Forum Discussion

Wonk's avatar
Wonk
Member
7 years ago

Is detecting BC classified as a pre-existing condition?

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?
  • 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??
  • That is very slippery wording @Wonk. Get thee to an ombudsmen if there's any trouble...
  • I agree with @Sister you need to have been diagnosed before changing funds.
  • 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."
  • I'm pretty sure that pre-existing condition refers to something that you are aware of/been diagnosed with.
  • 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?