Undiagnosed CPTSD and Private Insurance?

[sickandsleepy]

Hi All

I've tried searching for the answer to this online, and I know it depends on the insurer - but how does getting a CPTSD/PTSD diagnosis work if the incident happened many years ago and I've had intermittent symptoms since.

I’ve read that it doesn’t cover pre existing symptoms or conditions. I can understand how this would work for physical conditions, but when looking at the list of mental health conditions they cover, most of them would have pre-existing symptoms.

I guess I'm trying to figure out if I would only be covered if I was insured at the time of the traumatic incident (I was 16, 30 now).

mine specifically says this 'You cannot claim for any pre-existing condition that occurred during the five (5) years prior to the start date of your policy. Benefit will be considered for pre-existing conditions where you have been free from symptoms, treatment, medication or advice for two (2) years from the policy start date. All claims must be pre-authorised.'

Am i just doomed to pay to see a psychiatrist out of pocket? I take sertraline daily but this is NOT for PTSD, it's for just 'low mood'.

I don't know if I'm making ANY sense... apologies in advance!

If you haven't yet received a formal diagnosis of PTSD then I expect it wouldn't be classed as a pre existing condition.

It doesnt matter if you didn't have any symptoms (or was not covered by your health insurence) when the traumatic event happened, as PTSD can happen at any time afterwards (I was diagnosed with PDTD for trauma that ocurred over 20 years ago).

Can you self-refer to mental health services with your insurence provider? In my experience the first stage was an hour long telephone assessment, it was this assessment that diagnosed PTSD. The insurer then provided a list of specialist trauma therapists.

I really hope you find the right treatment you need. 🙏

@SwimBikeRunBake Thank you for this. I think I have to be referred by my GP which is fine as they're lovely, I'm just worried with the insurance company that as I take Sertraline they'll see it as all one thing and decline to proceed with it :(

It will depend what the psychiatrist diagnoses. They may formally diagnose PTSD but link your low mood to this so the insurance company may say the PTSD isn’t covered as you have been / are being treated for it with the Sertaline. Low mood often goes alongside PTSD .

@Aligirlbear I guess I would be able to 'pre-authorise' it with the insurance company to avoid this happening? At least I'd know one way or another and not be hit with a shock bill.