Knee appointment with specialist via private health insurance... tbink I buggered up my claim

[NooNooHead1981]

...by declaring that I had previously had knee symptoms for a long time, and now Aviva is saying that as it is a pre-existing condition that they will have to see what the medical underwriters say re: getting insurance to cover it.

Fair enough, my own silly fault. I shouldn't have said "yes" to previously having symptoms on the form, then going into great detail about it 😳😒🙄

I'm actually pretty pissed off with myself to be honest. I've had knee pain in my right knee for about 20-odd years, and I have had intermittent periods of knee locking when standing from being crouched down, which I have been finding are becoming more frequent after recently getting back into running.

Having seen a physiotherapist on the NHS earlier this year who told me that I have an instable kneecap which is maltracking when I bend my knee, so it partially is coming out of the joint, I think I've been pretty dumb to jeopardise my chances of getting decent help from a private specialist.

I already have an appointment to see a orthopaedic doctor next Monday but I'm guessing I will need to cancel now unless Aviva say that I can get cover. If I hadn't mentioned the symptoms being previous ones, then all would have been ok.

Any advice in preparation for what to say when I hear back from Aviva? Or should I just go with my silly mistake and accept I have messed up with the claim? I'm guessing I can't really talk my way out of the symptoms unless I say that it was never a proper diagnosis or condition, just symptoms.

I shouldn't have said "yes" to previously having symptoms on the form,

You did have symtoms though, you correctly disclosed a pre- existing condition, to say no would be false.
If you had said no it would have invalidated your claim anyway as they would find out from health records.
It's always best to be as honest as possible with insurance as if you make one incorrect disclosure they can end up cancelling your policy altogether.

Are you in the UK? You could see your GP and be referred to the NHS. There will be a delay so I’d do this as soon as you can.

It’s one thing to have a bit of an issue that has occasionally popped up in the past, and the another thing for it to be a chronic issue. You really can’t claim it’s a new issue for the latter. It’s fraudulent.

Whether they would ever do something about it is another matter, but rather than you buggering up the claim, it was not a claim you could have made it in the first place.

Usually when you take out insurance it’s under a moratorium. I think you could argue with them if your condition has only just been diagnosed and if you didn’t seek any treatment advice or medication during the 2 year moratorium period. It really depends when you took out the insurance and whether you’ve been to the dr about your knee recently.

https://www.aviva.co.uk/health/health-products/health-insurance/understanding-medical-underwriting-types/

She saw the NHS physiotherapist this year.

Thank you all.

Yes, it would have been dishonest of me not to declare the symptoms that I'd had for years, which is why I told them about it.

I'm presuming that as it's a chronic condition, although not disabling, that it will be under the pre-existing conditions. I have long periods where it doesn't flare up at all, but others when it comes on badly and I have to watch the exercise type I do.

It was pretty bad this year when I had several occasions where it locked when I was sitting down, and another when I rolled over in bed. A quick Google (which is never a good idea, I know...) shows "patellar subluxation" ie partial dislocation, but obviously I have to get an expert to decide what it is.

I'm pretty sure the pain is on a par with a dislocation, as it is so hard to unlock and straighten it when it gets stuck. One day I actually thought I might need to call an ambulance to help me get up from being crouched down as I couldn't straighten it 😳🥺

When did you take out your insurance?

It was with my husband's work and he has been with his company for nearly 13 years now.

Oh, that might change things. How often have you seen a doctor / someone for your knee in those 13 years?

Also, double check the provider. Whilst he may have been there for 13 years, doesn’t mean it’s been the same policy in those 13 years.

Probably about 3 times, the first being in 2010 when I remember seeing my GP and telling him that I felt like my knee was dislocating.

Then I had an MRI scan which was inconclusive and the doctor told me that he couldn't see anything really noticeably wrong, and that there aren't any fragments that might need clearing etc.

Then I think I had a referral from my GP last year to get physio on it, so it's really only been a few times now. But when it does flare up, it is horrid and I literally don't even like the thought of having to straighten it out, letalone actually doing it.

Hmm, I actually think you could have a case for arguing that it’s not a chronic condition during the term of your policy. Your OP made it sound like it was something you had dealt with for years rather than something that has popped up occasionally, in terms of getting help for it. In fact, try and find out if the 2010 appointment was before or after your policy commenced.

And like I said, double check the policy. I cover my son through work, and they changed provider last year. Even though I pay for him rather than my work (who pay only for me), anything that arose during his previous policy with a different provider was now a pre existing condition.

under the moratorium if you go for 2 consecutive years without having any treatment or seeking advice then the joint should become eligible for cover. From what you’ve said I think you do have an argument for cover especially since you had a scan and the dr said there was nothing wrong with it in the past and you’ve been with them for so long.

I used to sell private medical cover for an insurance company

Ah, excellent thanks 😊 I'll see what Aviva says when I get a reply. I'm hoping that as it is an intermittent problem, it will be viewed more favourably. The few occasions that I've seen a doctor about it hasn't ever come to any definite conclusion or diagnosis, so I will try to get that across to Aviva.

Our Bupa policy covers pre-existing conditions after 5 years so depending on how long you’ve had the insurance there is hope!