Health insurance advice

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Gemini

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#274566 29-Aug-2020 08:53

Health insurance advice please
Earlier this year I had some bowel issues I've never experienced before. SX refused to pay for tests as they said it was pre-existing, which it wasn't but some of the symptoms were the same .i.e. stomach ache, cramps.
Does this mean they can forever deny any bowel related issue because I had these symptoms - seems utterly ridiculous to me as different conditions can have the same symptoms. I've lost faith in them and my doctor

Batman

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#2551733 29-Aug-2020 09:25

not sure about your exact situation but you could try the insurance ombudsman

yes SX are going to deny all claims relating to your stomach cramps until the end of your life or your insurance whichever comes first

i'm wondering if you shop around you may find other insurers who may take you on - but you need to be honest and tell them everything

afe66

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#2551736 29-Aug-2020 09:34

Insurance companies make money by collecting premiums that they don't pay out....

Not sure why it's the doctors fault though.

Batman

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#2551739 29-Aug-2020 09:45

afe66: Insurance companies make money by collecting premiums that they don't pay out....

Not sure why it's the doctors fault though.

except this insurance says "we're not for profit we're for you" so one of the statements is incorrect

Batman

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#2551741 29-Aug-2020 09:47

https://www.southerncross.co.nz/group/community-impact/not-for-profit

Gemini

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#2551748 29-Aug-2020 09:53

From their website

A pre-existing health condition is any health condition, sign, symptom or event occurring or existing before the start of your cover (or start of upgraded cover) where you were aware, or ought reasonably to be aware, of that health condition, sign, symptom or event.

So this means if you've ever had a headache or stomach ache you are not covered for anything that may cause them in the future .e.g bowel cancer, brain haemorraghe etc

Batman

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#2551751 29-Aug-2020 10:00

yup they really should have an independent doctor to look into claim acceptance - that is what you should ask the ombudsman.

they are using in house assessors who are heavily biased against the policy holder

maybe write to them to use an independent assessor and nicely mention the ombudsman and legal advice

any lawyers who can give advice on how to write a nice letter

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Fred99

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#2551821 29-Aug-2020 10:53

Batman:

maybe write to them to use an independent assessor and nicely mention the ombudsman and legal advice

Is that the Insurance and Financial Services Ombudsman?

They don't get involved until a "notice of deadlock" is declared (ie you'd exhausted all possible means to resolve a dispute through the insurer's internal complaints processes etc). But the declaration that "deadlock" has been reached can only be made by the insurance company.

https://www.ifso.nz/complaints

tdgeek

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#2551900 29-Aug-2020 13:07

As a side topic, if your claim goes nowhere, have you asked about public health for the ailment? I had 3 hernias, two pre existing so no cover. Ok, after all this time Ill stump up 11k and finally get them sorted. The private consultant said he can do it, but go to doctor, get a referral for public, they have to see you in 3 months and have to operate in another 3 months, and that's what happened recently. (excluding lockdown delay)

We had insurance, yes myself and the wife had major surgeries, but we would have had anyway, just not a comfy room and better food. We cancelled a while back. It appears the days of never ending waiting lists might be over. My hernia op was done by private (same consultant as it happens) as public was behind so they feed them to private to keep up. Given my needs/discomfort is what I assume well below yours, I suggest that option.

boosacnoodle

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#2551947 29-Aug-2020 15:22

tdgeek:

I had 3 hernias, two pre existing so no cover.

Was this with Southern Cross? They covered mine.

timmmay

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#2551956 29-Aug-2020 15:33

I had a situation where Southern Cross claimed something was a pre-existing condition, but I showed that it was not on my original policy documents and they had added it themselves. I asked for it to be removed. I went through a big process, getting information from GPs, etc, finally got it removed. I found persistence, politeness, and using their own processes was necessary to get it done.

tdgeek

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#2552046 29-Aug-2020 19:59

boosacnoodle:

tdgeek:

I had 3 hernias, two pre existing so no cover.

Was this with Southern Cross? They covered mine.

We were with NIB, pre existing, no.

I am with SX via an employers plan. I didn't sign up as we were with NIB then, but if I had there was a period for initial employer signups that would have covered pre existing for I think the first 60 or 90 days

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mdav056

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#2552156 29-Aug-2020 22:01

Whatever it costs, get those symptoms checked and sorted. I know these symptoms...and SX sorted them, but I had been with them for many, many years.

gml