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 doesn’t matter whether the two issues are connected - you’re supposed to declare everything.

So many people get caught out with insurance claims unfortunately - you have to be so honest.

She's not been dishonest though.

The OP says she was never formally diagnosed. In any case, IBS is not an illness and is a diagnosis of exclusion.

The insurance companies just like to try to get out of paying.

The hospital care was amazing but obviously, this is Australia, and the bills are absolutely eye-watering.

Are you sure you're in Australia? That sounds like America. None of this makes sense.

There's got to be more to this.

OP simply wouldn't be charged for emergency care if a UK citizen.

There's something going on here with this story.

I suppose it depends on what you consider to be an illness.

Searching online, the consensus seems to be that IBS is a “condition”.

The definition of a condition is given as

“A 'medical condition' refers to a specific health issue or illness that can be diagnosed by healthcare providers based on symptoms, medication use, or diagnostic testing. It includes a wide range of conditions that impact an individual's health and ability to function, such as chronic diseases or acute illnesses”

Based on that would have assumed that it would have to be declared, although never being formally diagnosed with it does muddy the waters somewhat.

This ^

When buying travel insurance you have to answer the questions you are asked.

I always buy via the phone rather than online because I might want clarification of what the questions mean and that's easier with a human being than with some AI bot.

As I've posted earlier my insurer asks if I've ever had any heart problems and if I've sought any medical advice or treatment in the last 12 months. Simple. (That was Saga by the way. Whether they still ask the same questions I don't know, but that was what they asked last year)

If I was looking at buying travel insurance and I was asked about any other medical conditions more than 12 or 24 months ago, I wouldn't touch that insurer with a bargepole. Would I have to declare treatment for adolescent acne from 50 years ago? It's not worth the risk

You don’t need to claim on your insurance as there is a reciprocal agreement between UK and Australia.

People are being weird on here. Insurance doesn’t ask you to declare everything you’ve ever been to the doctors for.

It asks you if you have any current health conditions.
and then anything currently being investigated but not diagnosed and lastly and any hospital visits over last 3 years.

I state my high blood pressure. I don’t state that 15 years ago I had a chest infection that I got antibiotics for. Because it’s not a health condition.

The op doesn’t have IBS. I don’t see how the ombudsman wouldn’t rule in her favour.

but why do you have to pay? I know someone who nearly died in Australia and all he had to pay for was the ambulance? Everything else was covered including heart surgery?

Well, I'm so sorry for OP but grateful to this thread, I've just added something I went to the GP about last year, no diagnosis made but when I went online to add it I was asked a few questions about if it related to any specific conditions (answer no) and it's now listed on my policy as having been declared for no extra charge. In future I will mention anything I spoke to the GP about in the previous year, no matter how tiny.

You totally need to fight this.
totally different situation but one that they said I knew something was wrong before hand. We sent all the proof we could from doctors to bookings. They refused us until we went to the financial ombudsman for help. (You need to have a final response letter from the insurance company)
after 9 months we did get it settled I know you may not have that but if you can keep pushing for it. I knew I was being treated unfairly.

good luck and hope you feel better soon.

If you use that definition, it would seem best to send them a full copy of your medical record from the outset. Any reasonable definition of medical conditions to be declared would be current health conditions (or those that you have suffered from in the last 12 or 24 months) that increase your risk of making a claim, not a bloated tummy 5 years ago, a chest infection 10 years ago or childhood eczema.
As I have said, the insurance company are just trying to catch claimants out. There has been no dishonesty here and IBS is not linked to the appendicitis.

If this means everything that you've ever been to the doctor with then they may as well just have access to our medical records before they insure us.

Wouldn't it be easier for the insurance company to access medical notes when applying for insurance? I can't remember everything I've been to the GP for. Just as well I can't afford to go abroad.

Exactly. This is what I said above.
No one can possible remember every single occasion they have been to see a doctor since they were born.

