Private Health Insurance: Not eligible?

TomPucci85

Someone I know has a few ill symptoms of something that could be a potentially more serious. So they scheduled a video consultation with her doctor through Vitality Health Insurance to see if they can resolve it.

Now they've been experiencing these symptoms (stomach pain, loose bowel movements etc..) on and off over the past few years in "flare up" cases, but never really thought much of it, each time probably could have just been passed as a stomach bug and diarrhoea. They've never seen a doctor about it before, however this time the pain has been more severe.

When the doctor in the private health video consultation asked her how long they had been experiencing the symptoms, they mentioned as above, the past 5 years or so on and off. The doctor then told them, as they had only had private health insurance for 3 years that they would not be eligible for care in this case and that they should go to a&e to get checked up.

Are Vitality health able to do this? Reject new patients on it being an existing case, despite the fact they've never seen a doctor about any of it before, this is the first time they've approached care to look at it in a serious light. It's a bit ridiculous they can claim this to be an existing case!

Browntoa

Yes , it's now a self admitted pre existing condition and excluded

TomPucci85

So, simply disclosing they have had the runs and stomach pain before in the past instantly excludes them from care for something more serious.

So if I theoretically if I had health insurance cover the past 3 years, and develop a cough where I suspect it could be say, lung cancer, and the doctor asks how long have you had a cough for, with my reply being "I've had coughs a few times a year over the past 5 years, but just assumed it was the common cold" - this could exclude me from my health insurance?

It all seems a bit ridiculous and a bit of a scam. They had no idea simply having the runs and stomach pain could be something more than a stomach bug in the past. Surely there is a stance you can make on this? The disclosure to the doctor was incredibly vague symptoms that could have been anything, but they just wrote them off as non-eligible right away.

Weighty1

But to be fair to Vitality, the average person won't be have regular, even if infrequent, "flare up" cases of diarrhea with stomach pain. I think they are right to treat it as a pre-existing medical condition in this instance, albeit the insured party shot themselves in the foot somewhat if they disclosed it to the doctor, having never previously seen a medical professional for it.

Korkyb

If the Doctor advised your friend to go to A&E for the symptoms you describe then the Doctor needs a slap.


A&E is (as implied) for Accidents & Emergencies.


GP appointment is the way to go.