Pre Existing illness

Hi Everyone, I'm new to this site. I was given the suggestion by my doctor that I should have some type of weight loss surgery due to suddenly suffering from sleep apnea even after been through a sleep study. I've been with bupa for over 5 years. We had top level then downgraded then upgraded again when we discovered our kids might need surgery in the long term future. However BUPa are refusing to cover me saying its pre existing and I have to wait the twelve months from when we last upgraded. I can't understand if we've had top level before why we have to serve a waiting period again??

Hi and welcome to the forum!!

I believe that they make you do the 12 month waiting period as it stops people from going up to the top level for their surgeries etc and then for them to drop down once that is completed - at least for the 12 months, they private insurance companies can claim some of the costs required to cover the procedure/care required.

Does that make sense?

For example, if you need surgery and have the top level of cover, you would pay between $0-$500 for the hospital stay depending on your excess no matter how long you are staying in hospital. For someone who is not under private health (like myself), two nights in hospital is costing me $13,500. So they need to claim the cost back somewhere. But that's my understanding of it - I could be wrong :)

Anyway, welcome to the forum!
Carissa

slinkee30 wrote:

I've been with bupa for over 5 years. We had top level then downgraded then upgraded again when we discovered our kids might need surgery in the long term future. However BUPa are refusing to cover me saying its pre existing and I have to wait the twelve months from when we last upgraded. I can't understand if we've had top level before why we have to serve a waiting period again??

I have no background in administration of Private Health Insurance (PHI), but can only  guess that BUPA is going by the 12 months rule since upgrading from one level of cover to another (you may wish to re-read over your hard copy of cover on this.  If you don't have one, you could pick up one from their ' store-front' offices or on-line).

This is WAY over my head cognitively-wise, not sure if you would find this useful:  http://www.bupa.com.au/health-insurance/common-questions/i-am-a-member/changing-my-cover

Have you been in personally to sit down and do a face-to-face at one of their offices, rather than over the phone?  They then MAY be able to do a 'special exemption', keeping in view your long term membership.

All the best,
:)

Carissa5984 wrote:

Hi and welcome to the forum!!

I believe that they make you do the 12 month waiting period as it stops people from going up to the top level for their surgeries etc and then for them to drop down once that is completed - at least for the 12 months, they private insurance companies can claim some of the costs required to cover the procedure/care required.

Does that make sense?

For example, if you need surgery and have the top level of cover, you would pay between $0-$500 for the hospital stay depending on your excess no matter how long you are staying in hospital. For someone who is not under private health (like myself), two nights in hospital is costing me $13,500. So they need to claim the cost back somewhere. But that's my understanding of it - I could be wrong :)

Anyway, welcome to the forum!
Carissa

Thanks Carissa,
I just am really confused with BUPA at the moment. I actually had the top level years ago with them and served the waiting period for pregnancy etc. I have never actually left them, just downgraded as we thought we weren't going to need some of those services again. They said our previous waiting period is null and void since we downgraded. No one told me this when we did it and if they had not of we wouldn't have downgraded as we didn't want to serve a waiting period. Make sense?

Hey slinkee,

What a bummer, hey? Unfortunately I think it is the same for all Private Health Insurers. Once you drop your coverage you must serve the waiting period again. I can understand how frustrating that must be for you.

Perhaps you could try Denzel's suggestion of going in to speak to someone face to face. Maybe they would be open to negotiating a reduced waiting period seeing as you had top cover once before. Worth a try maybe...