Health Insurance Pre-existing condition

awec

Hi folks,

Hopefully someone will be able to point me in the right direction here as I'm a bit confused. This is my first ever time getting something done related to health in this country and fair to say it's pickling my head.

I went to my GP to get a mole looked at. It's something I've had forever but only in the past 6 months has it started to look like something I may need to get checked.

My GP wants to send me to the Beacon to see a dermatologist for a mapping, my health insurance (Laya) gives me full cover for the Beacon.

But they said if it's pre-existing I have to wait until I have had a policy for 5 years before they'll cover it (I've only had it 2).

Who decides here if it's pre-existing? My GP is giving me a referal letter that I'll phone to make an appointment with. Is the consultant on the phone able to say?

What is pre-existing?

I don't want to have to make another appointment with a GP and have to pay another 50 quid just to ask if he considers this a pre-existing condition. And I'd rather not end up totally screwed over at the end of it all and left to foot the bill. He (GP) made no mention of this during the 5 minutes we spoke.

Any guidance here?

LostArt

If it's a pre existing condition will depend completely on what date the consultant tells the insurer the onset of the condition was.

So basically, if he says the problem developed after you took out the policy you're fine. If it's before you'll have to pay yourself or go public.

awec

But in order to see the consultant I'll have to pay though?

LostArt

Yes, but most plans won't really cover this anyway.

Private consultants fee's are covered under your outpatient benefits. They'll give a set amount back for consultants fee's once you reach the outpatient excess. What plan do you have?

awec

I have Laya's CompanyCare Premium (with Excess).

So you think I'll have to have an appointment with the consultant BEFORE I go to the consultant to get the procedure done?

LostArt

If you have a consultants appointment it'll probably be for him to check things out and advise you on what to do next. (surgery, treatment, etc)

So on the Company Care Premium you have a €1 outpatient excess and a 75% return for consultants fees. You will get this percentage back from Laya, just hang onto the receipt and claim it back at the end of the year. Also, this plan is massively expensive, they have similar plans much cheaper, you can switch to these plans straight away if you want.

godtabh

Its not a condition yet. Its only a concern. It doesn't become an issue until diagnosed

awec

LostArt wrote: »

If you have a consultants appointment it'll probably be for him to check things out and advise you on what to do next. (surgery, treatment, etc)

So on the Company Care Premium you have a €1 outpatient excess and a 75% return for consultants fees. You will get this percentage back from Laya, just hang onto the receipt and claim it back at the end of the year. Also, this plan is massively expensive, they have similar plans much cheaper, you can switch to these plans straight away if you want.

I don't pay for it.

I guess when I phone the consultant I just ask for an appointment to speak to him and see if he thinks it would count as pre-existing?

Also, when is year end?

godtabh wrote: »

Its not a condition yet. Its only a concern. It doesn't become an issue until diagnosed

I'm not quite sure what this means.

I think the procedure they are sending me for is part of a diagnosis process.

LostArt

Your year end will be the end date of your plan. Renewal date is on your card.

awec

November so!

Tell ye what lads, this all very confusing! :pac:

Seems no matter what I do I am taking the risk that I won't get reimbursed.

Nonoperational

Just don't make an issue of it. You went to the doctor and he recommended checking out the mole. There's is no diagnosis of anything yet so it's not a pre-existing condition.

siobhan nurse

What did you end up doing? The words 'pre existing condition' have my brain fried! Basically pre existing conditions are whenever the insurance company (in my case aviva) decides they began!

awec

In my case it turned out what I needed done was just considered as a normal trip to the consultant - there was no procedure code or anything like that.

But yes, it's very difficult to figure out if you'll be covered or not.

LostArt

siobhan nurse wrote: »

What did you end up doing? The words 'pre existing condition' have my brain fried! Basically pre existing conditions are whenever the insurance company (in my case aviva) decides they began!

no, its when your consultant or gp decided it began