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!

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

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

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.

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

@Octavia64 That’s what I’m worried about it feels like they just automatically say no, hoping people will give up. I’ve already told them I’m disputing it, but they’re dragging their feet. I’ll definitely be making a formal complaint.

Any tips on how to word it so they actually take it seriously? Or should I go straight to the Financial Ombudsman? I just don’t have the energy for a drawn-out fight when I’m still recovering.

May I ask which insurance it is?

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.

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

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.

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.

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.

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.

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.

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.

@Cosyblankets It was over five years ago, and it was never anything serious just occasional bloating and discomfort. I only mentioned it to my GP in passing, and they weren’t concerned. No major tests, just a basic check-up, and it was never diagnosed as IBS officially. I honestly forgot all about it because it was never a big issue.

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!

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.

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 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.

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.

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

Write to your MP

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

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.

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.

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