Private Health Insurance for Twin #2

[callie taggles]

Hi there,

Has anyone had any issues with Health Insurers not covering the birth of the second twin?

I've recently changed from singles cover to couples cover and have been told that because they didn't receive the paperwork prior to the first ultrasound, twin 2 isn't covered as a private patient, and will be admitted as a public patient in a private hospital - at $725 per night just for accomodation costs!

They've recommended going public or changing hospitals, not ideal as the babies are due in May and I've got a great relationship with my obs.

Any suggestions?

Thanks heaps

Callie

[AJP]

sorry i dont know but thats soooo wrong

[Kitt3n]

How long have you been with them? Not exactly making you loyal is it??!!
Maybe you can offer to make a small up front payment to cover the cost of the twin?

[Tobily]

That is just bizarre!
What on earth is their justification for covering one and not the other on those grounds?
If they didn't get the paperwork before the ultrasound why on earth would they say they'll only cover one twin? Why not say they won't cover either of them?
That just seems totally odd.
Can you go up the food chain a bit and speak with someone else?

[Kitt3n]

i agree with flea bout going up the cahin, but if you have been with them for a wile i would be using that to my advantage eg "I have been your loyal customer for "X" amount of time and this could not have been forseen. As your customer, what are YOU going to do for ME regarding this?"

[Danielle_M]

I agree with flea, try & talk to someone in a higher position. Who knows... it may work it may not. How pathetic trying to get away with only covering one twin!!!
If they wont help at all maybe think of taking it to A Current Affair etc & see if the pressure of it going public may get them to ease up a bit???

Good luck, I hope it all gets sorted soon, as if you need the extra stress of this!

[Kitt3n]

talking to someone in a higher position wont necessarily get you what you want - you need to have something to back it up. trust me, im a complaints officer for an international company.
threats of today tonight etc dont usually work! you need to read your PDS and have an understanding of the product you have purchased. If there is a distinct reasoning in the PDS as to why they wont pay i would try to get them to come to a half way agreement - maybe your current premiums plus a 25% loading for the next few months?
The best way to get what you want from a company is not to get narky and demanding - stay composed, calm, and know what it is that you want, and know where you can refer them to (eg PDS)

good luck!!

[Danielle_M]

Originally Posted by catrionalee

threats of today tonight etc dont usually work!

Just to clear something up, I didn't mean "threaten" to take it to A Current Affair, I meant TAKE it to ACA (if thats what you wanted to do) I only suggested this because I have had a few probs with big companies in recent years & whilst ever I'm calm & polite they don't do anything for me, afetr I have turned nasty & actually taken action after sending numerous emails, phone calls & keeping a log then I find they tend to be alot more helpful.

It's only my suggestion as it's worked for me in the past.

[Kitt3n]

soz if i offended danielle!
but the key is not only to be calm, but to know where to refer them to in the policy documents - if you can refer them to a page where there is nothing regarding a clause stating that they will have to cover one twin only you have basically got em.

[pansy]

oh dear what Insurance company are you with?
We are with MBF and we were covered for both babies.On my form when I booked in to the private hospital it was stated that we would have to pay an excess if the girls were to be in special care.Well the girls were in special care most of our hospital stay..I kept on waiting to get a bill but one never came..
I would keep "harrassing" your insurance company..as I don't think that it's really fair...

[rayray]

I am pretty sure I have heard this before and it is a standard policy of many health insurers.

sux though.
If you have been with them a while I would push the issue and ask to speak to someone higher up, as things can often be waived in some circumstances.


ETA: No, hang on what is normal is you have to have your cover upgraded to family prior to giving birth, otherwise the first twin is covered but not the second. I'd definitely be taking it further. Ring some other health insurerd too - if you have met all your obstetrics waiting periods - and see what they will offer you. Politely let whomever you are dealing with at your insurer know that as well.

[satya]

That's really odd. If that's what the rules state no amount of publicity will change the outcome. Doesn't your OB work from a public hospital at all? Personally I'd be swapping to a public hospital or you could be up for a fortune with the likelihood of the babies being born early. You can still get a good relationship with a new OB - I've seen 3 (one for scans and amnio) and I've found them all great.

[Kitt3n]

.... and, if you dont have a copy of your pds - lodge a formal complaint, and request for them to send you a replacment, highlighting the clause where they indicate that they will not cover your circumstances. If you are not satisfied with this, take them to the regulatory body, which i believe is FICS.

[rayray]

Id definitely try to change insurers (if you can get it in writing that they will cover you) before changing hospitals and OBs

[Karina]

I would have a look into another insurer. If you have done your waiting time you shouldnt have to do the waiting time all over again with aother insurer. I think its dumb though - did you even know you were having twins before your first ultrasound?

[~Raven~]

because they didn't receive the paperwork prior to the first ultrasound

Did you give them the paperwork before the u/s and they didn't process it?

I recall when I was PG with Mason I was covered by singles cover and was told that I need to upgrade to family before the first u/s as if there was an abnormality it would be classed as a pre-existing condition and he would not be covered in the private hospital.
This was in the small print that I needed a magnifying glass to read but was only told to me when I asked if my bub was covered if I stayed on singles cover.

[callie taggles]

We are with Australian Unity, and i've had obs cover for over a year, so I've served the required waiting periods.

We've got our car and house insurance with them too, which I will mention though I don't think it'd make much difference.

We found out we were having twins at the first obs appt, then went overseas for 2 weeks and had the first ultrasound when we got back, so it would have been impossible for us to get the paperwork back to them in time anyway.

They mentioned pre existing conditions too when I spoke to them, but it seemed to apply to the second twin only, so I'm a little confused that if this was a singleton pregnancy there wouldn't be an issue with first ultrasound timings etc, it's just that there are two babies on the way.

Hopefully they call me back today and I can get a clearer understanding of what the sitch is.

[didlesdines]

I have singles top cover, I asked about this because it is not viable for all of us to have top cover so they have very basic, I was told as long as I change to family cover 2 months before the birth Myself and bubs will be covered.