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VHI - Waiting period / Will I have to pay for Op?

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    #32
    NUTLEY BOY
    Registered Users Posts: 2,344 ✭✭✭NUTLEY BOY


    AFAIK the concept of what is pre-existant is an objective one as distinct from a subjective one.

    You might feel totally healthy and have utterly no symptoms when you take out health insurance. This is your subjective and truthfully stated belief that you have no existing condition.

    However, a health insurer's doctor might say that by reference to the medical evidence the condition is one that must have pre-existed in technical medical terms. That is an objective judgment that a condition was pre-existant.

    The problem is that the insurer will plead the latter as the only opinion that matters if there is a conflict and they probably have that concept embedded in some paragraph of their rule book. That is the essential point made by nody.

    What you need to do is to stop stressing and start focusing. If the insurers deny liability ask them to explain their position in writing. You may find that they will then back off.

    As a general observation you need to be quite tough with insurers these days as the levels of competence that they display is shockingly variable and this refers to no company in particular !

    In short, get after them and start applying pressure for a decision. Follow them up in writing each time you issue a reminder. Use e-mail so that you have a record of what communication has taken place. if they have a telephone conversation with you get it confirmed in writing so that there are no slip-ups !

    Don't worry just yet as this may well resolve itself.


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    #33
    qf3l3k
    Closed Accounts Posts: 2 ✭qf3l3k


    I will definitely follow up with them as I was given procedure code by surgery specialist and rang them to confirm if everything will be covered.

    When you ring Aviva they ask you to provide all details (insurance number, name, date of birth), so they know exactly who they are dealing with.

    There was no additional questions asked by call center person and no other warinings given that payment might be eventually refused.

    Based on that information I took certain actions and made decisions how to continue with procedure.

    In fact it is not big amount of money I have to pay, but in that case it is just principal. If someone commits to something (in that case call center representative is authoritative person who speaks for Aviva) then let's not change mind after the fact especially if that might have financial consequences afterwards.

    Also, call center has a purpose right? My assumption is that ringing them I will get proper information. Otherwise it is useless and should be closed.

    Will see where I will get with them as for now they didn;t manage to respond for even one email I sent to them. Don't want to talk to them on the phone. Now everything in writing.

    Will see how long will take those guys to respond for an email. As for now they don't look much professional as I didn;t even received confirmation that email has been registered with whatever system they have.

    Lack of professionalism and total ignorance. At least within 24-hours they should reply saying that case is under investigation and they will come back with more information in X days, or something similar.

    Also, on customer portal.. I filed complain and no trace of any ticket or something opened for that, so from my perspective they just directing all emails sent to them to trash (that's my feeling at the moment).

    Main thing, to be honest, is the fact that they commit on the phone that there is no issue with covering particular procedure. I just hate this kind of behaviour. If someone commits to something, then be consequent. Don't mislead people for the profit. Also, don't push incompetence of your employees to your customers, becuase that is what probably happened. Call center person didn't bother to mention that procedure might be subject to pre-existing conditions, etc... I stated clearly that I want to be 100% sure that it's covered and ask to do check for me... had confirmation on the phone (unfortunately). Will try to get recording of course as suggested and then we will see.

    That is pretty much how I percieve Aviva at the moment.


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