Medical Insurance Sorry You Re Not Covered

Medical Insurance Sorry You Re Not Covered

Medical Insurance Sorry,​ youre not covered!
In the​ UK around 7 million people spend around £3 billion a​ year on​ medical insurance. One in​ seven policies are taken out by individuals with the​ balance being put in​ place by their employers. the​ problem is​ that Medical Insurance is​ complex and few policyholders take the​ time to​ really study the​ details of​ their cover. as​ a​ result,​ many misunderstand what will be covered. if​ you​ expect medical insurance to​ pay every health claim,​ youre mistaken.
Medical Insurance is​ designed to​ provide protection for curable,​ shortterm health problems and allow policyholders to​ jump the​ NHS queues to​ see consultants,​ be diagnosed,​ receive surgery or​ be treated. That sounds fine,​ but before you​ buy you​ need to​ appreciate the​ treatments and situations that fall outside the​ scope of​ the​ cover.
But first a​ word of​ warning. This article does not relate to​ any specific policy and the​ terms and conditions issued by individual insurers do vary. So please ensure you​ also check your policy documents. After reading this article,​ youll know what to​ look out for!
Sorry its a​ chronic condition
If a​ condition can be cured and is​ not a​ longterm problem,​ your insurance company will classify it​ as​ acute and should meet the​ cost. if​ your problem is​ incurable or​ its a​ problem that,​ despite appropriate treatment,​ will be with you​ for a​ long time,​ then your insurance company will classify it​ as​ chronic and no,​ you​ wont be covered.
But deciding whether a​ condition is​ acute or​ chronic is​ fraught with problems. Its rarely a​ black and white decision and this can lead to​ a​ major area of​ conflict between policyholder and insurer.
Its clear that asthma and diabetes are chronic conditions as​ youre almost certain to​ suffer from them for the​ rest of​ your life. So those categories of​ illness are not covered.
Problems arise when Doctors initially consider a​ patients condition to​ be curable,​ but the​ condition later deteriorates and the​ medical team changes its mind,​ its now become incurable. This can sometimes happen,​ especially in​ the​ treatment of​ certain types of​ cancer.
In these circumstances,​ the​ condition is​ initially defined as​ acute and is​ therefore insured,​ but deteriorates and becomes chronic and outside the​ terms of​ cover. This is​ possible as​ insurers retain the​ right to​ reclassify a​ condition from acute to​ chronic during treatment.
Sorry its too long term
The insurance company will not pay out for long term treatment. But you​ need to​ check your policy documents to​ see how they define longterm. you​ can find the​ situation where a​ course of​ ​Drug​s extends for say 12 months,​ but the​ insurer will only pay for ten months.
Sorry its preventative
Your insurance is​ designed to​ pay for the​ treatment and cure of​ conditions when they arise. it​ is​ not designed to​ pay for treatments that are used to​ prevent an illness.
Again,​ the​ problem of​ definition arises. Sometimes it​ is​ arguable whether a​ treatment is​ preventative or​ a​ cure. Take the​ ​Drug​ Herceptin for example. This ​Drug​ can be used in​ the​ early stages of​ breast cancer. Research shows that Herceptin can halve the​ incidence of​ cancer returning for women who have a​ particularly virulent form of​ the​ cancer known as​ HER2. in​ this situation,​ is​ Herceptin offering a​ cure or​ is​ it​ a​ preventative?
Insurance companies are split on​ the​ debate. Norwich Union,​ WPA,​ BUPA and Standard Life Healthcare will pay for Herceptin for HER2 patients whereas Legal and General and Axa PPP will not.
Sorry the​ ​Drug​ is​ not approved
Two of​ the​ main attractions for taking out medical insurance are to​ jump the​ queues at​ the​ NHS,​ and to​ get the​ latest treatments and ​Drug​s. But theres a​ rider.
The Institute for Health and Clinical Excellence exists to​ approve the​ use of​ new ​Drug​s by the​ NHS in​ England and Wales. Until that body has approved the​ ​Drug​ your insurer is​ unlikely to​ pay for its use. the​ problem is​ that the​ Institutes brief is​ to​ perform a​ cost/benefit analysis to​ ensure that the​ financial benefits to​ the​ nation from using the​ ​Drug​,​ outweigh the​ costs of​ using it​ in​ the​ NHS. a​ difficult brief and it​ has placed the​ Institute under scrutiny for the​ extended delays in​ ​Drug​ approval.
The compromise hit on​ by the​ Financial Ombudsman is​ that if​ your medical policy wont pay for the​ use of​ experimental treatments,​ then it​ should meet the​ cost of​ an approved conventional treatment with the​ policyholder footing the​ bill for the​ balance if​ the​ experimental treatment is​ more expensive.
Sorry its a​ preexisting condition
The basic principle is​ that if​ you​ are already suffering from a​ condition when you​ start a​ policy,​ then that condition preexists the​ policy and any claims for its treatment are invalid.
For this reason,​ insurance companies insist you​ complete an exhaustive questionnaire before they agree to​ insure you. After all they need a​ clear picture of​ your medical condition before they quote. For many applications,​ the​ insurer will,​ with your approval,​ also write to​ your GP for specific details of​ your medical history. They like to​ have a​ complete picture.
So lets say some years ago you​ twisted your knee playing tennis. it​ appeared to​ recover but now it​ turns out that you​ have a​ torn cruciate ligament and it​ needs to​ be operated on. Your medical insurance company could argue that the​ ligament damage was a​ preexisting condition and you​ have to​ pay for the​ operation.
Some insurers try to​ accommodate these grey areas with a​ moratorium provision within your policy. These provisions typically say that so long as​ you​ have been symptom free for two years relating to​ any condition youve suffered from within the​ last 5 years,​ they will pay for subsequent treatment. Not all policies have these moratorium provisions and the​ time periods do vary between insurers. you​ should carefully read your policy.
Sorry its not covered
Medical Insurance is​ an annual contract just like your car insurance. So when it​ comes to​ renewal,​ your insurer is​ at​ liberty to​ review not only your premium but also change the​ conditions on​ which your cover is​ provided.
Therefore,​ if​ your policy comes up for renewal mid way through a​ course of​ treatment,​ its possible to​ find that your new policy no longer covers that particular treatment. This means that you​ will have to​ foot the​ bill for the​ balance of​ the​ treatment.
Furthermore,​ with ongoing advances in​ medical research,​ more and more conditions are becoming treatable. This progress has the​ effect of​ shifting back the​ dividing line between chronic and acute conditions.
This hits the​ insurers pocket in​ two ways. With more conditions being reclassified as​ acute,​ the​ number of​ claims is​ increasing. And theres also a​ trend for new treatments to​ cost more Herceptin being a​ good example. the​ net result is​ that the​ insurers are finding themselves having to​ pay out far more. This is​ inevitably passed back to​ you​ through increased renewal premiums. And in​ an attempt to​ reduce their risk exposure,​ insurers have a​ tendency to​ adjust their definitions and exclusions. This means that you​ must read your renewal notice closely before you​ decide to​ renew.
So if​ youre tempted to​ buy Medical Insurance,​ be aware that everything is​ not always black and white. if​ youve got insurance and need treatment,​ youre well advised to​ contact your insurer without delay and get them to​ confirm that they will meet the​ cost of​ your proposed treatment.

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