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-   -   Incorrectly denied supplementary health insurance - but complex background (https://www.englishforum.ch/insurance/237985-incorrectly-denied-supplementary-health-insurance-but-complex-background.html)

Quinquangular 30.07.2015 19:38

Incorrectly denied supplementary health insurance - but complex background
 
Hello,

Not a new member but I wanted to anonymise a problem I have given the highly personal nature. I have Mod approval for this temporary duplicate account.

I am a bit surprised to have just been denied supplementary health insurance because I am deemed "high risk", even though I am in my late 20s and the truthful answer to all the questions on the questionnaire was that I lead a healthy lifestyle and have not required treatment for anything significant in the past several years. The insurance company has given the reason that my BMI is too low, which on paper, it is. Except this is my natural, healthy weight. Anyone who has met me knows that I am built like a bird, and I'm sporty and strong enough to go on 9 hour alpine pass hikes and (before I recently moved) do a good 6 hours of intensive exercise a week. If this were the full story, it would be easy and I would, as advised by the company, simply write a letter back explaining my current health is tip top. Which it is!

Except that's not quite the full story.

In my late teens I suffered from a severe eating disorder which involved hospital treatment. I have had confirmed recently that I have absolutely no lasting health effects from it. However, I have had a couple of scary relapses since (though neither led to health issues, just was close to the weight I know they could reemerge), and even though I have been completely well for a few years now, I would not be comfortable stating that it (needing treatment) could never happen again.

I am concerned that the possibility of an eating disorder is what the insurance company are alluding to. Even though, as I mentioned, the truthful answer is that my current BMI is completely natural and the questionnaire in the specified time horizon does not require me to disclose my past. However, I'm worried that if I ever present with a relapse again, or something that can be traced as being a consequence, I'll still be deemed to have lied by omission and have all my cover invalidated - against even anything unrelated. So I am wondering if I should volunteer the information.

Potential benefits:
- I was fully discharged from care at my current BMI. So lends proof to my claim that I am extremely healthy now
- I could argue for excluding the eating disorder as pre existing, but I should get supplementary cover for anything else - at least it's clear cut
- conscience

Potential issues:
- they don't buy my claim to be healthy today given my history and class me definitively high risk and I get nothing
- my current weight is unrelated to the history, even if it may be perceived as such

Does any of that even make sense? I am a bit worked up and a bit stuck. I'm not sure I'm thinking logically as this brings back memories I had archived. Advice would be appreciated.

:(

st2lemans 30.07.2015 19:46

Re: Incorrectly denied supplementary health insurance - but complex background
 
Try a different insurer.

Tom

Island Monkey 30.07.2015 19:50

Re: Incorrectly denied supplementary health insurance - but complex background
 
I can't figure out this supplementary insurance. My husband was turned down and all he had was an ACL sprain/reconstruction, which is covered by accident insurance not health insurance anyway :confused:

meloncollie 30.07.2015 20:21

Re: Incorrectly denied supplementary health insurance - but complex background
 
I understand the frustration that one can be denied when one is currently healthy, but past illnesses - even if no longer an issue - are part of a risk profile, and sometimes are enough of a reason for some insurers to deny coverage.

One of the reasons I was denied was that I had started early mammogram screening in the US, and continued that once I moved here. Every test was negative, meaning I actually had proof of not being ill - but falling into the broad risk profile that recommended preventative early screening (in the US we do tend to be over cautious wrt to screening) was enough for a rejection.

(Another reason I was denied was my age, I was an ancient crone of 40 at the time. But I suppose that taken all together I presented more of a risk than the insurer wished to take on.)

Basically, if you have a history of illness, or fall into a risk profile, some insurers could deny supplemental coverage.

As s2lemans suggests, try another insurer. However be aware that most ask if you have been denied before.

---

If you are looking for supplemental insurance in order to get better accomodation in a hospital, be aware that you can sometimes pay out of pocket to upgrade accomodation to a semi private or private room. This is subject to availablity, and one can be bumped should a 'real' private patient require the space. But some prefer to do this for a planned hospital stay.

---

So first, try another insurer, see what happens.

Good luck!

Guest 30.07.2015 20:55

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by Island Monkey (Post 2426681)
I can't figure out this supplementary insurance. My husband was turned down and all he had was an ACL sprain/reconstruction, which is covered by accident insurance not health insurance anyway :confused:

The ACL reconstruction he had, means, in very basic terms, that he had a health problem sometime. Irrespective of who paid for treatment, his health was impaired at one point. Health insurance can, for VVG (supplemental) view this as a risk and due to this they have the right to turn him down.

