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Post by Deleted on Dec 18, 2009 15:21:39 GMT
Hi
Has anyone got any suggestions please?
I've been knocked back on my claim for diagnosis from AXA/PPP by them saying that adult ADD is a general exclusion on all their health policies. They can't point me to the actual, official wording, but said that "it's not possible to list all the things not covered."
Have decided that I'm not going to accept that, as we AADDers have the right for recognition and treatment. I haven't got 2 heads - all I want is a diagnostic procedure! I'm not asking for the moon!
Have got the Financial Ombudsman involved, but in the meantime am going to write to the company expressing my complaint, as set out in the procedures in the policy.
Has anyone got any ideas about an angle? I've got to get them out from behind the "general ommission" smoke screen.
Hopefully
Jan
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Post by Deleted on Dec 18, 2009 18:01:18 GMT
Hi,
I have just been refused referral for ADHD diagnosis by AXA PPP aswell. The reason they told me is that they take ADHD as something that should have been diagnosed as a child. I told them they can check my medical records if they so wish and that there is plently of evidence to say that these things can be missed for many years.
The private consultants secretary said they had never authorised before but that someone did once this year but she never took up the consultation. Aparantly it was jsut the diagnosis they agreed to...not follow up treatment. AXA are claiming that is was a mistake.
Do let me know how you get on, I was thinking of complaining aswell although I am hopefully gonna get an NHS referral soon anyway. Maybe we can hassle them together at the same time?? LOL I don't have my policy booklets to hand but when I do, i'll get reading on how to complain.
Take Care and good luck!!
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Post by roland on Dec 20, 2009 12:42:02 GMT
I've encountered this before in my dealings with medical insurance companies in America and here with both my ADHD and my asthma.
The difficulty is that insurance companies exist to make money so they're betting that more people will buy their insurance than will file claims and to make sure of this they stack things in their favour. I also feel that they don't really want us to understand how they work out what's covered and not covered because they add all sorts of complications.
Anyway, generally speaking, medical insurance companies will only cover policy holders for unexpected medical events that will respond quickly to treatment.
Most of them won't pay for recurring, or long term treatment of chronic conditions.
For example if a policy holder has diabetes they won't pay for routine check-ups and treatment, but if the diabetes suddenly became worse and the policy holder is taken to hospital, then the company might pay for that hospital admission, but once the diabetes is stabilised again, coverage will stop.
In addition, there's always a "pre-existing condition" clause and for most insurance companies that means that they won't cover you for the first two years or so after you first got the policy for anything relating to the "pre-existing condition."
Some companies will also state that you need to have been symptom free for a set number of years before you take out the policy.
So you can see how, even though ADHD may not be specifically excluded, some insurance companies may say it is covered in the general terms and conditions.
I would suggest that you go ahead and write to them and complain on the principle of "nothing tried, nothing gained" but don't expend too much energy fighting them.
You might have better results if you take on the NHS (if there are no ADHD services in your area), because they have a legal duty to not discriminate in the way they provide access to healthcare.
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Post by Deleted on Dec 20, 2009 17:27:55 GMT
In addition, there's always a "pre-existing condition" clause and for most insurance companies that means that they won't cover you for the first two years or so after you first got the policy for anything relating to the "pre-existing condition. Not always. An awful lot of corporate policies write off all pre existing conditions (like mine did) right from the start. They will often stop paying once something becomes chronic but there again, they should at least pay for the initial assessment, even if they won't pay for the follow up treatment.
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Post by Deleted on Dec 20, 2009 18:33:53 GMT
The irony of it all is that my insurance policy only covers me for a couple of consultations, and diagnostic tests to £750. I'm not asking for ongoing treatment of a chronic condition. And the consultant I sourced at The Priory Hospital, Chelmsford was only charging £270 for the whole shebang - the complete diagnosis! Still going to battle it, but perhaps AADD needs a higher profile before anyone takes notice and changes things
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Post by Deleted on Dec 20, 2009 22:48:01 GMT
The irony of it all is that my insurance policy only covers me for a couple of consultations, and diagnostic tests to £750. I'm not asking for ongoing treatment of a chronic condition. And the consultant I sourced at The Priory Hospital, Chelmsford was only charging £270 for the whole shebang - the complete diagnosis! Still going to battle it, but perhaps AADD needs a higher profile before anyone takes notice and changes things Can you not put that through as a regular psychiatric assessment? That is about the same cost as a normal assessment really. What is the consultants name if you don't mind me asking? I might look into that myself actually!
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Post by Deleted on Dec 20, 2009 23:56:39 GMT
I was lucky--AXA/PPP paid for me to see a psychiatrist--referred by my GP for a possible ADD diagnosis combined with depression, and AXA raised no problem. This was over 3 years ago, though.
They paid for me for around a year of seeing my psychiatrist and a clinical psychologist but then stopped as the condition was then deemed to be chronic (which, in fairness, it is) and that was a specific exclusion on the policy.
My employers then changed their insurer to someone cheaper, who would not pay for me also because it was chronic (and existing at the time cover was taken out). I persuaded my employer to give me the cash instead of the cover. The money (including not having to pay tax on the benefit any longer) partly covers quarterly sessions with my psychiatrist.
On the whole, I though AXA/PPP did reasonably well by me, and the consultant said that they were usually more generous than other providers such as BUPA.
The market is probably getting tighter for all these companies and they are seeking get-out clauses more.
Might be worth having another swing past them with more general symptoms (e.g. depression arising from the ADHD, which they probably can't describe as pre-existing).
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Post by roland on Dec 21, 2009 0:08:56 GMT
Large companies with a large number of employees may choose to pay higher premiums and get a Medical History Disregarded (MRD) plan for their employees (although some may get different levels of coverage for different levels of employees) and with an MRD there may not be exclusions for pre-existing conditions, but all other terms and conditions will probably still apply.
In America, advocacy groups (CHADD for one) have been trying for a couple of years to get insurance companies to provide coverage for adult ADHD.
This might be a good time to complain to your insurance company because I read somewhere (sorry can't remember where) that demand for private medical insurance has been falling, and that's one reason why private specialists/hospitals are more willing to work with the NHS (they're not getting as much revenue from their private patients anymore). That could be good for all of us if private ADHD specialists decide to start taking NHS patients.
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Post by roland on Dec 21, 2009 0:28:03 GMT
sorry didn't see hugh's post. He's right falling revenues will mean that some companies, rather than looking for innovative ways to sell more plans, will start cutting back on what they cover.
Anyway, good luck with them, and I'll definitely be interested in hearing how things go!
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Post by Deleted on Dec 21, 2009 2:13:59 GMT
I have had no issue seeing a psychiatrist with AXA (had a corporate policy, then changed to private but still with medical history disregarded and no money limits on outpatient care) , it's just the full on ADHD assessment with Dr Craig that costs £995 that's the problem...to be fair that's not even a bad price considering a psychologist is involved too. AXA have been very generous really for psychiatric care...i've had on/off appts with a psychiatrist since 2005, a years worth of psychotherapy, CBT groups and 1-2-1, and now they are saying they will stop it in February. I am a bit peeved as I only jsut renewed the policy 2 weeks ago and they said psychiatric care was still covered. Oh well. They have been very good really. Just disapointed as I am not stable atm and need more help!
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Post by Deleted on Dec 22, 2009 10:50:54 GMT
Hi Tricky
(Don't know how to 'Link to Post' - perhaps someone can enlighten me?)
The name of the consultant is Dr Matthew Castle. Have Googled him and he appears very active in the Psychiatric field.
Jan
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