To think my insurance should cover me nearly dying?!

Forgot - we had bank insurance. There is normally something that requires you to declare medical conditions. We have always done so and generally found it cheaper than getting the same cover separately. However for one condition they wanted so much extra that it was cheaper to take separate insurance.

My niece is currently in Australia on holiday. She was admitted to hospital last month and stayed for one week. She was hugely relieved as she had to pay nothing at all because of the reciprocal agreement.

She wasn’t enrolled in Medicare at the time; she did so after her treatment.

So might make a material difference whether it was an official diagnosis or just a visit for digestive discomfort with ibs mentioned?

I'd like to see my medical history in this case. If nothing was officially diagnosed like op says I think they'll have to end up covering her.

( used to sell insurance, and ibs was never an extra charge and digestive discomfort would certainly not have required extra screening! )

Fortunately the Financial Ombudsman takes a different view to many of the opinions being expressed on this thread. You can read some of the Ombudsman's judgements on their website.

Read your insurance policy carefully. Most require you to declare conditions where you've seen a gp and/or been to hospital in the last year, 2 years, 5 years. They may also require you to declare some conditions whenever - and the person who has an inhaler will need to declare that as breathing issues and heart problems (generally now defined to include high blood pressure) are usually "anytime" must declare. If in doubt declare, it doesnt necessarily massively increase premiums.

A single episode of bloating or discomfort that was not given any prescribed medication or further investigation is unlikely to get them out of paying unless it was withing their time period for declaring anything. You have to go through their formal complaint procedure, you may then benefit from getting your GP to write a letter saying no reason to believe it was your appendix. S/he should should have referred you if s/he thought it was. The Ombudsman is likely to expect an expert opinion from the insurers if they refuse to pay.

They are corporate robbing bastards who will do ANYTHING to not pay out. I fucking hate them.

Thsi might help as far as the agreement goes https://www.servicesaustralia.gov.au/reciprocal-health-care-agreements-visiting-from-united-kingdom?context=22481

HOWEVER - Download your insurance policy and the policy terms and conditions - the very fine print and go over it with a fine toothcomb. My instinct is that they are trying to get away with it . If after you have read it and you are ok - To be honest the majority of policies ask questions about your health in the last 2 or 3 years - operations / medcines you are on / previous conditions , which if you were NOt diagnosed with IBs then it is totally irrelevant. Its like saying you have lung disease when you got a cold. If you never had a diagnosis by a medical expert =doctor then they cannot said you had it - you can ask your surgery for a copy of your medical records showing that you have had no diagnosis. When you are sure that you have done anything correct then contact again and threaten with social media , find the name of senior people and fight ! They did exactly the same with my sister and husband and she won . A word of advice about travelling before you come back check that the airline will accept you to travel and that you are fit to fly - they may have rules about how long you have after the op before you are deemed ok to travel.

Speak to the British Embassy nearest to you. They will be able to clarify the reciprocal agreement and generally support you.

Insurance companies need every tiny little apparently irrelevant thing declared or they will use it to wriggle out of paying.

You just need to battle on with them.

I think if you do have travel insurance through your bank you do have to notify them of certain medical conditions. It is worth checking with your bank before the next time you travel imho.
Better to be safe than sorry.

You can see your medical notes via the NHS app nowadays - if you’re worried about whether you should be declaring something, you can always check there.

Meant to add its also affected by age.

I had breast cancer 2 years ago and since then whenever I've travelled I've declared it along with everything else eg mild asthma, sciatica etc . However they recently diagnosed me with a low level heart murmur - they are not worried about it but I have to have another test in 2 years time, at same time due to a scan I had they told me I had gallstones - I have never (touch wood) suffered with gallstones and didn't even know I had them. Last time I went away I included these last 2 issues to my insurance company and they covered the gallstones but not the heart murmur.

100% Agree. DH has had a series of various musculoskeletal issues over the years, but no diagnosis or underlying condition has been established despite multiple investigations. I am mindful to include everything - as I don’t want the risk not being insured, but worry that it would be easy to forget something. The online forms are also challenging to fill in as the categories don’t ever seem to fit - and I say that as a Nurse.

And don’t get me started on the premium.

They ask to see your medical history when you make a claim.

And yet you’re the one who’s felt the need to come and snipe at me for giving a factual
answer 🤷‍♀️

I wasn’t enjoying myself at all (not that you care, you’d already judged me) - I was answering her question. She didn’t declare everything to her insurers so they’ve refused her claim. Unfortunately it’s very very common.

I’m used to being sniped at on here for my answers though - I’m autistic and just let it wash over me now.

If you have health conditions please don't assume that the standard travel policies that come with certain accounts will cover you abroad - please check the small print etc.

I'm no expert in these matters, @JasonMurrayMint but am pretty sure many of the bank "insurance included" packages will exclude pre-existing conditions as standard, so they won't need to ask because they've already covered themselves

Like most businesses they want to suggest they're giving you something extra while actually spending as little as possible, and specialist insurance costs money

Write to your MP

How did the insurance company find out about IBS if you didn't tell them?

The claim will have been denied by someone in a call centre whose medical training extends to knowing that the appendix is part of the digestive system and IBS is also to do with that system. Go through the appeals process and you should win — but first, contact NHS Overseas Healthcare Services https://www.nhsbsa.nhs.uk/contact-overseas-healthcare-services and they may be able to make the bill go away (in which case you should get a refund from the hospital).

If the insurance company does try to stick it out then you could also maybe contact the consumer pages of a major news outlet. The Telegraph and Guardian both have columns where a large famous company does something outrageous and after one call from the journalist or magically gets fixed.

I explained further up thread how they will use something like this to justify not paying out. It doesn't make it right of course and you need to push back.

An Australian who is very perplexed. As long as you are entitled to NHS services then you should be covered by the reciprocal agreement, even if you are just here in transit (which would be odd as we are an ‘end’ destination😁). Doesn’t matter that you went beyond A&E, it only matters was that it was a condition requiring emergency treatment, which includes surgery and ICU. What isn’t covered is if we can patch you up so you can hobble back to the UK for treatment, but this isn’t the case here so really confused about the route you are going through. That’s all provided you used the public hospital system, but tbh I can’t fathom in your particular case (emergency appendicitis) how you would have used a private system here.

I didn’t declare something minor from years ago that has nothing to do with this.

Non-declaration is non-declaration. Whether you think it has anything to do with your current condition or not. The proposal forms are quite clear everything must be declared.

I would have refused a claim on this basis (& when I worked for a major UK insurance company, I sometimes did).

Frankly, I think there is more to this than we are being told.

There is some loose evidence that people with IBS are slightly more likely to go on to develop issues with their appendix and they are probably using that here.

You're enjoying yourself at OP's expense. Whenever I see a response giving someone a kick when something's gone wrong it's so often yours.

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OP - Insurers will deny liability whenever they can and certainly at a first claim attempt. Don't back down.

I'd have a friend ring the insurance company for a quote for Oz next year and mention the exact situation with IBS that wasn't formally diagnosed and was self limiting years ago. I bet they still offer to cover and no additional cost. Obvs not binding but will give you some reassurance etc. You can even buy the policy and check the wording to see of it matches your existing policy.

I'd say they will most likely end up covering you in full as IBS doesn't lead to appendicitis, especially if IBS symptoms were years ago. The 2 are not connected.

Insurance companies are assholes.