# Is this considered a pre-existing condition?



## flossie (13 Feb 2012)

I have had VHI cover now for 2 years (started as First Plan Plus, now PMI 25 11). I was in with my GP last week who has diagnosed a condition and agreed that i need to see a specialist and receive treatment, to whom she has referred me. However, my symptoms have been present for 5 or 6 years and I am wondering is this considered a pre-existing condition in terms of health insurance?

Hope you can help....

Floss.


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## flossie (13 Feb 2012)

Just found this - looks like I won't be covered....

*Pre-Existing Medical Condition​*A medical or psychological condition from which an Insured Person has suffered, or for which an Insured Person has received treatment (including
Prescription Drugs) *or of which symptoms have manifested themselves prior to the Insured Person being first included for insurance* under this Policy or​within four weeks of this Policy having first incepted.


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## LS400 (13 Feb 2012)

The condition may have been present, but if you were not aware when you took out the policy, and were not on any medication for same, or were not asked to get a medical report before cover started. I would be under the impression you would be covered. 
 If you took out serious illness cover, and months later god forbid you realised you had cancer, that cancer may have been there for some time before being discovered. There is a Latin version of the words "in utmost good faith", when you were filling out the form.

Good luck with the treatment.


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## flossie (13 Feb 2012)

Thanks LS400...it's difficult to explain. I knew what the symptoms were etc. but avoided seeking medical advice. I told the GP how long this was present etc. and she has put it on the referral letter. Want to call VHI to discuss but afraid to, and at the stage where it's difficult to talk without getting emotional - don't want to be blubbering away to them on the phone


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## pj111 (13 Feb 2012)

LS400 said:


> The condition may have been present, but if you were not aware when you took out the policy, and were not on any medication for same, or were not asked to get a medical report before cover started. I would be under the impression you would be covered.
> If you took out serious illness cover, and months later god forbid you realised you had cancer, that cancer may have been there for some time before being discovered. There is a Latin version of the words "in utmost good faith", when you were filling out the form.
> 
> Good luck with the treatment.


 
The key date is the date of onset not diagnosis. 

That is the difference between health insurance or life, specified illness or PHI where it would be a material fact if you knew about it. 

Ask someone if they have a pre existing condition ? They might not be aware of one but that is not to say that they don't have a condition that they are not aware of.

_Patrick_


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## tester1 (13 Feb 2012)

Would your GP change the referral letter or has it gone as it seems you didnt know you had the condition but referral letter might suggest you did?


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## flossie (13 Feb 2012)

I believe the referral letter has the details of the dates....oh well, will see what happens. Thanks for the responses.


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## scuby (14 Feb 2012)

AFAIK, it's a pre-existing condition. once it's established by the Dr that it was there prior to joining, even though you did not know about it


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## pj111 (19 Feb 2012)

Don't proceed with private health insurance route unless insurer tells you that the procedure is covered if it is a pre existing condition.

_Patrick_


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## flossie (20 Feb 2012)

Thanks Patrick,

I have decided that I am going to pay privately for my treatment. Current public waiting time is about 6 - 9 months, and I just cannot wait that long, with GP agreeing with this and recommending going private. Should I not declare this to VHI, even if I am not claiming from them?

Also, my cover provides me with reimbursement for consultation visits. I can't seem to find anywhere that specifies if this is for any consultation or specifically for those not related to pre-existing conditions. Can anyone clarify on this?


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## pj111 (20 Feb 2012)

You don't need to disclose the operation to VHI. VHI won't be paying out. 

Leaving your GP aside, it is worthwhile ringing around a number of hospitals to get quotes for your procedures as rates can vary by 50%. 

Hospitals are like businesses and if they have low occupancy rates and vacant theatres, they will offer a deal.  

You will be able to claim your consultants fees as either an outpatient expense or day to day expense.

Trust me on the ringing around.

_Patrick_


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## flossie (20 Feb 2012)

Thanks Patrick,

I shall dioscuss this with my GP. WHen I get my appointment with the consultant I shall ask about the cost of the treatment plan and use that to see if there are other hospitals offering the treatment (it's specialised). I didn't know you could 'bargain' with them, so that's good to know. Also didn't realise i could continue to claim the consultant fees as aprt of my day to day expenses - anything is better than nothing I guess!  

Floss.

Thanks again,


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## Time (20 Feb 2012)

When I was in the states the hospital treating me offered a generous discount for cash. 
It cuts down on admin and dealing with insurance companies who might not pay.


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## flossie (20 Feb 2012)

Hi Time,

It would all be paid by CC/laser so don't see that there is much difference in paying with cash? No insurance company will be involved.....


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## pj111 (21 Feb 2012)

I'd leave the gp out initially and do your own research.

_Patrick_


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## flossie (21 Feb 2012)

Thanks Patrick, seems the consultant in question, and the suggested hospital, are one of the leaders in treatment. Guess at the end of the day your health is wealth, so worth me paying out for it. Called the Consultant's rooms today and they are calling tomorrow with an appointment when i have my calendar in front of me.....fingers crossed.


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## Kerry365 (9 Mar 2012)

Just in reply to Flossie. I cannot see a company refusing cash in today's economic difficulty. Credit card and laser take a nice percentage of the transaction. I work in a company and see huge CCard/Laser commission charges coming through.... Several companies deal with cash and all above board. Revenue commissioner are very thorough fair dues...


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