I have a rare neurological condition which was diagnosed in 2013 and for which I have been seeing a specialist in London since 2014. Part of the treatment of the condition involves Botox injections into particular muscles in my neck (this is a therapeutic, not a cosmetic treatment). I have been seeing the same specialist, in the same clinic, for the same condition, with more or less the same treatment since then. I have been claiming for treatment of it on my health insurance policy since 2014.
From July 2013 to July 2015, I had Aviva Level Health excess and my claims were dealt without demur. I settled the bill directly with the consultant and then at the end of the policy year I sent Aviva my receipts and they then reimbursed what I was due, less excess etc.
In July 2015 I changed policy to Aviva First Focus 500. When changing I made sure to mention my condition and if it would still be covered on the new policy, to which they assured me that it would. When I subsequently submitted my claim they told me that by changing policy, that I was no longer covered for overseas elective treatments. I keep very good records and all their calls are recorded, so I queried this. They came back to me and confirmed that I could claim in a similar way to consultant visits in Ireland, where I pay upfront and claim back at the end of the year. They also confirmed that my policy included elective overseas referral benefit. My claim was settled.
In July 2016 I changed my health insurance via Cornmarket to Irish Life Health Select More. At the time of changing I made sure to ask if my condition would be covered as per the previous policy to which they assured me that it would. At the end of the policy year in 2017 I submitted a claim. This claim was denied. I again queried it and it was settled.
Similarly in 2019 my claim was initially declined but when queried they said that “the claim was declined incorrectly” and they settled.
The same thing happened in 2020 and 2021, where they initially declined but then when I queried it they settled.
For this year my overseas pre approval form has been declined.
I know that insurance companies have to be cognisant of insurance fraud. However in my case, I have a pre-existing condition for which I am seeing the same consultant, in the same clinic, for the same condition and more or less the same treatment for the last 9 years. I am getting tired of having to fight annually with the insurance company. Each year they give various excuses as to why each claim should not be honoured, but when I query these, they settle.
Is it normal practice for insurance companies to decline the initial claim in the hope that a large percentage of people will not query it?
I intend to query why they again have declined but it is exhausting to have to go through this charade annually.
Any advice on what to do or has anyone else experienced something similar?
For me, it is not a matter of money – I am happy to pay the excess etc.
From July 2013 to July 2015, I had Aviva Level Health excess and my claims were dealt without demur. I settled the bill directly with the consultant and then at the end of the policy year I sent Aviva my receipts and they then reimbursed what I was due, less excess etc.
In July 2015 I changed policy to Aviva First Focus 500. When changing I made sure to mention my condition and if it would still be covered on the new policy, to which they assured me that it would. When I subsequently submitted my claim they told me that by changing policy, that I was no longer covered for overseas elective treatments. I keep very good records and all their calls are recorded, so I queried this. They came back to me and confirmed that I could claim in a similar way to consultant visits in Ireland, where I pay upfront and claim back at the end of the year. They also confirmed that my policy included elective overseas referral benefit. My claim was settled.
In July 2016 I changed my health insurance via Cornmarket to Irish Life Health Select More. At the time of changing I made sure to ask if my condition would be covered as per the previous policy to which they assured me that it would. At the end of the policy year in 2017 I submitted a claim. This claim was denied. I again queried it and it was settled.
Similarly in 2019 my claim was initially declined but when queried they said that “the claim was declined incorrectly” and they settled.
The same thing happened in 2020 and 2021, where they initially declined but then when I queried it they settled.
For this year my overseas pre approval form has been declined.
I know that insurance companies have to be cognisant of insurance fraud. However in my case, I have a pre-existing condition for which I am seeing the same consultant, in the same clinic, for the same condition and more or less the same treatment for the last 9 years. I am getting tired of having to fight annually with the insurance company. Each year they give various excuses as to why each claim should not be honoured, but when I query these, they settle.
Is it normal practice for insurance companies to decline the initial claim in the hope that a large percentage of people will not query it?
I intend to query why they again have declined but it is exhausting to have to go through this charade annually.
Any advice on what to do or has anyone else experienced something similar?
For me, it is not a matter of money – I am happy to pay the excess etc.