I read this story online the other day OP. Don't know if it's any help but the insurers did at least pay out in the end.
www.google.com/amp/s/www.thisismoney.co.uk/money/experts/article-14487513/amp/My-insurer-wont-pay-cardiac-arrest-earache-18-months-ago-SALLY-SORTS-IT.html

I just checked my travel insurance ( as part of an HSBC account) and like many others it specifies the last 12 months or diagnosed conditions. IBS and many, many other conditions including (surprisingly) controlled and uncomplicated diabetes, asthma, hypertension etc. So this does seem absurdly onerous.

I called up to mention my HRT ( menopause not on the list) and the call operator said that menopause is not considered a condition, just a part of life, so HRT does not need to be declared.

Good luck OP, this seems very unfair. I’m a doctor and putting ? IBS and watching and waiting with no investigation or treatment for 5 years is NOT a diagnosis.

I'm glad you checked about the HRT. Recently a woman didn't declare her HRT and was left with a huge bill after being rushed to hospital with a brain tumour. The ombudsman ruled in favour of the insurers that she should have declared her HRT. I guess it varies from insurer to insurer.

How many of us have been travelling for decades on invalid insurance because we didn't mention the Pill or HRT?

I did insurance gor a good few years as a nurse specialist advisor. They might turn it down if you had abdominal pain or something previously or some other gut condition but it sounds to me like they are linking it to something that wouldn't stand up in court. They often try it on.
Read the pics very carefully then start the appeals/tribunal process. I really can't see how they can link this to a previous illness. Keep going, I'm sure you will be OK.

This must be what every day life for Americans is like.

Some posters seem to be insisting you have to log every concern you ever had that made you go to the GP, even when it turns out to be nothing. That can’t be right.

I’ve just taken out travel insurance for a trip to the US. I knew it would cost a lot due to certain ongoing medical conditions - osteoarthritis in both knees, TIA leading to slight vision loss in one eye, high blood pressure and highish cholesterol plus some minor issues. I am no longer under any hospital or consultant for these conditions although I do take a lot of medication to keep things under control.

Before I looked online for cover, I made a list of all my medications and dates of hospital appointments and procedures in last 5 years which meant re reading various letters and reports. I used a comparison website for insurance with or existing medical conditions and chose to look at a company that I recognised rather than the cheapest.

However, when I went through the online form, I found the multiple choice questions did not allow me to fully detail my treatments so decided to phone and talk to an advisor. By going through the questions with him, I was able to ask for an explanation of certain questions and give more detailed information from which he was able to select the best response. I went into minute detail, even down to mild allergies and a skin condition which will never need medical attention on holiday as I was obsessed with not facing any problems abroad.

Interestingly, the quote I accepted via the phone call was over £200 cheaper than the one I got when going online through the comparison site! It still cost me £550 for an 8 day trip to the US but I was expecting to pay a lot before I planned my visit.

I’m now racking my brains trying to think of other visits to my gp over the years that I have forgotten about! As I’m now 65, I’m sure there will be some but the insurance company were only interested in my more recent medical history, many of the questions asked covered the last 5 years. I get very anxious when I read about people like the OP having problems with claims! I certainly would never just choose the cheapest insurance quote.

@octavio1996 i had discussions with life insurance and others. I made it clear there was never a formal diagnosis and the test results were concluded with no abnormalities. You’re not a doctor at the end of the day so it’s not for you to self diagnose. And it was fine. I’ve had this bs with my dog’s insurance too and we contest it also on same grounds and get it paid.

also my insurer and my health insurance both have a 5 year limit so if it’s not flared up again they can add it back to cover in insurance. Sounds like your company are being out of order. I’d complain contest, get a letter from your gp confirming it was never a formal diagnosis or you were told you don have it and that during your investigations there were no signs or suggestions of appendicitis.

we have to do that with the dog. Vet writes a letter explaining how the new thing is not related to this historic thing that is an exception.

Travel companies have been stung by so many con claims that they tend to refuse claims if they can.

It’s awful. This is health insurance for you. Why we should be so grateful for the NHS and that we don’t have these battles getting everyday care.

Many insurance companies require you to tell them about anything you’ve been to a doctor about, even if it didn’t lead to a diagnosis. It’s all in the small print unfortunately.

I agree that insurance companies like to avoid paying out but disclosing all health issues is the norm with travel insurance.