Island Monkey 30.07.2015 21:04

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

The ACL reconstruction he had, means, in very basic terms, that he had a health problem sometime. Irrespective of who paid for treatment, his health was impaired at one point. Health insurance can, for VVG (supplemental) view this as a risk and due to this they have the right to turn him down.
Well.. not a health problem.. an accident. They have no problem differentiating between health and accident when it benefits them :rolleyes:

I thought they might offer insurance excluding that injury, but no. Funny as he managed to get Tagesgeld insurance (self-employed) which excludes the knee/recon complications.... but if he snaps the reconstruction in a new accident... that is covered :confused:

Guest 30.07.2015 21:31

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by Island Monkey (Post 2426702)
Well.. not a health problem.. an accident. They have no problem differentiating between health and accident when it benefits them :rolleyes:

I thought they might offer insurance excluding that injury, but no. Funny as he managed to get Tagesgeld insurance (self-employed) which excludes the knee/recon complications.... but if he snaps the reconstruction in a new accident... that is covered :confused:

As I said above, no matter what his state of health and existence of risks, insurers based on VVG have the right to refuse him. Taggeld also is regulated by VVG just like supplemental health insurance, he just got lucky with the Taggeld insurers taking him on despite the knee/recon.

Taggeld and supplemental health insurance are two different insurances, despite being based on the same law (VVG). The same rules apply for both, Taggeld probably just was more lenient.
As for his knee being snapped again, if that happens it'll be UVG (accident insurance) which covers for it, not Taggeld, basic or supplemental health insurance. UVG do not exclude clients due to risks they might pose.. Complicated, I know :D

Island Monkey 30.07.2015 21:43

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

As for his knee being snapped again, if that happens it'll be UVG (accident insurance) which covers for it, not Taggeld, basic or supplemental health insurance. UVG do not exclude clients due to risks they might pose.. Complicated, I know :D
Nope. He is self-employed (in winter), so has no employer UVG paying tagged if unable to work. Hence why he took out a separate policy to cover loss of earnings if he injures himself (again).

Guest 31.07.2015 20:56

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by Island Monkey (Post 2426702)
Well.. not a health problem.. an accident. They have no problem differentiating between health and accident when it benefits them :rolleyes:

I thought they might offer insurance excluding that injury, but no. Funny as he managed to get Tagesgeld insurance (self-employed) which excludes the knee/recon complications.... but if he snaps the reconstruction in a new accident... that is covered :confused:

"Art. 3 Krankheit

1 Krankheit ist jede Beeinträchtigung der körperlichen, geistigen oder psychischen Gesundheit, die nicht Folge eines Unfalles ist und die eine medizinische Untersuchung oder Behandlung erfordert oder eine Arbeitsunfähigkeit zur Folge hat.1
2 Als Geburtsgebrechen gelten diejenigen Krankheiten, die bei vollendeter Geburt bestehen.


Art. 4 Unfall

Unfall ist die plötzliche, nicht beabsichtigte schädigende Einwirkung eines ungewöhnlichen äusseren Faktors auf den menschlichen Körper, die eine Beeinträchtigung der körperlichen, geistigen oder psychischen Gesundheit oder den Tod zur Folge hat."

Both accidents and illnesses include impairments of health. Illness is the impairment of health which isn't the consequence of an accident, while accidents are sudden, unforeseeable, unusual external factors which lead to an impairment of health.

Quinquangular 31.07.2015 20:57

Re: Incorrectly denied supplementary health insurance - but complex background
 
Thank you so much for all the replies. There was another one that seemed to have gone missing?

Anyway I perfectly get that insurers are under no obligation to provide supplementary but what I find odd is that they won't just exclude a preexisting condition. And together with denying my health supplementary they denied my accident supplementary :confused: so even though my risk of contracting certain illnesses, or heaven forbid, be a victim of a crime against the person, may have nothing to do with my previous condition, I can't get extra cover?

It's at the forefront of my mind as a friend has just been hospitalised following a brutal altercation in Zurich. Not that there was anything wrong with his care but if I could pay for more to be covered, I would.

As for changing insurers, I am tied to two providers via work and also only have a month left to sign up for the basic (they took their sweet time) before my 90 day window expires.

After sleeping on it, I've decided to simply write a letter explaining my current state of health. It is completely truthful - in the time span covered by the questionnaire, I have not needed treatment of any sort. Maybe I've just been too emotional about this all and joined up two similar but unrelated things in my mind out of surprise.

Guest 31.07.2015 21:03

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by Quinquangular (Post 2427202)
Thank you so much for all the replies. There was another one that seemed to have gone missing?

Anyway I perfectly get that insurers are under no obligation to provide supplementary but what I find odd is that they won't just exclude a preexisting condition.

