confused about the rules for surgery

lisyloo

This is probably a silly question, but I presume he’s not covered by private medical insurance?

you can often choose which hospital you go to on the nhs and check waiting times. Have you done this?

I believe your insurer are saying they will not provide the medical cover if he’s still awaiting an op, but in this scenario they should cover you under the cancellation section.
so they are saying it’s their preference to compensate you for the holiday (minus the excesses you agreed to) rather than take the risks of covering you (If he hasn’t had the op).
Im pretty sure they are within their rights to do this and the choice is theirs and not yours unfortunately.
in general insurers are entitled to go for a cheaper option e.g. write off your car rather than repair. The determining factor is minimising cost which overrides what you might want unfortunately.
You should only lose the 2 excesses (that you agreed to) not the cost of the whole holiday.

Lots of employers recognise the convenience of being able to schedule medical care and that’s why they provide private insurance.
I sympathise but unfortunately with the nhs you don’t get convenience of speed and fitting around holidays and currently the nhs seems fairly broken to me. I totally sympathise on this. 

However you do have some options so I’d suggest you research where he can get the op done and what the various waiting times are.

it has never been the case with the nhs that you can schedule around holidays unfortunately but you should be covered for cancellation. What you can’t do is force your insurer to cover you for medical costs now he’s waiting for an op just as you wouldn’t be able to force an insurer to fix your car or your washing machine if writing it off was cheaper.

helenajosephine

Hi lisyloo. Tbh, I sometimes wonder why we bother with insurance at all. OH is retired and doesn't have private cover. He did when he was working but the one time he looked into claiming on it, he discovered that there was some sort of clause that meant the treatment he needed wasn't covered. It feels very much like that now with this travel insurance. 

You're right of course, the insurance company can basically put in their own rules and in a worse case scenario we'll be a couple of £k worse off. It just seems wrong that the reason I took out insurance was to cover the risk of cancellation, and now cancellation is a risk, it's pretty much worthless. It's just adding stress to an already pretty stressful time.

lisyloo

Sorry, I don’t understand why you will be a few £ks worse off.
if they are saying they won’t cover you for medical then that is their choice but they should cover you for cancellation.
i suggest you confirm this with them.

if they say they won’t cover you for cancellation then you should ask them to point you to the section in their policy that excludes cover for a new condition after booking.
you have a contract and they need to stick to it.

They cannot decline cover and you have recourse to the ombudsman.
what they can do is decide to cancel rather than risk large medical bills. So they can “write-off” your holiday just as they can a car or washing machine.

Have you checked the cancellation conditions of the holiday booking(s)?
It may be less than a total loss if you cancel now???

sheramber

I took the policy out in good faith on the basis cancellation due to illness is covered, yet the discovery of something that needs surgery doesn't seem to qualify as an illness for which we can claim.

Your cover was agreed on the information given at the time. That information has now changed and your husband has an untreated condition.
 You are required to notify the insurance company of any changes so that they can review  the cover provided.

In your case they are not prepared to provide cover for the new condition.

if you had gone abroad without telling them and needed to claim they would require your medical history from your GP. which would show that the condition arose before you travelled and they would have refused any claim for treatment abroad and consequential expenses.

The Staysure policy states 

We are unable to provide cover for any pre-existing medical condition(s) where you have an undiagnosed medical condition, or a condition where you are currently on a waiting list, undergoing treatment, or tests or, where you are awaiting the results of any tests.

The value of having insurance means you can now cancel and recover any costs less any excesses.

Without insurance you would lose the lot.

helenajosephine

Hi, thanks again lisyloo and sheramber. I seem to be eternally confused about this. I'm not normally so dim. I think I do need to go back to Staysure customer services to clarify what I think I understand. 

The policy wording seems to suggest that the OH's condition is covered for emergency medical cover and repatriation whilst we're on holiday, but if he has the surgery before we go and there are complications that prevent us from travelling, then the cost of cancelling the holiday will be our responsibility. That's obviously the 'worst case scenario' - and something that would be devastating in any event... 

Thanks again for your advice. I hadn't realised that an effect of getting older is in the complication it brings to travelling ! 

sheramber

You need to get written confirmation from Staysure  as to what cover you will have.

lisyloo

Is he fit to travel? And could the surgery be delayed?

helenajosephine

sheramber said:

You need to get written confirmation from Staysure  as to what cover you will have.

Thanks, I'll speak to them again and get some clarification in writing 

helenajosephine

lisyloo said:

Is he fit to travel? And could the surgery be delayed?

He feels fit, but will need to get a note from the GP to confirm he's fit to travel if he's going to be covered by the insurance. It's one of those things that if you get offered the op, turning it down might mean going back to the back of the queue. We've been travelling for the best part of 30 years, and this is the first time we've had health issues that have threatened our plans, so I think I'm just feeling at a loss. 

lisyloo

helenajosephine said:

lisyloo said:

Is he fit to travel? And could the surgery be delayed?

He feels fit, but will need to get a note from the GP to confirm he's fit to travel if he's going to be covered by the insurance. It's one of those things that if you get offered the op, turning it down might mean going back to the back of the queue. We've been travelling for the best part of 30 years, and this is the first time we've had health issues that have threatened our plans, so I think I'm just feeling at a loss. 

Its not an unknown issue.
It has always been like this, only now the NHS is more broken than it's ever been.
Private health cover is an option if you're well off enough (although they will now exclude his existing condition).

I am not sure why you are feeling this is such a big issue.
You are insured for cancellation so you'll get most of your money back and do you want to be going away to a foreign country if there's a risk he might need treatment??
Surely postponing the holiday and taking it later is a better option for you? 

You next steps as we've already said are:
1) Research the waiting times and his options for having the operation elsewhere in the country
2) Confirm with the insurer if you're covered under the cancellation section as they won't provide medical cover.

If the answer to 2) is no ask them to tell you the paragraph that says you're not covered for cancellation and then come back here.
There is Free recourse to complaints and an independent ombudsman if they are not being fair. 

The surgery is unfortunate but you are insured financially so you just need to postpone (or just go on the holiday prior to the operation).

Have you done any research at all into how long the waiting lists are?