Medical Insurance and Endometriosis

skullncrossbones

Hello everyone,

Please bear with me, I shall try to make this as short as possible. A few years ago I had a ovarian cyst removed, at this time they found a small area of endometriosis which was lasered. All good. Six months ago I started getting periods that are every 2 weeks, lasting for 2 weeks, making life extremely miserable. After the nhs screwing up my referral twice I decided to go privately. The doctor did a scan and told me I have stage 3 endometriosis which will require another operation. Now I would love to have this doctor perform the op but the cost is something I am concerned about. So of course I am thinking of medical insurance, however if I have had a consultation in november and am happy to wait a couple of months due to work/life commitments, what is the best way of appoarching insurers? I fear they will want to know when I saw the private doctor...if I say november which is after I got insurance they will not pay for the operation as the doctor will saw they saw me in november and the operation is in march for example.

Any advice is greatly appreciated.

tomtontom

Do you already have cover or are you looking to take it out now?

Insurance is very unlikely to cover treatment for a pre existing condition, or one not declared at the time of taking out the policy. You would need to ask the question to get a definitive answer.

Does your consultant not do NHS work as well as private?

skullncrossbones

I am looking to take it out now. I would declare it at the time of taking out the policy, however thought that if I were to have the operation next year they would be more likely to pay for it?

Unfortunately not

tomtontom

You can get cover for anything for a price, but that price is likely to be higher than the cost of your treatment. An insurer will look at when your condition (or the indicative symptoms) occurred, not the date of your treatment.

If you're happy to wait a couple of months then get referred again in the NHS. Through the choose and book service you should have a choice of where you are seen, so you can do your research and get the best care possible. I can recommend two consultants in Nottingham if that is any help?

skullncrossbones

Yea I've looked online and companies state that they will not payout for prediagnosed illnesses...think I'll have to rob a bank and pay myself.

Thank you but I'm in London my referral from the NHS has come through and I have an appointment at a clinic in december...I'm going to have a think and then make my decision. Thanks for the advice.

tomtontom

These should be of help to you.

http://www.fertilityfriends.co.uk/forum/index.php?board=9.0

https://healthunlocked.com/endometriosis-uk

If you know where you're going then do some research and find out which consultant specialises in endo. You can make contact beforehand (email their secretary) and ask to be seen by them (rather than one of their team). There's no guarantee they will oblige but if you explain the difficulties you've had to date they might be more willing.

System

If you think about how insurance works, they are not going to knowingly and deliberately put themselves out of pocket, presumably to the tune of several hundred pounds or more.

It may be better to try and finance the operation through a loan or similar?

Nicki

It is definitely possible to get cover for pre existing conditions but this is a lot more expensive than standard cover which excludes pre existing conditions and usually also has a waiting period (ie you cannot claim for anything related to that condition within a certain period of starting the policy). With my health insurance (provided through work) that period is 2 years, unless you had not sought medical treatment for the condition in the 5 years before you took the policy out.

I suspect for an op like the one you are talking about which is probably going to be day surgery, it would be a lot cheaper to pay for it outright than pay 2 years insurance premiums at an enhanced rate. And quicker to have it done on the NHS than wait for your qualifying period to expire. But it's worth phoning round all the insurers and checking out whether you can make the numbers add up for you.

Jojo_the_Tightfisted

skullncrossbones wrote: »

I am looking to take it out now. I would declare it at the time of taking out the policy, however thought that if I were to have the operation next year they would be more likely to pay for it?

Unfortunately not

Nope. They're not in the business of paying for stuff if they can avoid it - a preexisting condition that already required surgery is not going to be something they'd cover, not matter how long you delay the operation. And if you forgot to declare it, not only would you get a huge medical bill, you'd be in danger of being accused of attempting Insurance fraud.

Ask the private gynae if s/he has an NHS practice; they are perfectly entitled to add you onto their NHS list without insisting on a further referral or wait.