Just like they don't have to provide insurance at all, they can provide only part of the insurance or only from a certain point onwards, excluding preexisting conditions but paying for complications due to preexisting conditions, if they so choose.

And together with denying my health supplementary they denied my accident supplementary :confused:

Why? Supplementary means they aren't obligated to take you in so they can deny you, which they seem to have done.

so even though my risk of contracting certain illnesses, or heaven forbid, be a victim of a crime against the person, may have nothing to do with my previous condition, I can't get extra cover?

You can't if they say the won't accept you, as they don't have to. Look for other insurers who might take you in if you want the coverage.

It's at the forefront of my mind as a friend has just been hospitalised following a brutal altercation in Zurich. Not that there was anything wrong with his care but if I could pay for more to be covered, I would.

As for changing insurers, I am tied to two providers via work and also only have a month left to sign up for the basic (they took their sweet time) before my 90 day window expires.

After sleeping on it, I've decided to simply write a letter explaining my current state of health. It is completely truthful - in the time span covered by the questionnaire, I have not needed treatment of any sort. Maybe I've just been too emotional about this all and joined up two similar but unrelated things in my mind out of surprise.

Good - don't lie, be honest and hope that they'll do what you think is best for your health, but try to not be too disappointed if they don't accept you, because it's their right.

k_and_e 31.07.2015 21:05

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by Quinquangular (Post 2427202)
As for changing insurers, I am tied to two providers via work

in case your employer has some agreement with health insurance providers, the provider often has to accept you.

and you are not tied to them. it is a free country with free choice:)

Mélusine 31.07.2015 21:42

Re: Incorrectly denied supplementary health insurance - but complex background
 
My son has a blood clotting disorder, for which he is fully covered (100%) by AI.

But because of it, he was refused by the supplementary insurance. It went as far as their advisory doctor, but they said that it was a potential risk anyway. And he's only 9...

marton 31.07.2015 21:59

Re: Incorrectly denied supplementary health insurance - but complex background
 
Luck of the draw, every insurer acts differently. I added supplementary insurance when I was 60 without any problems......
I had to ask three or four before I got a reasonable offer.

marton 31.07.2015 22:16

Re: Incorrectly denied supplementary health insurance - but complex background
 
Luck of the draw, every insurer acts differently. I added supplementary insurance when I was 60 without any problems......
I had to ask three or four before I got a reasonable offer.

KiwiSteve 01.08.2015 11:17

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by marton (Post 2427228)
Luck of the draw, every insurer acts differently. I added supplementary insurance when I was 60 without any problems......
I had to ask three or four before I got a reasonable offer.

I suspect it may also depend on your medical history/honesty when filling out the forms. I filled in the form honestly and was refused ( the questions do go back to issues lying in the dim and distant past). I have not repeated the process, but am now reconciled to doing without and saving the cost of supplementary insurance.

marton 01.08.2015 11:32

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by KiwiSteve (Post 2427328)
I suspect it may also depend on your medical history/honesty when filling out the forms. I filled in the form honestly and was refused ( the questions do go back to issues lying in the dim and distant past). I have not repeated the process, but am now reconciled to doing without and saving the cost of supplementary insurance.


About "I filled in the form honestly " well if you don't then you run the risk that they wiil accept you but later will not pay for treatment.

vuachère 20.08.2015 14:43

Re: Incorrectly denied supplementary health insurance - but complex background
 
I am currently filling the form which asks whether I have ever suffered from a range of illnesses (included headaches and sinusitis too). Would anyone happen to know how exactly should I interpret these questions? If I have ever suffered from one of these (e.g. headache- which I am currently having), the answer is yes. If I have been ever "medically treated" for headache (as in going to the GP/specialist and getting medicines), the answer is no. :confused:

fatmanfilms 20.08.2015 15:45

Re: Incorrectly denied supplementary health insurance - but complex background
 
Quote:

Originally Posted by vuachère (Post 2436715)
I am currently filling the form which asks whether I have ever suffered from a range of illnesses (included headaches and sinusitis too). Would anyone happen to know how exactly should I interpret these questions? If I have ever suffered from one of these (e.g. headache- which I am currently having), the answer is yes. If I have been ever "medically treated" for headache (as in going to the GP/specialist and getting medicines), the answer is no. :confused:

Yes you are currently suffering .....

If you lie they don't have to pay out.

MsWorWoo 20.08.2015 16:21

Re: Incorrectly denied supplementary health insurance - but complex background
 
Has anyone here NEVER had a headache? Maybe it's a question designed to trip you up so they can say you lied and refuse paying out. Or maybe it's not. Is it translated? could it be a translation error, migraine perhaps? Can you ask your provider?


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