Definition of medical 'treatment' for holiday insurance

katejo

When a travel insurer asks us to declare any condition for which we have had a hospital referral/treatment in the past year, is there a recognised definition of 'treatment'? By this I mean "Does it include an annual check up for a longstanding condition when nothing new is recommended and no change is made to prescribed medication? One insurer has told me that I don't need to declare such a check up while another refuses point blank to say what is meant by treatment.
i am happy to declare the check up if needed but don't want to say that I have had treatment if nothing has changed. I can't answer questions honestly if I don't know what the insurer means in their terminology. Surely a patient who has attended their check up and is confirmed as stable is a lower risk than someone who doesn't bother to go?

Quentin

Taking medication is treatment.

ThinkingOutLoud_2

katejo wrote: »

One insurer has told me that I don't need to declare such a check up while another refuses point blank to say what is meant by treatment.

Quentin is right. A common thing for someone who had high blood pressure to say is "but I don't any more" - not since taking my medication. They may be stable - but in effect they are not the same risk someone who does not have high blood pressure - they are being successfully treated for it.

katejo wrote: »

I can't answer questions honestly if I don't know what the insurer means in their terminology.

I sympathise - this is not really fair. One could be extreme and say it is hiding disability discrimination behind a lack of transparency / obfuscation. But, if insurers do not assign a special meaning to a word in their policy wording definitions- if not then it is fair for you to assume it means what it says in the dictionary. But, that is not always clear...

katejo wrote: »

Surely a patient who has attended their check up and is confirmed as stable is a lower risk than someone who doesn't bother to go?

Agreed, but you are not "no risk". This is a kind of limitation of some screening processes - most people who had a condition or have one that is well controlled go for check ups. These are of course to make sure that it is well controlled - so by implication there is a risk however small that will change. Likewise - insurers are wary of some middle aged men who don't like going to the doctor and so often have undiagnosed conditions...they are worse!

So screening and definitions vary by insurer - you know this I think. Usually the better screening systems ask things like how many medications you take or if you are waiting test results (sounds like for short time each year this is true). So sometimes, buying your insurance outside of the test cycle helps. Have you tried All Clear, Avanti and Freespirit?

Also some insurer's words / approaches inadvertently or deliberately favour some conditions over others. This can be checked out often by referring to the charity website forum for your condition (if there is one). Maybe, you are not alone and others are able to say where they found a solution. Again, you may have tried this.

Finally, a few insurers seem to have found another way - someone suggested Eurotunnel the other day on thread I think you saw. Sounds a bit left field, but for Europe only - their partner insurer seems to rely on your doctor being happy and in my paraphrase (check their words) that your condition is not going to worsen.

Let us know.

katejo

Thanks thinking Out Loud

i don't have any problems with getting a policy. I have never been refused one. It is simply unclear sometimes what the insurer wants from you. I have tried All Clear before. They were the one which specifically said that I didn't have to declare a routine check up. At the same time though they refused to cover my possible minor wrist fracture when it hadn't been confirmed. That isn't a problem any more so I might try them again. I am not going to buy a policy until i have a final test result due any time now though I am not expecting it to be a problem. Most years I only have a couple of longstanding conditions to declare but i had several hospital referrals in 2016. I suspect I am going to have to pay extra this year only (hopefully). The structure of their questions doesn't allow you to declare a precautionary hospital referral but state that no condition/problem/cause of symptoms was found/diagnosed

csgohan4

important for any health insurance policy to declare everything, so they have no comeback when you need to claim.


A lot of insurers use obscure conditions which happened many years ago and blame your current condition on this which is irritating or say because you didn't declare, your insurance is invalid

ThinkingOutLoud_2

csgohan4 wrote: »

important for any health insurance policy to declare everything, so they have no comeback when you need to claim.


A lot of insurers use obscure conditions which happened many years ago and blame your current condition on this which is irritating or say because you didn't declare, your insurance is invalid

I think Kate and many other for sure have the issue that when you have one or more chronic conditions - some of the declaration points can affect your declaration -as here an annual check up or even a reduction in drugs needed.

So declaring everything is clear - but if the insurer won't define a term I hangs off e.g. "treatment" or confirm if that check up is an issue > that makes it harder.

Ultimately, the insurer also needs to be clear, fair and not misleading. But often the clear aspect leaves something to be desired.

I think a solution is to quote if you can online and then call to buy -so there is a recording of you raising questions and their answers to those on record.

Chris_Pollard

Katejo, I can understand your dilemma. The exact wording of the question would be helpful.

People applying for insurance used to be obliged to provide "material facts" - this was included within the Declaration that is usually signed, but often now part of the on-line application process. The Consumer Insurance Disclosure Act 2012 has put a stop to this practice given the perceived onus this places on a customer who would have answered lots of personal medical questions, and is then left trying to work out if there is anything "material" about them that they haven't been asked that they need to declare.

This Act requires you to honestly answer the question. If the question is poorly phrased, or open to significant ambiguity, then in the event of a dispute, the insurer itself will either hold its own hand up, or the Financial Ombudsman Service will help hold their hand up.

I would err on the side of caution, and presume that an annual review at a hospital, or with a specialist consultant would be covered by this question. Equally, I would assume that any condition you have that has required you to have prescribed treatment, be that physiotherapy, medication or counselling would need to be disclosed.

I would also encourage you to drop a line to the insurers involved to help them to understand their questions are confusing. They have a vested interest in making questions clear and in plain English. This avoids them having to sift through lots of unnecessary or irrelevant information, and it also helps them to process and pay claims and reduce disputes.

katejo

Yes I have made the point about definition of 'treatment' more than once but all I get is a set reply telling me to ask my GP. I point out that this doesn't help me but get nowhere.
Many years ago I was trying to declare my epilepsy (seizure free). I was asked whether my seizures were petit mal or grand mal. I assured them that I was seizure free but said that my seizures had been neither of these. They insisted so I explained that there are around 40 types of epilepsy and mine were complex partial but they wouldn't accept that. I gave up and hung up on them. A few days later I was sent a quote. If the person on the phone doesn't have medical expertise, they should refer us to someone who does.


A few years back I declared my underactive thyroid to one insurer. They insisted that my condition wasn't stable because I had had a check up and a minor adjustment to my dose. I argued that it was stable because it had been monitored every year and adjusted if needed.


Many thanks for your advice. I always get tied up in knots over their poorly designed questions and refusal to answer reasonable questions. There should be a blanket definition of what counts as treatment. In a long term condition, a hospital check up. which doesn't result in any significant change to the medication or any new procedure shouldn't count. To charge an extra premium for such an appointment 'punishes' the patient for being responsible in their own care.