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?

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.

@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

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.

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??

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

Is detecting BC classified as a pre-existing condition?

Wonk
Member
7 years ago
Thank you ladies for all your thoughts. Surgery went well and I’m feeling good now that I’m back home today. Next anxious wait for the pathology tests next week.
arpie
Member
7 years ago
All the best for your surgery @Wonk - make haste slowly - keep your meds 'up' to control the pain/discomfort whether you think you need it or not ..... and ask away if you have any questions that we may help you with. xx
BroniD
Member
7 years ago
Morning @Wonk. Thinking of you today.. Stay strong..
kmakm
Member
7 years ago
@Wonk I did a bit more than usual when I was having chemo. I loved it!
Wonk
Member
7 years ago
Thanks @Mjheke I am actually a distance from my GP (I've followed her everywhere for the last 25 years!).
You're right, I don't need the stress right now, I'll just wait until later when I'm home recovering and sort things out then.
Hmmm @kmakm I think I'm going to discover online shopping big time when I'm home all day...good opportunity to shop for Christmas. Knew there'd be an upside to this.
lrb_03
Member
7 years ago
Many GP practices and hospitals don't use email to send confidential patient related material because of a (perceived, I think) lack of security. Part of that concern is valid, if it gave the wrong people the ability to hack in to patient information. I believe many practices, their email accounts are on totally separate servers to the practice server, which has all the patient data
kmakm
Member
7 years ago
@Wonk You may have heard of this little thing called online shopping... ;)
Mjheke
Member
7 years ago
The Ironic thing about that is that your Health insurance company will want you to email the forms to them! And what choice do you have if you want it done ASAP? Are you a distance to travel to your GP? Is there someone who can pick them up for you?

The other option is that on my forms there was a fax number that you could fax the form to the insurance company-Is it possible to get the GP reception to fax it directly to them?

You really don't need this stress with everything else going on...Deep breath.
Hugs,
Michelle x
Wonk
Member
7 years ago
Frustration over paperwork! My GP completed the form today, but her receptionist would not email it as it 'contravenes their privacy policy'. So now it is in the post. I doubt I'll see it until the end of the week (after the operation). The specialist had no problem emailing his back. All it means is I have to pay the excess up front, and I'll get it back if the paperwork goes through. Not like I'm going to be out at the shops spending any money after the operation anyway!
Wonk
Member
7 years ago
Hi @BroniD, from what I’ve now read we should be fine. The health care fund have given me a form to send to both my GP and Specialist to provide history about the condition. I also need a copy of my GP’s referral letter and and authority to release information form. Once I have everything I send them to the health fund and they get an independent medical assessor to decide. As @mjheke said I’ll put a note on these requesting them to fast track their assessment. All the best with yours.