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!

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.

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.

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.

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.

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.

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.

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

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.

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! )

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.

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.

You need to have exhausted the internal complaints procedure before you can go to the ombudsman. If the complaint is rejected the Telegraph and Times consumer columns regularly help people in this situation.

It could do, I don’t know.

I just know that you’re supposed to declare absolutely everything you’ve seen a doctor for, no matter how minor and no matter whether it led to a diagnosis or not.

It’s the same as not declaring accidents to your car insurance even if you don’t claim. You’re still supposed to tell them and they can deny your claim and cancel your policy if they find out you’ve not been honest.

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

I'm the same, @CarefulN0w, but nearly came a cropper when I first had my hearing aids and honestly didn't think they'd be interested. I called them just in case and it turned out they did indeed want to note this on the policy - though happily they didn't charge me extra

TBH I still can't quite work out why they needed to know ... maybe they had some idea I wouldn't hear the bus that could have run me over?

Typo

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.

OP has stated that it was something mentioned in passing several years ago and for which nothing was taken any further, and that she'd genuinely forgotten. She completed her insurance proposal in good faith - that's the important bit from an insurance point of view - and the company are repudiating on those flimsy grounds and unfairly so, IMO (ex insurance bod).

OP, lodge a formal complaint as soon as possible (make sure you state that it's a complaint, all sorts of things kick in at that point for an insurance company under Financial Conduct Authority "Treating Customers Fairly" rules) and be prepared to take it to the Ombudsman. There's more information here: https://www.financial-ombudsman.org.uk/

I've known many an insurer try it on to see if they can get away with it, knowing full well they're liable. They can be absolute fuckers and it's why I will go with a reputable "brand" when buying insurance. They can all be slippery buggers but at least the big names have a reputation they're interested in protecting and established complaints handling teams.

Yes, this too. You have to complain internally first.

The problem with IBS is it’s a blanket term used to describe a variety of symptoms and often in my opinion carelessly applied. I’ve had various gastric issues and a couple of doctors have used the term IBS to describe it without coming up with a definitive diagnosis - it’s not a diagnosis in itself really. So people on here saying you should have really disclosed it are perhaps not understanding that it’s barely helpful to use it in any form, let alone for insurance. And it sounds like some jobsworth at the insurance company would try to say they’re linked anyway, so disclosing it wouldn’t have helped.

You're definitely not supposed to mention everything you've seen a dr for.

You're definitely supposed to mention pre existing conditions and any current treatment. And anything you have seen a Dr for recently and are still waiting to be resolved. Bloating and tummy aches from a few years ago wouldn't be a problem. Existing IBS requiring ongoing treatment might well be a problem.

Did you go to a private hospital or did you choose public?
Did you use your travel insurance? Maybe it would have been simpler to register for Medicare.

If you register with Medicare you should get some back if the treatment was in a public hospital.

Exactly - I can’t remember all the tiny ailments I have been to the doctor with over the years. I have so many ENT problems investigated and all were benign but I could tell you anything about each one. I’d be more than happy to tell an insurance company they can simply have access to my medical records. It is way too onerous to make people list every single thing that might be relevant.

The policies that come with banks you can often call them to declare existing conditions and they then send you a letter with the conditions listed per person. Usually “excluded” though from the policy.

Most people won’t be covered as they age with standard travel insurance anymore.

The thing is, it doesn’t matter (in the eyes of the insurance company) whether X undisclosed condition is linked to Y incident. It’s about whether you’ve declared everything openly and honestly.

It’s a bit like how car insurers see you as a higher risk for accidents when your car is hit while parked. It may not be linked the later claim of your car being written off, but they still need to know about it.

Absolutely agree, trying to remember the list of things that we've been to the doctor for, but have turned out to be nothing, for a family of 4 is really hard. I've no intention of misleading anyone, but may inadvertently do so. It took over a year to sort out a claim, so I'm really cautious now and probably won't ever go to the US again, in case I screw up and lose my house.

Fortunately the Ombudsman also takes the view that it's ridiculous to expect people to remember every cough and cold. Ongoing conditions for which you receive medication - have to declare. An ear infection 20 years ago that responded to antibiotics - irrelevant as no reason to believe it was anything serious. I dont declare my broken ankle from 10 years back.

Something where surgery has resolved the issue - declare if within their time period for anything or if in their "anytime" declare list.

It depends on the policy. Many do ask that you declare any doctors visits even if you never ended up needing treatment.