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Old 12.05.2009, 12:34
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Supplementary Insurance-should I claim?

Can anyone help me. I changed to Avanex ten months ago and had to fight to get supplementary cover for one of my kids because she tends to get anaemic.

My daughter is now seeing a psychotherapist. I got a referral letter from her general doctor.

I need to know whether I should submit a claim for the psychotherapist's fees? I know I am covered for upto 75% under the supplementary cover but I am scared that Avanex will turn round and revoke it in the future because it is a discretionary cover. This is the first time, my daughter has needed to get this kind of help and she has never had any other health issues.

What should I do? Claim or keep quiet?

I would really appreciate someone's advice on this.

Thanks

February
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Old 12.05.2009, 12:39
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Re: Supplementary Insurance-should I claim?

Try contacting one of our members, Jenny, for advice. She is our resident expert on all things health insurance related.
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Old 12.05.2009, 12:40
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Re: Supplementary Insurance-should I claim?

Once you have supplementary cover it cannot be cancelled by the insurers unless you failed to pay the premium, or failed to disclose some material fact in the first place.
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Old 12.05.2009, 12:40
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Re: Supplementary Insurance-should I claim?

If this is a supplementary insurance and your primary insurance covers it then i don't see why you can't get reimburse for the supplementary coverage. Just be sure you keep photocopies of all your bills.
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Old 12.05.2009, 15:14
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Re: Supplementary Insurance-should I claim?

Thanks for the responses. I feel a bit more at ease after getting some feedback. I completed the application with Avanex truthfully, so I don't know what else they can say. However, because it was a fight to get extra cover for my daughter, I'm just afraid they will throw something back at me. I don't see the need to hide anything because its not worth it. I will contact Jenny and see what she has to say.

F
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Old 12.05.2009, 15:59
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Re: Supplementary Insurance-should I claim?

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Once you have supplementary cover it cannot be cancelled by the insurers unless you failed to pay the premium, or failed to disclose some material fact in the first place.
Or the contract period ends, usually aligned with the basic insurance till the end of year.

They could also do that because you neglected to report the visit to the psychotherapist if they find that out when you try to claim something else in the future irregardless if it is related or not.

Any excuse is enough really.
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Old 12.05.2009, 19:31
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Re: Supplementary Insurance-should I claim?

So, are you saying that IF, I submit the claim together with the doctor's referral letter now, come December or whenever the contract period is renewed for basic insurance, they could refuse to give the extra cover?

Also sorry for being a bit ignorant, but how can I have failed to inform the insurers if I do choose to submit a claim?

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Old 13.05.2009, 10:54
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Re: Supplementary Insurance-should I claim?

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So, are you saying that IF, I submit the claim together with the doctor's referral letter now, come December or whenever the contract period is renewed for basic insurance, they could refuse to give the extra cover?
Yes but not basic insurance, I'm talking about the "supplementary cover" you said you had to fight to get. The comparis forums are full of people whose additional insurance cover was canceled by companies. Though not everyone does have a yearly contract, mine with Mutuel is for 5 years.

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Also sorry for being a bit ignorant, but how can I have failed to inform the insurers if I do choose to submit a claim?
You wouldn't. I meant that if you don't submit this claim now (this is your hesitation isn't it?) and then later submit some entirely different claim unrelated to this one; they may refuse to pay and cancel your contract (the supplementary cover) immediately because you failed to mention this visit to the psychotherapist.

And finally the disclaimer: I am not an insurance expert; just sharing what I came to learn.
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