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Health insurance and pre-existing conditions

Health insurance and pre-existing conditions

Old Oct 22nd 2014, 10:28 am
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Unhappy Health insurance and pre-existing conditions

I'm having a bit of a nightmare with finding health insurance.

Before I came to NZ I had no health insurance in UK. I have had knee surgery in the past and been told that I will eventually need a knee replacement.

I am struggling to find health cover that includes the knee, and am reading that I could wait up to ten years on the public system - IF I gain enough points to be put on a list in the first place.

I do not have the $15000 - $28000 that it is estimated it would cost when I need to have it done.

Can anyone help me solve my mini crisis?
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Old Oct 22nd 2014, 10:32 am
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Default Re: Health insurance and pre-existing conditions

I would be surprised if you could find an insurance firm to cover a pre existing problem, but that's just my opinion from when husband got health cover in the UK through work.
Hopefully someone will have some advice that enables you to insure
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Old Oct 22nd 2014, 10:42 am
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Default Re: Health insurance and pre-existing conditions

I realise that. I was trying to figure out what I would do when I need a new knee, and it seems I would be *f***ked*.

I'm really worried
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Old Oct 22nd 2014, 12:17 pm
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Default Re: Health insurance and pre-existing conditions

Originally Posted by M_and_M View Post
I realise that. I was trying to figure out what I would do when I need a new knee, and it seems I would be *f***ked*.

I'm really worried
I know something of how you feel and appreciate you do have added concerns with already having had some surgery and likelihood of needing future operations but wonder how you came to understand that the wait here would be ten years - would it be any different in the UK if you didn't have private health care insurance?

I have a shoulder problem and run into all sorts of problems because my GP 'guided' me to tell porky pies and say it was an accident, so I got sent for a few physio session and don't get adequately treated or diagnosed and now ACC refuse to fund any further treatment related to this 'claim'.

Refusal by ACC is on the basis that it is degenerative, age related wear and tear - although nobody had actually done any tests or been able to make a specific diagnosis. The latest development was to be referred into private healthcare system and I had to pay myself for radiology and subsequent ultrasound guided steroid injection. That did the trick for a while but now I have no idea where I am supposed to go with this and have constant pain I shoulder and difficulty sleeping - I fear that its going to cost me a lot of money to get fixed and have to play next steps very carefully on what I say and do so as not to jeopardise any chances of getting appropriate care or treatment in public sector or via private healthcare.

There was a 'suggestion' made by GP that I could say I had another accident and see if ACC would provide for costs of tests under a different claim but so far I am leaving that option on the back burner, as I can manage the pain myself for the time being and might really need that option to be there further down the track

All very tricky to know what to say or do next and I feel that my chances either way might already be pretty farked too for having this on my record already. I am experiencing similar pain in a hip joint now and have nagging thoughts that it might be onset of arthiritis or somesuch and wondering how the heck would you actually get diagnosed and referred into the public hospital system for that and whether I even want to face up to the potential of that just now.
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Old Oct 23rd 2014, 8:50 am
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Default Re: Health insurance and pre-existing conditions

Just go on the waiting list for public if you're having trouble now with your knees, if it gets to the stage you can't work I'm sure rather than paying you sickness benefit the points system will kick in and will get you sorted hopefully fingers crossed.
Bo Jangles I would be very cross at your Dr for encouraging you to do that.
I got attacked by a bull here and even though I was totally disabled the instant it happened, I had to prove my injury with an MRI because it was hidden. I got told it would have been easier for them to accept my application if I had had lots of broken bones showing rather than a spine injury. I wouldn't ever fake an accident to get into the acc system, they ring you and interview you, want visible proof etc, etc and will always fall back on the degenerative, age related wear and tear thing if they can possibly get away with it.
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Old Oct 23rd 2014, 9:33 am
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Default Re: Health insurance and pre-existing conditions

Originally Posted by SSky View Post
Bo Jangles I would be very cross at your Dr for encouraging you to do that.
A bit of Dr Hobson's choice though and quite the norm as I understand it - what are you supposed to do when faced with the regretful look, a shaking head and sharp intake of breath that says this is gonna hurt: 'Do you have private healthcare insurance?'
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Old Oct 23rd 2014, 10:34 am
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No I don't. I would just opt for public if I had a health problem.
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Old Oct 23rd 2014, 10:40 am
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Default Re: Health insurance and pre-existing conditions

The question was from the doctor to me - in this instance I was told if it wasn't as a result of an accident the only option was to go private.
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Old Oct 23rd 2014, 7:37 pm
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Ah sorry, thought you were asking me lol.
That must surely have only been for immediate treatment your Dr recommended that. Still he shouldn't have told you to do that should he.
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Old Oct 23rd 2014, 8:24 pm
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Originally Posted by Bo-Jangles View Post
A bit of Dr Hobson's choice though and quite the norm as I understand it'
I have to say that this has been obliquely suggested to me also & to my husband.
From what I have gathered over the years, yes, this is the norm.

