To think my insurance should cover me nearly dying?!

Can I just ask, we have travel insurance through our bank account but we are never answer about existing conditions etc, is there some sort of fine print we should be searching for? Bit worried now.

Sorry OP they really are just trying it on, it feels more and more like a John Grisham novel.

This is mostly right, but your passport probably won't work because reciprocal care agreements are generally based on residency, not citizenship. 🤓🙏

An American living in the UK and paying NI ought to get free treatment in Australia, whereas a Brit living in the US and not paying into the NHS probably will not. Certainly that's how it works for EU reciprocal entitlement anyway — maybe the UK/Aus one is based on citizenship, but then it would get into the weeds caused by things like the Channel Islands etc. (You aren't entitled by the UK–EU post-Brexit agreements to drive in the EU on a Guernsey licence, for example.)

That's why there is a card (GHIC, which is an extension of the old EHIC) to prove your entitlement. But if you don't have it, you can call NHS Overseas Healthcare Services and they can issue the appropriate bits of paper anyway.

Insurance as a business is not loss making overall and in fact travel insurance is one of the more profitable parts. Motor insurance is loss making some years.

You can't go straight to the ombudsman. You have to exhaust the internal complaints procedure first and get a final response.

I get that insurance companies have their terms, but surely this is just them looking for a loophole?

That's exactly what Insurance does though. Not necessarily loopholes, but they do look for anything that can mean not having to pay out. As I said it's a loss making industry. Imagine if they did cover your treatment so far, how much did you pay for the insurance and how many thousands has the treatment now cost? They would have had a financial loss anyway.

None of that helps you of course but just trying to explain how insurance works. They were banking on you not having to claim anything, then they've at least made some money selling you insurance. Now they stand to lose a lot of money so will try to find the smallest detail they can use to avoid paying out.

Speak to senior management and raise a formal complaint.

May I ask which insurance it is?

IBS symptoms can often be something more sinister. It must have been bad enough for you to visit doc or it wouldn't be in your notes. When you say years ago how many years ago? What tests did you have?
But yes i agree with others Australia has a reciprocal agreement

Yeah I though that fine as a young thing but over the years I’ve racked a few. Plus the let’s run a test just in case or never really got to the bottom / self resolved.

I mean I had a post viral wheeze a couple of times as an adult saw Gp got an inhaler and it went away after a month or so. I wouldn’t consider myself asthmatic or it to be something to mention to an insurance company as resolved without long term issue. Or issues with Anemia resolved with treatment. I had glandular fever as a teen that wasn’t diagnosed or treated but picked up on a full blood screening as an adult. I haven’t been abroad in ages (12 years) but do I really need my whole medical file to get travel insurance? It’s quite off putting tbh.

Many insurers ask if you've experienced this and that "in the last two years" - though I believe some ask for five - so I guess it depends on what "years ago" means exactly

It's possible they're just trying for a loophole since it's hardly unknown, but that's that the Insurance Ombudsman is for. It's not unknown either for insurers' decisions to be overturned, so I'd give them a go if you get really stuck

It’s very common for them to refuse in the first instance. Consider this the first battle in a war. Make a compaint.

UK and Aus have a reciprocal agreement for emergency care. My husband nearly died from DKA and we paid nothing.

If you are a UK citizen then I don't understand what is going on

Sadly looking for any reason not to pay is exactly what most insurance is about. It's a loss making industry. More often the premiums don't even cover treatment. You will probably find they have decided that because the appendix is attached to the bowel and you have had previous investigations relating to the bowell, that is the reason they are not paying out. It does sound a bit of a stretch though. Have you spoken to senior management?

Sometimes they will lump conditions together really broadly so even though the appendix has nothing to do with previous investigation for IBS, because you had previous investigation for a bowell issue but didn't declare it they are using that as leverage not to pay out. Incidentally while there may be no direct link there is some evidence that people with IBS can be slightly more at risk of developing issues with the appendix.

Don’t panic, provided you’ve disclosed everything (sounds like you have apart from unrelated minor IBS which wasn’t treated further), it’s very likely they’ll end up paying out. Insurance in the UK is heavily regulated so if they won’t budge I would raise a complaint through their formal procedure and if they still won’t pay then go to the financial ombudsman who will make a final ruling.

People love to scare monger on threads like these but whilst you should absolutely always declare pre existing conditions or medical investigations, the ombudsman will not rule for example that your insurance is void for treatment for a heart attack because you forgot to disclose you went to the GP about cataracts.

I’m sorry about your awful experience. Health insurers are notorious. But if you are in a public hospital most of your bills should be covered by Medicare under reciprocal agreements https://www.servicesaustralia.gov.au/reciprocal-health-care-agreements-visiting-from-united-kingdom?context=22481

@Cyclebabble gives good advice. I would also ask to see what is in your medical records. You say you weren't formally diagnosed, but the Dr may have written something like "probable IBS". You can then ask your GP to contact the insurance company to correct the record, if you think it's a misrepresentation of the appointment at the time.

I think travel insurance is getting ridiculous who on earth can remember every tiny medical appointment where they discussed possible issues which are not even a formal diagnosis. There needs to be a better way for the consumer.

Is there a way you can get a letter from the hospital to declare that there is no way that this was a pre-existing condition, that you couldnt have known it would happen and that mild ibs years ago has nothing to do with appendicitis? I would think about contacting some kind of consumer right/citizens advice.

I recieved insurance payout after nearly dying before going on holiday (the insurance covered the cost of the trip) and we had a letter from the hospital saying that although I was discharged they heavily advised me not to travel. I was surprised they paid. They even send me condolences for what I went through. Get all your bases covered. I kind of hate insurance companies who will do anything possible not to pay, just look at the state of health insurance in America. Good luck op.

Just been reading. You can apply for Medicare even after treatment which should reduce the bill though

Probably best to start with the insurance company's complaints/appeal policy, then go to the ombudsman if you have no luck. It sounds unfair but unfortunately insurance companies are known for this kind of thing, in the same way that they will say your claim is invalid because you left a downstairs window open even if the burglar broke in through the front door. Good luck.

I had a similar issue (indeed refusal seems the first tactic for insurance companies). Follow the complaints procedure (at the time of my issue I worked for the regulator- which helped and it only took 24 hours to resolve - keep all documentation/ expenses an do not let the bastards get away with this!

Yep - ANY health condition, relevant or not, needs to be declared. If you under-declared it renders your insurance void.

It isn’t quite that simple. You have to enrol for Medicare and treatment is subsidised, not necessarily free. It can cost over $1000 for an ambulance alone.

Hi I work for a travel insurer. This turns on what you did not disclose and if you answered the questions fully at the time you purchased the policy. For a major claim an insurer will ask for access to your medical records and if this shows that there is a condition you did not disclose then they would not pay up. I note that the non-disclosure does not have to be directly related to your condition you are now suffering from. If the insurer would not have covered you it will not pay out.

In terms of your options if the insurer is not paying make a formal complaint- noting very clear that this is what you are doing and ask for the case to be reconsidered. If the insurer still does not pay the claim then you can take the case to FOS, the Financial Ombudsman Service. The case will however turn on the reasonableness of disclosure. For example, if your prior condition involved a hospital submission then FOS is unlikely to rule against the insurer- on the grounds that it is unlikely that you would forget this.

A minor treatment at a Doctor's surgery might be more acceptable.