Hospital Claim rejected by Health Insurer

Thekeencyclist

Hi All,

Just want to see what the general thoughts are on the following before I ring up to argue my end of things.

First of all, last year I switched jobs and my policy lapsed by 1 week before I remembered to renew it so I am now serving the 5 year waiting period for pre-existing illness's etc (thankfully I dont have any!!).

Roll on to this year, I had to go for a scan a couple of months ago. I have had the same scan done twice before and was covered by the health insurance for it.

The scan is not due to any symptoms or conditions that I have, it is more a pre-cautionary / routine scan every 5 years to avoid or detect symptoms as early on as possible as my father suffered from cancer almost 15 years ago. So as I say, the scan is more to detect anything as early as possible.

So the other day, I receive a letter stating that the health insurer has rejected the claim by the hospital stating that "the symptoms and conditions were present before joining the health insurer and therefore a pre-existing condition waiting period applies".

As mentioned above, I neither have any symptoms or condition but it is simply a routine / pre-cautionary scan on a 5 yr basis.

Whats the gut feel here, is this something I have to pay for myself or should it be covered by the health insurance as its not a pre-existing condition????

Thank You!

https://boards.ie/discussion/2058199859/hospital-claim-rejected-by-health-insurer

In future if you miss a renewal date threaten to switch or ask another company to take you on if you switch without that stipulation. Will very likely get it waived.

The reason you're getting the scan done does pre date the cover. Insurance companies doing what insurance companies do. I'd still phone them.

Wishbone Ash

coylemj

First of all, last year I switched jobs and my policy lapsed by 1 week before I remembered to renew it so I am now serving the 5 year waiting period for pre-existing illness's etc (thankfully I dont have any!!).

You don't have to serve any waiting period just because your cover lapsed for a week. It's only if you have a period of over 13 weeks without cover that you have to serve a waiting period.

https://www.hia.ie/consumer-information/waiting-periods/new-customer-waiting-periods