Medical Insurance Cost Cutting Plan Article Discussion Area

The_silver_surfer

abcmum wrote: »

My claim has been refused on the grounds that it is pregnancy related, although the policy states that it DOES cover complications of pregnancy. I have an Incisional Hernia as a result of my c/section in Dec 09. An incisional hernia is not considered a complication of pregnancy... I am lodging an appeal, but am really disappointed tohave this cover only to be told the first time I have needed to claim that my condition is not covered even though, medically it requires major abdominal surgery. Grrrr - please check all exclusions, but then also read between the lines. It would seem that these companies will go all out to find a reason NOT to pay up! Personally, I think I'll take Martin's advice and stick to the NHS. These private plans should alleviate the strain on the NHS however, not make it worse!!!

Out of interest which insurer is it you are with? ......Is it Aviva?

Normal pregnancy and child birth is excluded from almost all PMI policies. As if it were included many would claim then cancel the policies afterwards. This would push the cost of everyone elses premiums through the roof.

Yes you are right complications in pregnancy are usually covered by most insurers though and there is a very good argument that this is a complication in pregnancy, it seems to me.

I would go through the insurers complaint procedure asking them if this is not a complication in pregnancy then what is?

If you do not get anywhere with the insurer you could look at going to the FOS (Financial Ombudsman service) who really do have some teeth and who's decision is legally binding on the insurer but not on you, so doesn't affect your right to take them to court.

MsPink

I'm trying to find a private medical plan that will cover my knee.

I'm 28 and 2 years ago I had an ACL reconstruction privately paid for by my employers plan by AXA. They decided that the injury fell under the umbrella of "chronic, recurrant or long-term" and stopped my physio at 6 months post-op (it's a 9 month rehab).

I had another MRI on it in September last year and I have ongoing kneecap problems. I'm not looking to get cover for that.

What I would like cover for is if I re-tear my ACL or if I damage other ligaments in my knee. Is that possible? I've changed jobs so I no longer have an employer plan.

The_silver_surfer

MsPink wrote: »

I'm trying to find a private medical plan that will cover my knee.

I'm 28 and 2 years ago I had an ACL reconstruction privately paid for by my employers plan by AXA. They decided that the injury fell under the umbrella of "chronic, recurrant or long-term" and stopped my physio at 6 months post-op (it's a 9 month rehab).

I had another MRI on it in September last year and I have ongoing kneecap problems. I'm not looking to get cover for that.

What I would like cover for is if I re-tear my ACL or if I damage other ligaments in my knee. Is that possible? I've changed jobs so I no longer have an employer plan.

Important question. When did your comapany plan cease?

If within the last 30 days it may be possible.

Assuming for now the answer is months ago then yes this condition will be covered after two years membership with Pruhealth under new moratorium underwritting. All new conditions are covered straight away. All existing conditions (suffered from in the last 5 years) will be covered after two years.

In their joining criteria they ask the following:

I understand and agree that:

1 No applicants have ever suffered from heart disease, stroke, cancer or mental illness;

2 Any conditions for which any applicant has had symptoms, treatment or advice in the last five years may be excluded from cover for two years from start of cover after which benefits are available for eligible treatments and conditions;

3 If any applicant makes a claim, PruHealth will have to request information from them or their GP to determine whether the
condition was pre-existing or not;

4 All applicants to be covered are aged 65 or under.

MsPink

Thanks for the PM

My previous employer cover only finished on 23rd June, so less than 30 days. I did get quotes with AXA to take my existing policy with me but tbh I was so unhappy with their refusals to pay, it doesn't seem worth paying them premiums when I know that they're unlikely to pay.

Quentin

MsPink wrote: »

Thanks for the PM

Rogue brokers break the rules by using the pm system to tout for business.

The silver surfer just brings disrepute on himself by his unprofessional behaviour here, especially over his constant pruhealth promotion via pms.

Brize

MsPink wrote: »

I had another MRI on it in September last year.

A note of caution: Consultant-led treatment in the past twelve months will preclude a 'switch' to all bar one insurer.

Two general points:

1. AXA PPP offer a very wide range of continuation policies for group leavers.

2. When insurers withdraw cover for a chronic condition, they will still pay for acute flare-ups of that condition.

Please take specialist advice - you can search for a PMI broker at https://www.amii.org.uk

stephenni1971

Silver Surfer

You really are determined to abuse the forum rules that most everyone else tries their best to abide by.

MsPink posts a question you reply to on the board and her next post confirms you have pm'd her.

MsPink wrote: »

Thanks for the PM

Despite that in your next post you go on to say ( my bold )

Of these i would recommend Pruhealth

You promote yourself as a professional and yet time and time again you show yourself up to be a cheap opportunist. Added to that you KNOW you can never recommend a product or a provider on this forum.

Time to grow up?

The_silver_surfer

stephenni1971 wrote: »

Silver Surfer

You really are determined to abuse the forum rules that most everyone else tries their best to abide by.

MsPink posts a question you reply to on the board and her next post confirms you have pm'd her.



Despite that in your next post you go on to say ( my bold )



You promote yourself as a professional and yet time and time again you show yourself up to be a cheap opportunist. Added to that you KNOW you can never recommend a product or a provider on this forum.

Time to grow up?

Appologies post deleted. Trying to be helpfull but perhaps went a bit far.

I recommend the OP takes the advice of Brize above.

The-mouth-of-the-south

Can I have some advice on what most PMI class as a pre exsisiting condition - for example - I strained my knee a few years back and went to GP - he gave it the once over and said looks ok rest it for a week - I did this and its been fine since.
Also with the Pruhealth cover I notice it mentions about mental health - I was signed off work for 8 weeks back in 2006 due to feeling depressed and stress (I was in a really stressfull job - call centre) - I didnt have any medication and was offered councilling which I said yes to but never went when the letter came through some weeks later as I had left my job and felt ok. Would this be classed a mental health issue and exclude me?

My main reasons for wanting to get cover is for orthapedic reasons - I do a lot of gym work and often hear about injuries which need surgical repairs, the NHS route is so slow for a lot of stuff in this line so I was hoping to get some PMI which would cover this area.

many thanks

Errata

Also with the Pruhealth cover I notice it mentions about mental health - I was signed off work for 8 weeks back in 2006 due to feeling depressed and stress (I was in a really stressfull job - call centre) - I didnt have any medication and was offered councilling which I said yes to but never went when the letter came through some weeks later as I had left my job and felt ok. Would this be classed a mental health issue and exclude me?

It is a mental health issue. You consulted your GP, they diagnosed a health problem and referred you for treatment. The fact that you decided you didn't want the treatment isn't relevant. Having said that, declaring it may not necessarily exclude you from private health insurance.