Health Insurance Question

Jayob10

Up until last year I was always covered with VHI on health insurance which was paid for by my dad. This included payements for years.

However my dad took me off his health insurance last year and I do not have any myself.

Turns out I may need an MRI scan in the next month, is it possible for VHI to cover this if I explained I have only been off coverage a year and if I start paying for my own health insurance from right now?

or is this totally out of the question? I was stupid not to get my own insurance sorted but its typical the one year i'm off it I need something, after paying for years without ever really using it.

Any info would be greatly appreciated

sarahlulu

I can't see VHI paying for a scan while you were not covered. It can be hard enough to get them to pay for procedures when you are on cover.

Ogham

Have you been referred by a GP to a hospital. The scan can be done free in the "public" system - but you may well have to wait a bit longer than if you went private.

Kristopherus

Also remember that if you sign up with Aviva or Quinn you will have to serve a waiting period before qualifying for benefit. You might be lucky if you go back to VHI. They just MIGHT scrap the waiting period, seeing as you were previously on their books.

NuMarvel

All three health insurers have direct payment agreements with particular centres and hospitals for certain types of scans such as MRI, CT, etc.

As far as I'm aware, none of the health insurers apply waiting periods to this benefit. So, it is feasible to join health insurance today and have a private scan tomorrow, fully covered! (I'm basing this on my own experience when I worked for BUPA/Quinn. Things may have changed since however.)

The best thing to do is ring all the health insurers and ask outright if they apply waiting periods to the MRI scan cover. Before signing up to any of them however, check that the centre you're booked into is fully covered by your chosen health insurer. Also check that the medical reasons you're having the scan are recognised by the insurer. (The insurer calls these clinical indicators)

Something else to consider is whether or not your particular condition will require hospital treatment after the scan. If it does, that's where the waiting periods will apply, so before signing up with anyone see if they'll recognise your previous time on your parent's policy. Because the break in cover is more than 13 weeks, they are not obliged to, so VHI may be your best bet here. VHI have a "safety net" protocol for people who experienced financial hardship. It may not apply in your particular circumstances, but no harm asking anyway. Some details here.

broker2008

Yes good advice from NuMarvel and there are no waiting periods for MRI Scans as they come under outpatient benefits if one is under 55. The reason why you need an MRI scan, is going to be a pre existing condition going forward. VHI might take this into consideration and waive your waiting period but in return they might tie you in for 5 years for that particular pre-existing condition as another insurer may not recognise same. If they won't waive, make sure that you choose provider that has direct payment for MRI without having to pay upfront and then subject to an excess.

Quinn have direct payment with Advance Radiology Clinic in Dundrum, VHI have direct payment for Beaumont Hospital and Aviva have Charlemont Clinic, St. Vincents and Euromedic in Cork where the others don't.

padraig roscommon

Hello guys,
I began my aviva health insurance plan 4th jan 2010 and in march I was suffering from a suspected hernia. I served my 26 wk waiting period and went to my gp in august and explained to her that I have had this problem since march so she referred me to a consultant and proceeded to have my hernia operated on. As I had waited the for the 26 week waiting period before I had consulted with my gp I presumed I would be covered but now after reviewing my health records obtained from my gp aviva are refusing to pay for my operation because I had been suffering with the hernia since march which was within the 26 week waiting period.
Is this standard procedure or have I a leg to stand on?
Any insight would be greatly appreciated.

3DataModem

padraig roscommon wrote: »

Hello guys,
I began my aviva health insurance plan 4th jan 2010 and in march I was suffering from a suspected hernia. I served my 26 wk waiting period and went to my gp in august and explained to her that I have had this problem since march so she referred me to a consultant and proceeded to have my hernia operated on. As I had waited the for the 26 week waiting period before I had consulted with my gp I presumed I would be covered but now after reviewing my health records obtained from my gp aviva are refusing to pay for my operation because I had been suffering with the hernia since march which was within the 26 week waiting period.
Is this standard procedure or have I a leg to stand on?
Any insight would be greatly appreciated.

I'm afraid this is standard procedure.

NuMarvel

padraig roscommon wrote: »

Hello guys,
I began my aviva health insurance plan 4th jan 2010 and in march I was suffering from a suspected hernia. I served my 26 wk waiting period and went to my gp in august and explained to her that I have had this problem since march so she referred me to a consultant and proceeded to have my hernia operated on. As I had waited the for the 26 week waiting period before I had consulted with my gp I presumed I would be covered but now after reviewing my health records obtained from my gp aviva are refusing to pay for my operation because I had been suffering with the hernia since march which was within the 26 week waiting period.
Is this standard procedure or have I a leg to stand on?
Any insight would be greatly appreciated.

From the information you give here, I'm not sure why Aviva won't pay the claim. The 26 week waiting period (called the "initial" waiting period) only applies to actual treatment received within that time. If a condition develops after joining then treatment related to that condition is covered once the treatment is received after the 26 weeks expires. In fact, I'd go so far as to say that you could have gone to your GP back in March and the operation would still be covered once it was carried out on week 27 or after.

The only other thing I can think of is that Aviva have medical advice that the condition was present before you joined. Pre existing conditions are subject to a longer waiting period and aren't based on when the patient becomes aware of the condition, but when symptoms began.

If they haven't done so already, ask Aviva to confirm in writing why the operation isn't covered and ask them to specify which of their terms and conditions supports their action. I've had a look at their rules and I can't find anything that says conditions that develop after joining aren't covered at all.

3DataModem

NuMarvel wrote: »

From the information you give here, I'm not sure why Aviva won't pay the claim. The 26 week waiting period (called the "initial" waiting period) only applies to actual treatment received within that time. If a condition develops after joining then treatment related to that condition is covered once the treatment is received after the 26 weeks expires. In fact, I'd go so far as to say that you could have gone to your GP back in March and the operation would still be covered once it was carried out on week 27 or after.

Be careful with this advise.

I suggest reading this: http://www.avivahealth.ie/health-plans/terms-conditions/

There are 3 types of waiting / exclusion periods:

(1) Waiting Periods applicable for all in-patient treatment, day case treatment and out-patient PET and PET-CT scans only

If this applies, then you are probably covered.

(2) Waiting periods for day-to-day benefits

If this applies, then you are not covered (1 year).

(3) Exclusion periods for pre-existing conditions

If this applies, then you are not covered (5 years).

NuMarvel

3DataModem wrote: »

Be careful with this advise.

I suggest reading this: http://www.avivahealth.ie/health-plans/terms-conditions/

There are 3 types of waiting / exclusion periods:

(1) Waiting Periods applicable for all in-patient treatment, day case treatment and out-patient PET and PET-CT scans only

If this applies, then you are probably covered.

(2) Waiting periods for day-to-day benefits

If this applies, then you are not covered (1 year).

(3) Exclusion periods for pre-existing conditions

If this applies, then you are not covered (5 years).

I know, that's why I also said:

NuMarvel wrote: »

The only other thing I can think of is that Aviva have medical advice that the condition was present before you joined. Pre existing conditions are subject to a longer waiting period and aren't based on when the patient becomes aware of the condition, but when symptoms began.

If they haven't done so already, ask Aviva to confirm in writing why the operation isn't covered and ask them to specify which of their terms and conditions supports their action. I've had a look at their rules and I can't find anything that says conditions that develop after joining aren't covered at all.

dollydishmop

Ogham wrote: »

Have you been referred by a GP to a hospital. The scan can be done free in the "public" system - but you may well have to wait a bit longer than if you went private.

Second this

padraig roscommon

thans very much for the info recieved ill get onto aviva and request for a reason for non payment in writing. thanks again