To think my insurance should cover me nearly dying?!

[octavio1996]

Posting here because I’m at my wits’ end and don’t know what to do. Currently stuck in Australia after a total nightmare and my insurance company is refusing to pay out.

Basically, I was travelling here on holiday with DH and the DC (two teens, one younger), having an amazing time. Then out of nowhere, I got really ill massive pain, collapsed, rushed to hospital. Turns out it was a ruptured appendix and I ended up in intensive care for days, genuinely thought I was going to die. DH was beside himself, kids were terrified. The hospital care was amazing but obviously, this is Australia, and the bills are absolutely eye-watering.

Here’s the kicker: my travel insurance is now refusing to pay. They’re saying it’s a “pre-existing condition” (it wasn’t), or that I didn’t declare something minor from years ago that has nothing to do with this. I’ve been on the phone to them constantly, but they’re just fobbing me off. We’ve already had to put thousands on a credit card just to get me discharged. We were meant to fly home next week, but I’m not even sure I’m well enough to travel, and obviously, we can’t afford to stay indefinitely.

Has anyone been in this situation before? Do I have any chance of fighting this, or are we totally screwed? DH is trying to stay calm for the DC, but I can tell he’s panicking too. I just want to go home and not be bankrupt.

TL;DR: Nearly died from a ruptured appendix, travel insurance won’t pay, stuck in Australia with a huge bill. Help!

You have to declare absolutely everything to travel insurance - did you?

Not sure on insurance thing but as far as I'm aware Australia have a reciprocal agreement with the UK so you shouldn't be charged for treatment unless you went to a private hospital ( assuming you are a UK citizen of course)

How can appendicitis be an existing condition.
I'm sorry you are going through this.
Insurance companies will try and get out of paying
for the most stupid reason.
A friend had 5 stitches in his hand. Never declared it.
When he lost his bag they refused to pay out.

I don't understand why you had to pay. Australia has a reciprocal agreement with the UK and emergency medical treatment is free. All you have to do is produce your passport.
I went several times to A&E when I have been there, registered with a doctor, baby went twice when we were there last time, and never have I had to pay for anything.

Find out more about healthcare for UK citizens in Australia. Essential and urgent hospital treatment is free. There is a charge to visit GPs and receive prescriptions. You can recover some costs through Medicare, Australia's universal health insurance scheme.

https://www.gov.uk
Health - Austr

@biscuitsandbooks I declared everything they asked for! I don’t have any history of appendicitis (obviously, or I wouldn’t have a bloody appendix to rupture!), and I’ve never had any issues that should be relevant. They’re saying I didn’t declare mild IBS from years ago, which was never even diagnosed properly and has nothing to do with this. How on earth was I supposed to know that would count?!

I thought travel insurance was meant to cover emergencies, not look for any excuse not to pay. Feeling completely trapped right now.

Emergency refers to A&E, not any urgent treatment that results in surgery and admission to a ward.

What is it they claim you fail to report? Had you gone to your gp with stomach pain before travelling?

@octavio1996 there’s your answer - you have health issues that you didn’t declare to your insurance company. You have to tell them absolutely everything.

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.

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.

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

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!

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.

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

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.

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.

@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’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

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.

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.

@vivainsomnia They’re claiming I should have declared IBS symptoms from years ago, even though it was never officially diagnosed and I haven’t had any issues in ages. I’ve never had anything remotely like appendicitis before, and I certainly didn’t see my GP about stomach pain before travelling. This came completely out of nowhere!

I get that insurance companies have their terms, but surely this is just them looking for a loophole? It’s not like I had some secret history of appendix problems I failed to mention. I was just unlucky!

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