health insurance problem

melissa16

Hi everyone.
This is my first post and I'm at my wit's end.
I joined VHI oct 10 on the teacher plan.
I was admitted into hospital in August 2011 and got gallstones taken out October 11. I was under the illusion I would be covered but now bills are continously pouring in as my claim was rejected because gallstones are a pre- existing condition!!
I'm looking into this but wanted to know has anyone had this problem?
:(

ScouseMouse

Were you diagnosed with gall stones before you took the policy out?

Had you been to the doctor previously with pain that turned out to be gallstones?

Doom

I think that full knowledge of the condition before hand will void the claim, were you attending a gp with unidenified pains before you took out the health insurance

bbsrs

melissa16 wrote: »

Hi everyone.
This is my first post and I'm at my wit's end.
I joined VHI oct 10 on the teacher plan.
I was admitted into hospital in August 2011 and got gallstones taken out October 11. I was under the illusion I would be covered but now bills are continously pouring in as my claim was rejected because gallstones are a pre- existing condition!!
I'm looking into this but wanted to know has anyone had this problem?
:(

Pre existing condition not covered or any condition diagnosed in the first 6 months of a new policy if i recall correctly. Sur if it worked that you were covered the minute you took out the police for every condition old or new no one would take out health insurance until they were sick.

melissa16

Hadn't been to a gp as I never had any pains, only got a pain the night I went in, was with vhi ten months at that stage.

sandin

This is probably more suited in an insurance forum or possibly consumer issues.

Even with a regular examination you'd hardly know you had gallstones 10 months before they suddenly become an issue.

I think a letter to VHI outlining the sutuation and asking them for a final determination.

Once you have this, you make a compalint to the Ombudsman (can be done online in 5 minutes) and they will arbitrate on the dispute.

If what you are saying is true, my guess is they will find on your favour. - With relation to the bills, just send a letter to hospital sayign that you have sent a complaint to the ombudsman and ask if they can hold off looking for payment until his determination.

Do the letter to VHI now - post it Tuesday and if the response is negative, make your complaint to the ombudsman the day the leter arrives from VHI.

At the very lest it will take the worry from you for a while - stress is not good!!

ScouseMouse

Dont mean to worry you, but just went looking around their website. I found this in the terms and conditions. The way I read it, they are saying the gall stones may have taken whatever length of time to form. If their doc says they grew for two years before they bothered you, then that may be the date relevant. Not the date you joined.

Let us know how you get on.

Taken from here:

e) No benefits are payable for medical conditions the date of onset of which is determined on the basis of medical advice to have been prior to the
date the member was included on the contract, unless the member has been insured continuously for a minimum period of time. The minimum
period is as follows:
Member’s age when he/she is included Minimum period
Under 55 5 years
55 to 59 7 years
60 or over 10 years
This rule is applicable to all benefits other than those outlined in Section 9 of your Table of Benefits as well as those benefits in Section 10 that are
subject to an excess.
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.