Private health insurance

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Inevitably posting here for traffic!

Have been forking out on a private medical insurance policy I can (very) ill afford for just shy of 2 years, and am waiting on a hip replacement (that I was told I would need not far off two years ago ). Am patiently waiting on the two year point (policy is two year moratorium) in order that I can claim the op on the insurance for various reasons.

The need for the replacement is loosely and amongst other things rheumatoid arthritis related. An injury technically responsible, but hurried along by arthritic swelling.

I started breastfeeding my baby daughter not long ago and this has sadly triggered a minor to moderate flare up - hips unaffected but knees and toes (knees and toes, knees and toes) and an elbow proving very problematic.

Obviously I intend to get a referral from the GP for further investigation and medication ASAP, but am terrified that would remove my ability to claim for the hip replacement, since as I understand it a 2 year moratorium offers cover for previous conditions for which there's been no mention or treatment for 5 years, after 2 years of policy. Does anyone with any knowledge of private health insurance know whether treatment of the arthritis in the knees, toes and elbow would mean I would run into problems claiming for the hip - that they might consider there was relationship enough between the two things that it would qualify as being the same issue within the 5 year period specified?

TIA and apologies for lack of concision, feeling a little sorry for myself at the moment!

Hopeful bump.

I'd love to help but not sure what moratorium means?!

Moratorium means they can legally not have to pay during a period specified, and actual claims are postponed for this duration.

Dunkling's right essentially a 2 year moratorium means that after 2 years on the policy, the insurance co will pay out for pre-existing stuff (i.e. stuff that's been identified/investigated/treated within the last 5 years).

My concern - which I hope to God is needless - is that getting a prescription for an arthritis flare in my knees etc will enable the insurance co to wriggle out of covering my hip replacement on the basis that some degree of arthritis in the past has contributed to the need for it, even if it hasn't outright caused it.

To add - what I'm hoping is that this won't be the came on the basis that we're dealing with different parts of the body - so at the 2 year point, even if I've taken e.g. NSAIDs for the knee flare up, I won't have received any medical attention for the hips in well over 2 years. But I've no idea whether or not the "different body parts" thing is relevant, or whether any whisper of the arthritis being involved in the hip issue is enough to nullify any claim.

To do that they would have to be able to argue that the hip, knee and elbow pain you have now are all related and arising from a single cause (which occurred during the moratorium) .

Your hip issues might be worsened by RA but i wouldnt have thought that RA is the originating cause, is it?

Caveat: i work in insurance claims but not specifically health insurance.

Thank you so much for replying Blue, that is very reassuring! Logically to tie the cause of all the issues together would be impossible since, as you rightly identified, the actual originator of the need for the hip op was not the arthritis itself (even if prior arthritis hadn't helped the matter). Am cautiously optimistic!

no worries.

when you see your surgeon about the hip and they are applying for funding from the insurance, explain to them that you are concerned about the insurance company being clever and that you would like them to be explicit in documenting that the hip damage has a specific originating cause (not RA). They very much go by what the doctors tell them.

IME private health care in the UK is money ill spent.

Unless you have taken out the policy as a young person and not claimed for years, they almost always find some reason not to pay.
EG You were treated for back pain following a fall from a horse in 1960 so your claim for treatment for a hip replacement in 2017 is invalid as it is obviously a complication resulting from the pre existing condition...
Even if they do pay for one thing premiums rocket up for subsequent years, especially of you are looking at chronic conditions.
IME you are better saving the money from the premiums and self funding if necessary. Or you can pay for a private consultant appointment jumping the NHS referral queue and then access NHS treatment for free.
If you stay healthy you can spend the money on something else.

We have private insurance

It is a good policy but we have trashed it over the last few years, physio, operations, blood tests, ultrasounds, x rays, MRI

Dh cant leave his job...we will never get cover anywhere else

mouse

I am afraid i have no advice im afraid, its been decades since i worked in health insurance but i hope it all works out for you

I'm a bit unsure OP as you state in your OP that you were TOLD you would need a hip replacement - so surely that would invalidate it anyway?

Sorry if I am confused but it reads like 'I was told I would need a HR in the next 2 years so took out private insurance to pay for it 2 years down the line' that would make it an existing condition surely?

If it's in her notes (from just before the policy started) that the operation is required, it is highly likely that the insurance company will refuse to pay for it.

It's not a pre-existing condition in the sense that further things might go wrong. It is an identified required procedure. And that procedure was not carried out. Indeed, if it ever came to pass that not having the operation (or at least pursuing the referral) on time made the slightest difference to the extent of the condition, then it's possible it'll be excluded in its entirety.

I would reccomend waiting it out. They will do anything to wriggle out of paying.