To think my insurance should cover me nearly dying?!

I’ve heard about the reciprocal agreement, but it doesn’t seem to cover everything, and we’ve still had to pay a fortune upfront. I just don’t see how they can justify refusing to cover an emergency that has nothing to do with a minor stomach issue from half a decade ago!

Again, something is not right with this. If you were treated as a public patient, in a public hospital, which is typical for acute appendicitis, then the reciprocal agreement should cover everything you have described. It certainly did when I worked in the system, and I checked with a colleague still working and they said no changes.

I have a feeling, when you/or your DH if you were not able to interact, were asked about admission, instead of saying public, for which the reciprocal agreement should cover 100% costs associated, you said your travel insurance was paying, which then makes it a self-funded admission in the public hospital. Or, you said private on the basis you thought travel insurance would cover that (which would match with the reciprocal agreement only paying what it would have for public care). I can only conclude that’s how it’s gone this pear shaped. In which case, I can understand why your travel insurance would be scratching its head wondering why it is being asked to pay for this as self-funded or private as opposed to what should have been covered under public via reciprocal and bucking up about it.

To make it all a bit more complicated, you can choose private in a public hospital here. There is pretty much zero benefit of this to the patient apart from choice of Dr. However, given emergency admittance for an acute condition, you don’t have time/capacity to research which Dr you want, then there’s the aspect of which ones are currently on and there on site, as typically they spend a portion of time in public hospital and portion in private hospitals to make their $$. So, even if you are a private patient in public hospital you are just going to get who is on and available in theatres or ICU at the time. They will still try their best on admittance to try and get the ‘private’ ticked if they can though as the public hospitals need the extra $$ that goes with this. If you have private health coverage here it’s no loss to say yes, I always do, you just make sure they waive the private hospital excess payment you would pay in an actual private hospital. This does not extend to someone with travel insurance though who has opted to be self-funded or private via travel insurance, that’s a completely different thing!

I’ve not RTFT, only the OP’s comments.

I was the underwriting/claims manager for an insurance company for life/health claims. I worked there for 17 years.

I didn’t have anything to do with travel insurance but the principles of underwriting and claims assessment are the same.

If your policy was fully underwritten, rather than a short-form application that just excludes pre-existing conditions, a claim can only be denied for non-disclosure if it’s a material fact.

IBS that occurred several years before and had fully resolved would not have affected the terms that were offered, nor is it related to what is being claimed. It is not a material fact and cannot be used to decline your claim.

If your policy was a short-form application and not fully underwritten, they still can’t deny your claim as a ruptured appendix is not a pre-existing condition.

You need to ask for it to be treated as a complaint and for a final response to be issued. Once you receive this you can go to the insurance ombudsman. If it gets to that point, I’d expect you to be awarded full costs, including your credit card interest, plus a distress and inconvenience sum.

Maje it clear to the insurer that you WILL be referring this to the ombudsman - each referral costs the insurer money even if they win. Knowing you won’t be backing down is sometimes enough for them to cave.

If this is the full and complete version of events as you’ve described, the insurer doesn’t stand a chance in hell of winning at the ombudsman.

So how do they know? If it’s self-diagnosed then you didn’t definitely have it. Stress, a change of diet or rich food can cause irritable bowels. I think you’ve got to majestic sure you five use clinical terms that can be used against you.

I forgot to add in my previous post that it is very easy to get a summary of your medical records, or at least a list of all the times you have visited your gp together with basic info from any letters they have received from consultants at hospitals. I think it was something the receptionist can do very easily.

I was asked to provide a summary of my medical records when I last renewed my Blue Badge and was pleasantly surprised that all I had to do was phone the go surgery and request one - it was emailed to me within days at no cost. Basically it is a print off listing all your gp visits with any outcomes, in my case going back to the 1980’s when I assume records were computerised, covering all my gps since then. It also included a list of my current medication.

I found this really helpful when phoning to get my recent travel insurance quote and now have a copy on my phone. No chances now of missing any vital evidence for insurance purposes!

When I declared my pre existing health issues to my travel insurance company (free with my bank), at the end they asked if there was anything else. I jokingly told them about a verruca. They added it to my list!

Interestingly they did cover me for my heart murmur/leaky valves.

Seriously, it must be very scary for you and I wish you the best of luck.

It’s in the small print. You have to phone the number provided and disclose anything to them within 1-2 years and/or some permanent diagnosis. Otherwise the insurance is not valid.

You don’t just get insurance free / cheap with your bank account irrespective of any diagnoses.

I’m assuming you opted for private care on the understanding that you had travel insurance? The system is quite complex here with some things being covered by Medicare, others your insurance (if you have it) and often there is still a “gap payment” as I learned the hard way with my cancer treatment. If you have a breakdown of your costs you might be able to get the hospital to claim what they can from Medicare if they haven’t already done so but if you have had a private hospital bed nothing except insurance will cover that. Good luck.

The best way to think of insurers is as a massive bunch of scamming cunts.

They take your money and will do literally ANYTHING to get out of paying out.

