Co-insurance and/or Exclusion of Disorders Acquired after the Inception Date of Private Medical Insurance; Chronic Disease; Fibroids

Laymen might be forgiven for assuming private medical insurance providers are required to provide cover against any medical condition that hasn’t been specifically excluded under its general terms and conditions.  They aren’t though.

They aren’t because, whilst the general terms and conditions of a policy don’t actually say that they aren’t, nor do they say that the insurer is required to carry on providing cover to any policy holder whose policy it should decide to cancel.

This happened to a colleague of my husband’s, who had been diagnosed with uterine fibroids.  She had received treatment for her condition and had put in a claim to cover the cost of that treatment which served to inform her insurer as to her diagnosis. Fibroids are nasty, stubborn things that are notorious for growing back again after having been removed, however.  Her insurer did reimburse the cost of that first treatment and even the cost of a second treatment.  Thereafter, it provided her with 30 days notice as to its intention to cancel her policy.

Of course, it is impossible to take out any new insurance policy the providers of which won’t seek to either exclude or seriously restrict cover for any pre-existing conditions the insured might already have been diagnosed with.  Thus, my husband’s colleague, a woman only just in her mid-twenties, unmarried but hoping, eventually, to have children, was left without cover pertaining to a condition that might continue to plague her right up until she reaches menopause.  It is a condition that will almost certainly diminish her overall quality of life, one that may even affect her future fertility.  From an insurer’s point of view, it can be said to represent a significant insurance risk.  Presumably, this is what motivated her insurer to cancel her policy.

No doubt there are innumerable other conditions that private medical insurers might choose to treat in much the same way.  I happen to know rather more about uterine fibroids than I do about any of them, however; I too was diagnosed with fibroids, roughly four years ago.  I too underwent an initial round of treatment that was less successful than my doctor had hoped it might be.  I too received reimbursement for the cost of that procedure and for the cost of a subsequent, happily rather more successful procedure.  My medical insurance providers didn’t go so far as to cancel my policy but did impose changes to its terms and conditions upon renewal – my premium would be doubled and I would need to pay a 25% co-insurance in respect of ‘each and every claim on all gynaecological disorders’ – not only for any further treatment I might need for my fibroid condition but for any treatment I might need for any number of other genealogical conditions, even the ones I haven’t got as yet.  

Linked articles:  to come

Recommended websites:  http://www.mdjunction.com/uterine-fibroids