do.

She joined the VHI in June 2006 through a work(group plan) she was admitted to hospital in July 2006 and a few times after that in the same year. When being admitted to hospital she was asked did she have health insurance to which she said yes VHI as she had taken out a policy.
Over the past few years she has been quite ill in and out of hospital and in 2008 was diagnosed with Crohns disease.
As far as she was concerned she was covered by VHI the whole time apart from doc or a&e fees.
In June 2009 she received a letter from VHI looking for some medical history from her GP to which she did not act on as she went into have our baby the same week.
In Novemeber 2009 she received another letter stating information was required to which she got her gp to fill out the form and send it back.Now since January 2010 she has so far received 4 hospital bills adding to over €1000 and has been informed there is more to come.
The Vhi are saying that because she may have had an underlying illness and did not inform them of this that is why claims are being rejected.
Is this right can they do this she did not know untill 2008 that she had crohns.
We don't know what is the next step is there anyone that can shed some light for us.
Sorry for the long post

All health insurance has exclusions and qualifying periods. If someone joined in June 2006, they would not get covered for much the following month. It is clearing stated on the membership card that you must ring the company before any procedure to confirm it is covered.

dudara

Moved to Banking & Insurance & Pensions

dudara

helimachoptor

Some corporate plans have the exclusion periods waived. OP I'd ask her company about this.

NuMarvel

Hi JJ

As Heli and GK have stated, when someone takes out health insurance for the first time, there are waiting periods before certain types of cover kicks in.

In the case of a condition that was present prior to starting health insurance, this waiting period is 5 years from the date of joining, assuming your partner was 54 years old or younger when she joined VHI.

The group scheme may have some waivers/reduction applied, but generally speaking this only applies where the company pay for it and the company would have to be quite large for the pre existing waiting period to be reduced or waived. It's no hamr checking this anyway.

When someone takes out health insurance, they are not required to submit any medical information at the time, as pre existing conditions are determined at the time of claiming instead of joining.

It's important to note that the determination of pre existing isn't based on when the member became aware or was diagnosed. This is what the VHI rule book says:

"When determining whether a medical condition pre-exists membership it is important to note that it is the date of onset of the condition that is considered rather than the date upon which the member becomes aware of the condition, as medical conditions may be present for some time before giving rise to symptoms or being diagnosed."

All that said, the first thing I think your partner should do is ask for a copy of the information submitted by the GP, as it appears that it's this that VHI have used to determine if the condition was pre existing or not. Under Data Protection, VHI are obliged to give you this information.

Once she gets the info, she should have a look to see what the GP says and get in touch with the GP to clarify any questions that may arise. The GP may have linked the Crohn's to seemingly unrelated symptoms. If the GP entered incorrect information, ask the VHI how to go about correcting this. It may be the case that another medical report is needed, but it probably varies from case to case.

In the meantime, she should also respond to the people sending the invoices to tell them she is looking into the matter. Don't ignore these as it will only make matters worse in the long run.

There have been similar case on here a few times before. These two threads are two where I gave similar advice, but if you use the search function it may have come up a few times before:

http://www.boards.ie/vbulletin/showthread.php?t=2055489750

http://www.boards.ie/vbulletin/showthread.php?t=2055804661

Hope this all helps.

broker2008

from the hia website:

If you are taking out health insurance for the first time and have a pre-existing condition e.g. diabetes, the health insurer can impose a waiting period in respect of cover for treatment for this condition. The maximum waiting periods that the health insurer may impose in this case are as follows:

• 5 years, for a person who is under the age of 55 years.
• 7 years, for a person who is of or over the age of 55 years and under the age of 60 years.
• 10 years for a person who is 60 years or over.

These waiting periods may apply from the date of policy commencement. It should be noted that whether or not a condition existed at the time that an insured person began serving a waiting period is decided on the basis of medical advice. Whether or not the insured person was aware that they had the condition at the time that they started serving the waiting period may be considered not to be relevant by the insurer. If this matter is important to you, you should consider clarifying it with your insurer.

I presume that there was no previous insurance held prior to June 2006 with any of the health insurers ? if not the above will apply.

Unfortunately, there are more and more instances where bills are not being settled due to pre-existing conditions and I think it is fair to say that many are unaware of the rule - for all 3 insurers. This is only for new entrants to the health insurance market or where waiting periods have to reserved where cover was lapsed for more than 13 weeks.

If insurers/hospitals were to check with each other that procedures were definitively covered where potential pre-existing conditions could be an issue, hte situation would be resolved.

Another area to look out for is where an insurer effectively downgrades cover due to excesses (to reduce premium) and the person subsequently switches back to their original plan or another insurer and finds out due to a pre-existing condition that there is a 2 year waiting period for "the upgrade" of no excess.

JayJay10

Thank you for all your replies they were very helpful

msshono

Hi there

Can anyone advise me on the following?

I am looking into taking out Health Ins at the moment. I don't have any existing diagnosed conditions really. Only problems I have is some back trouble...trapped nerves or something along those lines...I have never been 'diagnosed' as such, just gone to a chiropractor and an osteopath a few times to get a bit of relief and then it will go away for a while.

Do you think I would be excluded from claiming for the partial allowances/reimbursements they allow you for those 'day to day' medical appointments with the likes of chiropractors/osteopaths?

How does the process work of validating your claims? You send in your receipts and do they then check with the practitioner how long you've been attending/when diagnosed?

Any info would be great

Thanks

NuMarvel

As far as I'm aware, the out-patient/everyday/day to day cover isn't subject to the pre exsting waiting periods so you can claim as normal. The administrative burden on insurers to validate every out-patient receipt they receive wouldn't make it worth their while.

Your insurer may ask for more information if you are submitting high value claims, i.e. claims where the cost of the service provided is above what one would normally expect. Even in that case though, it would be to determine if other services were provided at the same time and not when did the symptoms begin.

If the condition does require hospital treatment though, the pre existing waiting periods will apply and these are based on when symptoms began and not when you're officially diagnosed. In that circumstance, your insurer may ask your practitioner how long you've been attending.

broker2008

msshono wrote: »

Hi there

Can anyone advise me on the following?

I am looking into taking out Health Ins at the moment. I don't have any existing diagnosed conditions really. Only problems I have is some back trouble...trapped nerves or something along those lines...I have never been 'diagnosed' as such, just gone to a chiropractor and an osteopath a few times to get a bit of relief and then it will go away for a while.

Do you think I would be excluded from claiming for the partial allowances/reimbursements they allow you for those 'day to day' medical appointments with the likes of chiropractors/osteopaths?

How does the process work of validating your claims? You send in your receipts and do they then check with the practitioner how long you've been attending/when diagnosed?

Any info would be great

Thanks

Outpatient expenses for chiropractors and osteopaths are not subject to waiting periods if you are under 50 for vhi and under 55 for aviva. There are differences between plans as to how much is actually paid out and for how many visits. The companies would reserve the right to query the authenticity of such claims.

You can take out day to day a or day to day 50 with aviva, healthsteps silver or gold with vhi on a standalone basis without the need to purchase a hospital plan.