If you sneezed three years ago. It will be an excuse not to pay. Look at the recent case of the woman holidaying in the US whose doctors said she couldn't be moved. I think it was Aviva that said if the family did not agree at that moment on the phone to repatriate her, that they would cut funding off. They basically were willing to risk killing her to avoid paying.

I had to have emergency surgery the day I was supposed to fly on holiday. The insurer (through Lloyds) never paid out. Not pre existing conditions. The just made it impossible. They would ignore for months and then ask for another piece of info. In the end they wanted my GP to provide my entire medical history so they could examine the run up to the operation. There was no run up. At all. I gave up as it as apparent they wouldn't pay.

I lost a pair of earrings that were listed on the house insurance, the insurer said that unless I could 100 per cent guarantee they were lost on the house they wouldn't cover them.

We had our bikes stolen from our garage. They had been bought in cash, years before. We didn't have photos of them so they would pay out because there was no evidence they existed. Well apart from the fact we had been paying extra bike insurance for FIVE YEARS.

They're a bunch of cheating bastards I'm afraid.

What are they charging? Do you know? When are they expecting payment? It’s really easy to forget things mentioned in a GP appointment when it’s just a vaguyidea and no treatment is given.

We have this and I'm now worried too!

OP best wishes, I think you have a good case.

Of course insurance is not a loss making industry

I checked with our insurer and It is regarded prescription medication and you do need to declare it. It made no difference to the policy cost.

And HRT isn’t even medication! It’s hormones.. madness !!

But the in the OP’s case the GP suggested her symptoms could be due to IBS. However, she may not actually have had IBS. I bet the GP could write a letter of support if asked to do so for a fee

@joshingaround biscuitsandbooks has been panicking people - and she's wrong. She now admits that her insurer only asked for something like 2 or 3 years - it was most likely 2 years - for any visits to a doctor. You do have to declare conditions that are ongoing but not e.g. your C section. You declare covid if you saw your gp in the last however many years they ask for - so maybe yes if within the last 2 years but not from 5 years ago. You also have to declare any conditions they specifically say they must be told about if you have ever had them, so things like heart problems and breathing issues including asthma. So I'd phone up and ask if a one off chest infection counted. I cant remember but cancer if probably one of the "ever had it" things you must declare.

Anything I'm doubtful about I phone and ask them, you may be told they dont want to know if it's in the past or that they can cover you for a small amount extra - I had to pay about £2.50 once because an infection meant a gp visit.

Have you now enrolled in medicare?
UK reciprocal healthcare agreements with non-EU countries - GOV.UK

I am Australian but my family are English - there is reciprocal rights unless you went to a private hospital but as an emergency I doubt it? When we land we can get a temp medicare card (equivalent of NHS) - ring medicare and ask for advice? I am pretty sure you can also go to medicare and get a refund. My english hubby went to A&E twice last visit and staying in hospital for a few days and he just had to show his english passport.

Reading this all with alarm. I have a long history of various medical stuff including cancer.

I have to have specialist travel insurance as there are only three who will consider me - and only one who does not cost more than £2k just to insure me. However it takes me about three hours to get insurance online as I have to go through all my conditions that I’ve currently got. And if you press one button incorrectly you literally have no way to correct it and have to start again! Not just that part again, the whole claim again. It is appallingly bad, but that’s what I have to work with as a cancer patient.

But there are plenty more illnesses and chemo related stuff in the past that haven’t bothered me for 20 years eg appendicitis or UTIs when I was having chemo (only caused by chemo, never had one since). Do I literally have to ALSO include stuff from 20 years ago in case I have something else (eg bowel perforation (never had it, just using an example) because otherwise they might say it’s related to the appendix op you had 20 years ago? Or related to the C-section I had with my children? Do I have to declare c-sections? Do I have to declare covid? - I had to call the GP as I got a chest infection but recovered and that was five years ago. Where do you draw the line?

Because the discussion has evolved a bit and people are finding it interesting.

I think there must be more to the OP's story than we're being told, otherwise (as you say) she shouldn't have any issue getting her treatment covered.

Why are people still going on about insurers and ombudsman when in this case they shouldn’t be involved - this is why we have reciprocal agreements between countries

@anyolddinosaur thankfully I've never had to claim on my travel insurance, but when I last took it out (well before COVID) I was asked about everything I'd seen a doctor for in the last x amount of years - I think maybe two or three? I don't remember which insurer it was though.

The person I know who had their claim refused had their complaints dismissed by the Ombudsman on the basis of non-disclosure. This was car insurance rather than travel, but it's made me incredibly cautious ever since. I would rather over-declare than risk not saying something and getting refused a claim.

All to the good, @Umbilicat

To follow up I remembered another tiny thing, added it to my policy and have been charged £30 for it, which is annoying but better that way round than having an entire claim denied because I didn't mention it. I'm going to have a policy of listing everything mentioned to the GP in the past year in future.

That's why I often think threads like this are worthwhile, Umbilicat, even if the OP mentions things which don't make sense on the face of it

It's the sharing and extra info we all get that helps IME, and if it's helped you too that can only be good

Get onto Martin Lewis. This is just the kind of fight he likes.