I've had to resort to private for my eyesight. Properly monitoring my eyesight is precious to me due to an RTA many decades ago. I was unable to gain that through the public system because of the loading of wait lists and patients. Left me little alternative really.

Sorry to read about the attack by a bull SSky. I didn't know they had matadors here in NZ. Not sure if I have read you correctly or not. Are you recovered/recovering?
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Old Oct 23rd 2014, 10:32 pm
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Default Re: Health insurance and pre-existing conditions

Originally Posted by SSky View Post
That must surely have only been for immediate treatment your Dr recommended that.
No, I was guided by him assuming he knows his stuff and was given two options: make up a story and claim ACC or otherwise have to go private and pay myself for radiology diagnostics, physio or whatever.

A painful shoulder with no broken bones is clearly not an emergency, which is why I fear for how M&M will fare in this system. How exactly does one proceed with a pre-existing conditions or old injuries in the public health system here?

People are quite blasé about playing the system which seems to work out fine for most if the medicine or therapy works first time and you're all fixed and back on track; however once it transpires that there's an on going issue then you fall into a trap in the middle and the public system no longer will entertain you unless you have the will to then tackle the bureaucracy.

It's not a very nice place to be, my shoulder today is particularly bad and of major concern to me that I don't have an obvious or clear pathway to getting it fixed - other than down the expensive private route.

If I went to the Doctors today I know for sure that I will get the same old story, so perhaps I should beat myself up, go and play rugby or fall off a log or something over the weekend.
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Old Oct 24th 2014, 12:51 am
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Default Re: Health insurance and pre-existing conditions

I believe M_and_M to be in for a very long wait. A pal of mine has been waiting for a knee replacement ever since I've known her. That's 8 years now. She hobbles about in pain but as she can still hobble , does not get the op.

From here.

Originally Posted by NZ Medical Journal
The hip and knee replacement tool developed by the Orthopaedic Working Group of the National Waiting Times Project (Appendix 1) was used to score the patient and an Oxford hip or knee score (OHKS)3 given to the patient to complete. For the last 2 years the threshold for certainty has been 79 points or higher and active review over 62 points. Patients falling below the threshold for active review are classified as Clinical Benefit (CB). These patients are returned to their GP for ongoing care. Surgery is rarely advised if the score is less than 50 points.



Appendix showing point scoring.


Attachment 119438


Attachment 119439



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Old Oct 24th 2014, 9:55 am
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Originally Posted by BEVS View Post

Sorry to read about the attack by a bull SSky. I didn't know they had matadors here in NZ. Not sure if I have read you correctly or not. Are you recovered/recovering?
I worked on a dairy farm for three years, he wandered into the milking yard with the ladies and was not happy about me being there. Yes after an op to fix things I'm fine :-)
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Old Oct 24th 2014, 10:05 am
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Originally Posted by Bo-Jangles View Post

If I went to the Doctors today I know for sure that I will get the same old story, so perhaps I should beat myself up, go and play rugby or fall off a log or something over the weekend.
lol please don't beat yourself up :-)

Is it not the same in the UK though, you go on a waiting list and then you get seen eventually.
ACC is for accidents ... I hear what you're saying though. You get rugby players chucking themselves about on the field recklessly and if they get injured they get the best care immediately even though they knew what they were getting into.

Knowing how ACC work though and the grilling I got after a genuine work accident I still wouldn't fib and create a ficticional accident just to jump the queue
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Old Oct 27th 2014, 6:52 am
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Default Re: Health insurance and pre-existing conditions

Originally Posted by BEVS View Post
I believe M_and_M to be in for a very long wait. A pal of mine has been waiting for a knee replacement ever since I've known her. That's 8 years now. She hobbles about in pain but as she can still hobble , does not get the op.

From here.

[/FONT]


Appendix showing point scoring.


Attachment 119438


Attachment 119439



That's exactly what I fear bEVS. Seems there's no way out because even if the knee was fine, they exclude degenerative conditions in health insurance
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