Is detecting BC classified as a pre-existing condition?

Wonk

I changed Health Insurers in April. Kept the same level of cover. There’s no problem with my impending hospital stay, however my fund asked me if it is a pre-existing condition. My last mammogram screening was October 2016, my next was October 2018. No signs or symptoms in between. So when my breast cancer was detected last week does this mean it pre-existed in April for the purposes of health fund claims? Just curious to see if anyone has had the same thing happen?

kmakm

I have no idea but if your last mammogram before you joined your new fund was clear, I don't think it can count as a pre-existing condition. @Zoffiel, @Romla?

Sister

I'm pretty sure that pre-existing condition refers to something that you are aware of/been diagnosed with.

Wonk

Thanks ladies.  If they deem it to be a pre-existing condition, I will have to pay $500 excess (as this was under my old fund), whereas there is no excess under the new fund.
I found some fine print in the policy.  Can you interpret this wording?  It's the last line that I find unclear.

"A pre-existing condition is where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by us (not your own doctor), existed at any time during the six months before the day on which you purchased your health insurance or upgraded to a higher level of hospital cover. The medical practitioner we appoint must consider any information regarding signs or symptoms provided by your own treating general practitioner and/or specialist. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed."

Romla

I agree with @Sister you need to have been diagnosed before changing funds.

kmakm

That is very slippery wording @Wonk. Get thee to an ombudsmen if there's any trouble...

lrb_03

I would definitely agree with @kmakm on this. Having said that, they would surely have to prove that you and your GP had discussed a symptom that may have suggested bc??

Romla

Hope this helps

http://www.ombudsman.gov.au/publications/brochures-and-fact-sheets/factsheets/all-fact-sheets/phio/the-pre-existing-conditions-rule#.W-bJeqg5pwk.link

Sister

It does seem to be very slippery wording as @kmakm says.  Mind you, I don't know how they would say that they could tell if you had bc at the time if you didn't know it.

Mjheke

I was also recently diagnosed (26/11/18) and it certainly has been a roller coaster. I had surgery Monday (5/11/18). I had the same issue with my health fund, as I had not been with them the required time. I only had 3 days before surgery to sort this issue out as I had been told they had a 10day turnaround to decide if it was a pre-existing condition. Depends on who you are with and what the process is but i just had to get both my GP and the surgeon to fill out forms from the provider saying that I had never been seen about this previously. I picked mine up as a palpable lump, but had had a normal screening mammogram almost a year previous. 

They were great, I noted on my forms when I sent them in that it was urgent with the surgery dates and I got told I was fully covered the next day. 
Good luck and hugs xx

Wonk

@Romla that is great detective work! I found a clause in your link that makes sense.
”These signs and symptoms should have been reasonably apparent to either the member, or a reasonable general practitioner had the member been examined in this 6 month period”
As no one can pick it up without x-ray/ultrasound it is definitely not apparent. Which is why it was such a shock!
Thanks @Mjheke that’s exactly what I wanted to know. I have the forms to fill out but not enough time to process them. I’ll make a note on them like you did and see how I go.  I hope everything is going well for you after surgery. Thanks to all you lovely ladies ( @kmakm , @Sister , @Irb_03 for being so responsive to my questions. I can’t believe how much this is helping me get through these early days. I know you are all going through your own journeys and you are so selfless dedicating yourselves to helping others on this forum. From the bottom of my heart I thank you xxx

kmakm

@Wonk I first came here with a multitude of questions which were always answered, and then in a remarkably short time, someone came on with a question that I was able to answer. At a time when I felt so useless it felt so good to help someone else. We pay it forward to thank the wonderful folk who helped us at the beginning, and all the way through. I still have questions! K xox

kmakm

@Mjheke That is excellent service from your healthfund. Can I ask which one it is?

Sister

As @kmakm said, we have all been in your position and the help on this forum, while certainly not replacing medical advice, has armed us to sort through what we have been told and to know what to ask and prepare for, as well as be a collective shoulder to lean on.

kitkatb

Well said @kmakm  this forum has been a godsend when we feel overwhelmed at a time we feel most vulnerable.  We either have a good ole cry with others or pee our pants laughing from some of the comments and black humour banded around this site from people who just understand.  

melclarity

@wonk my goodness these health funds make you scream don't they! I have to agree with others, you are definitely in the clear, it is not a pre existing condition and of course they would try to say so grrr! you have been clear until your recent diagnosis. Super clear cut and yes get your GP to fill in the form. Lots of great experience on board, so always someone will be able to jump in, no matter your question, everyone has experienced things to different degrees. xx