Holiday Insurance

NickyBat

Have recently returned from holiday and whilst abroad i had to have an emergency operation, i have now been slapped with a hospital bill of 14,000 euros and the insurance company are refusing to pay as they say it was a pre-existing medical condition. it wasnt as although i had had some problems before going away i had not had a definite diagnosis by either the hospital or GP. Can anyone help!

dacouch

Travel Insurers tend to have an exclusion for "Undiagnosed Conditions" eg the doctors are trying to diagnose the condition.

Could you give us more information, as depending on the circumstances we may be able to help you

NickyBat

thanks for a speedy reply, briefly i had had stomach pains, been to local hospital they said could be many things, one being gallstones but would have to do ultrasound etc. the nhs being what it is the ultrasound dept wasn't open so they would just send me an appt as pains would prob settle down anyway.

The emergency op i had was a gangrenous gallbladder which the hospital surgeon has confirmed is not a pre-exisiting condition and could not have been predicted.

i also spoke to the insurance company before i went away, told them of the situation and they agreed that a) it was not known when the holiday was booked and b) a definite diagnosis had not been made therefore i was covered, now they appear to be back tracking!

dacouch

Which Insurer is it ?

Can you give us a time scale of events.

What is the exact reason the Insurers are declining the claim, is it due to this existing condition and / or are they saying it is connected with other existing conditions

What did you declare to the Insurers with regard the stomach pains, did you do it through their official medical declaration telephone number or was it off the record. Do you have any record of the conversation eg a confirmation letter or reference from them or a persons name etc

NickyBat

Timescale, went away 13/10, admitted to hospital 15/10, they are declining as they are just saying it is pre- existing!
The only record i have of previous conversation is the persons name and date of telephone call which was made to their official telephone number, i brough them fully up to speed of exactly what had happened and what had been said by hospital and GP.

dacouch

Resolving this probably will not be instant.

Advise the hospital that are owed the money that you are in negotiation with the Insurers so they are aware there may be a delay.

It would be helpful if you could advise us which Insurer it is, so we can look certain information up (I'm guessing it's Axa).

Was the operation in Europe by any chance and if so do you have an EHIC card

NickyBat

it is indeed axa (how did you know)?
it was Cypus, we do have the EHIC but it was no use - presaumably because i was taken to a private hospital - we have since been told the hotel have agreements with tour operators as to which hospital you get taken to - how true that is i'm not sure - we certainly weren't consulted.

dacouch

Quentin is an expert on EHIC, perhaps he may be able to give some advice on it (You may be able to recover a certain percentage from the UK government as a last resort).

I would suggest you send Axa a S.A.R (Subject Access Request), this is basically you requesting all of the information they hold on you under the data protection act. They make a charge of £10 for this, make sure you request a copy or transcript of the telephone call as it could be very helpful.

http://www.axa.co.uk/privacy (See the paragraph headed "Your Legal Rights" http://www.axa.co.uk/privacy
http://www.ico.gov.uk/for_the_public.aspx (The relevant government website which you may find helpful).

Once you have the SAR it will hopefully help your case.

The actions after receiving it would be an "Official Complaint" which Axa have to investigate fully and report back to you within a certain timescale. After this you have the option of going to the Ombudsman, however this can take a very long time to get a judgement (It is free for you to use).

Another alternative is the Telegraph's financial agony aunt, she has resolved many problems with Axa and appears to have a contact in their press office.

Here are some cases she has been involved with http://www.google.co.uk/#hl=en&source=hp&biw=1280&bih=711&q=jessica+telepgraph+axa&aq=f&aqi=&aql=&oq=&gs_rfai=&fp=1a646461bb6d78c4

If you are considering using Jessica, get the SAR first and bear in mind she will not become involved if the matter is actually in the hands of the Ombudsman so do it before going to the Ombudsman if you decide to use her

NickyBat

Sorry, who is Quentin ? I have looked into recovering some from the nhs here and apparently that is a no go mainly because it was a private hospital i was taken to.
I do intend to make an official complaint and go to the ombudsman if i have to but at the moment i'm just banging my head against a brick wall as axa here say the case is still open but axa in athens say it's closed and they are waiting for payment (i am currently compiling a letter to bbc watchdog to see if they can help also)
I will go and read up on Jessica - thank you

dacouch

Quentin is a poster on MSE and has good knowledge on these matters, he will be along soon to give his advice.

I strongly recommend you get your SAR in as it can take them a while to forward it, by requesting it this may help your case as if there is damning evidence on it they may back down

NickyBat

They have faxed copies of my own records from my GP that was sent them (i have now found out because after my visit to the GP he has put on my records "GB?" meaning gallbladder that this another reason they are saying it is a pre-existing medical condition but i really don't know how they can say this when as i keep pointing out to them a definite diagnosis was never made.
They have also given me copies of reports from the hospital including Dr, Surgeon and histology so i think i have everything (although i will double check).
Can you tell in your experience if you have heard of hotels having agreements with tour operators as surely as a matter of course people should be taken to the ordinary hospitals abroad not the private ones?