Insurance rejection adds to chronic pain
Consumers be warned: Your health insurer can refuse to pay out medical bills even when doctors are unable to diagnose what’s wrong with you.
Rhianne Danielsen of Christchurch spent years trying to find a cause for her pelvic pain and agonising periods – even an ultrasound proved normal.
She saw five doctors who were unable to diagnose her, then this year a sixth doctor referred her for diagnostic surgery. Her health insurer, NIB, told the 21-year-old she had a pre-existing condition and declined to fund her.
‘‘I still don’t understand, how can that happen when I haven’t been diagnosed with anything,’’ she said.
NIB chief executive Rob Hennin said pre-existing conditions were explained to Danielsen both at the time she joined and at the preapproval check.
A pre-existing condition was any injury, illness, symptom or diagnosis occurring any time before the customer’s policy took effect, he said.
‘‘As a pre-existing condition is the sign or symptom of any condition, it does not require a diagnosis to meet the definition of a pre-existing condition.’’
Last year the company paid out on 600 claims – equating to more than $2.5 million – by customers for treatment and surgery related to endometriosis.
Danielsen said she would continue to pay her health insurance but didn’t think symptoms should be treated as a pre-existing condition.
‘‘I’m just incredibly confused: how can anyone be covered if they haven’t been covered from birth?’’
She is now on the public waiting list to see a gynaecologist, and it could take months before she gets an appointment to see if she qualifies for diagnostic surgery. In the meantime, her pain meant she often had to take time off work.