Forum Discussion
Wonk
7 years agoMember
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?
26 Replies
- BroniDMemberHi @Wonk, I'm actually in the same position, we also recently changed our private health cover. My last mammogram was in Oct 2017. I'll get in contact with my healthcare fund tomorrow but I believe that cause my last was clear this should definitely not be classed as pre-existing.
- melclarityMember@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
- kitkatbMemberWell 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.
- SisterMemberAs @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.
- kmakmMember@Mjheke That is excellent service from your healthfund. Can I ask which one it is?
- kmakmMember@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
- WonkMember@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 - MjhekeMemberI 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 - SisterMemberIt 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.