Curlyfella
Registered User
- Messages
- 82
Hi Poka,
I agree with you and empathise. Personally, I find the disclosure from LAYA and other health insurers to be very poor.
Our family plan is through my wife's work with Irish Life Health. We get all this nonsense each year - the most egregious part being some form of "reasons why" letter which starts off with something like...…"having considered your personal situation, etc., we recommend the blah, blah policy for you, etc., etc."...………...IT'S A GROUP POLICY!!…….has everyone in my wife's work got identical needs to us??!!……...and precisely what review did they do on us??!!
In the case of LAYA, if anyone thinks that they are covered for cancer, be careful. LAYA claims to cover chemo but in my experience (via a close friend a while back)…..what LAYA means is that it covers certain forms of chemo but not others - but in any reasonable reading of the point of sale material, this distinction is, not at all, made clear.
[To elaborate, when diagnosed with stage iv cancer, part of one's hope is that some new drug will come along that will reverse the anticipated trajectory of the disease. New drugs do come along which can be of great benefit including extending lifespan and dramatically improving the quality of life. This drugs are proprietary, in huge demand, the outcome of massive R&D, etc. and as a consequence likely to be very expensive. My friend thought that he would be covered for one such drug but he wasn't. They were apparently too new, too high-tech. What's really bad is that some people will not be able to afford the correct treatment. The "too new" bit is really deplorable because without substantial means, the impact will be that if, the much hoped and prayed for, new drug does come along...……...Mr. Ordinary may not be able to afford it personally and his insurance won't cover it.]
The specific questions that I would like to know are:
1. What precise disclosure requirements health insurers are obliged to follow?
2. Can anyone show me anywhere in LAYA's communications which addresses the OP's concern and my concern in relation to cancer drugs? Specifically, where in the point of sale material was the OP advised the his/her psychotherapy fees would no longer be covered? And where in relation to chemo treatment is it made clear that certain therapy will be covered and other therapy denied? [For the avoidance of doubt, the chemo in question was recommended by his oncologist and is considered international best practice therapy as he used an "international second opinion service."
3. What is the independent redress channel / arbitrer in relation to health insurers? Is it the FS&PO?
There is a story about this exact thing below - Laya refused the cover but were pressured by a TD and now have said they'll cover for 3 months.
€150,000 price tag for Quin woman’s vital cancer treatment
https://clarechampion.ie/e150000-price-tag-for-quin-womans-vital-cancer-treatment/
Quin woman secures cover for break-through treatment after public campaign
https://clarechampion.ie/quin-woman-secures-cover-for-break-through-treatment-after-public-campaign/
is there anywhere to find out exactly what is and is not covered for your policy?