I believe, the VHI have limit of 180 days out of the country for cover, unless you take out one of the extra travel options. I am making the assumption that the person is young and travelling or a student abroad and the condition may have started while away. The insurance company have 'learned' this and are now not covering the bill. I know St. James often have young 'foreign nationals' admitted, who want of a better word have lost it. They take them in, try and findout who they are and to contact the parents to bring them home.