VHI insurance cant give prior approval for cover of operation?

lightspeed

Hi all

I have a diviated septum and need to have an operation so can breathe through the blocked through my left nostril as currently only the right side of my nose is functioning.

It is most likely that i can get cover with VHI but they cannot confirm for sure until after the operation is done.

The issue is that they wont cover pre existing conditions prior to 2009 which was when my policy with them began. They dont cover pre existing conditions for the first 5 years.

I honestly dont know if i was born with my nose crooked or if i got bang on it when i was younger. I said to the doctor when i noticed how often i was getting head colds and they gave me a spray. When that didint d much the local docter referred me to an ENY consultant who confirmed that it is a diviated septum that would require quite a bit of work to fix.

The issue i have now is that VHI say they cant confirm if they will cover it as the claim can only be accessed after the operation when the claim s submitted.

Each time they ring, they say to check with the consultant and my local gp when the condition developed. I only met my local doctor last week for the referral. The consultant advises to check with VHI and that they will check with my local doctor. The local doctor advises me to confirm with the consultant.

I have to sign a form stating that if VHI dont cover the opertation, I will be liable for the bill which is just over €7000.

So is this legal that they say they cant confirm prior to the operation if the claim will be covered?

coylemj

You need to say this to the consultant: 'If the condition is found to be congenital and you're prepared to certify this, then the VHI will cover the procedure, otherwise they won't and I can't afford to pay for it out of my own pocket'.

'nuf said.

Tom Young

OP: In your own view, is your post appropriate?

lightspeed

Yeas of course i do, in your view, why is it not?

I find it surprisng that a system like this is in place which is clearly used to the advantage of insurance companies to imtidate customers not to seek medical attention, for fear that they will have to foot the bill despite paying ever increasing health insurance fees.

As a result, i want to clarify if the above unjust system in place is legal?

Im need seeking advise on what course of action i should take, but i am curious if it is legal.

Tom Young

So, you've read the charter where it says you cannot seek legal advice?

coylemj

lightspeed wrote: »

I find it surprisng that a system like this is in place which is clearly used to the advantage of insurance companies to imtidate customers not to seek medical attention, for fear that they will have to foot the bill despite paying ever increasing health insurance fees.

As a result, i want to clarify if the above unjust system in place is legal?

Im need seeking advise on what course of action i should take, but i am curious if it is legal.

OP, the reason for this condition is to stop a system arising whereby healthy people avoid paying for medical insurance when there's nothing wrong with them, only to jump on the bandwagon and take out insurance as soon as they get ill, thereby forcing the rest of us to subsidise them. It would be the same as allowing people to drive uninsured and take out a policy after they crash into someone.

You have no recollection of an injury to your snout in the past five years, there should be no problem for the consultant to certify that the condition is either congenital or was as a result of a childhood injury. You just need to mention to the consultant that when he/she is submitting a claim to the VHI to mention that it was to correct an old injury or condition. I really can't see why you need to discuss this with a bunch of anonymous people on the internet.

Is the VHI policy legal? Most probably yes, if for no other reason that the same policy is implemented by all of the players in the Irish market and with the tacit approval of the regulator.