Is AN claimable? I am lost on the definition of Benign Brain Tumor...

[sporeguy]

Dear friends,

I submitted my claim last week and I just received a letter of definition from the insurance company in Singapore.

Below is their definition of Benign Brain Tumor.

Benign Brain Tumor

A benign tumour in the brain where all of the following conditions are met:
• It is life threatening;
• It has caused damage to the brain;
• It has undergone surgical removal or, if inoperable, has caused a permanent neurological deficit; and
• Its presence must be confirmed by a neurologist or neurosurgeon and supported by findings
on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques.

The following are excluded:
• Cysts;
• Granulomas;
• Vascular Malformations;
• Haematomas; and
• Tumours of the pituitary gland or spinal cord.

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They are still studying my claim and I guess I will be informed in a week or two.

At first I'm confident that it is claimable because AN is a type of Benign Brain Tumor.
However, I am confused and quite angry at the conditions they gave for Benign Brain Tumor.

I worry they will dismiss my mum's case by saying, it is not life threatening and didn't cause any damage to the brain.
If this happen, what shall I do? I really need the advices of you kind folks....

Thanks, Richard


Below is my mum's Radiological Report.

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Exam Date: 30Mar2009
Exam Ordered: MRI IAM Full Study

MRI internal auditory meatus.

Clinically: right tinnitus, sensorineural hearing loss.

A post contrast MRI internal auditory meatus study was performed.

There is an elongated intra and extracanalicular acoustic neuroma seen on the right side.
This measures approximately 13.2mm in length and shows diffuse contrast enhancement.
Normal appearances are seen of the left internal auditory meatus and the nerve VII as well as nerve VIII complexes.

Normal appearances are seen of the rest of the brain parenchyma and no area of suggestive of infarct, haemorrhagic lesions or mass lesions noted.

Impression: the appearances are those of a right-sided acoustic neuroma.

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[Jim Scott]

Richard:

Insurance companies are notorious for finding ways to deny a claim using arcane policy definitions that often don't make sense.  Excluding 'vascular malformations' may allow the insurance company to conveniently define your mother's AN that way and thus deny her claim.  However, that could be disputed by any reputable neurosurgeon because an acoustic neuroma is not a 'vascular malformation' .  It definitely is life threatening if not removed or irradiated.  That should not be arguable.  Technically, an acoustic neuroma ('vestibular schwannoma') is not a 'brain tumor' because it does not actually invade the brain.  It resides in the skull and can push against and displace the brain, which is never good.  This was my experience.  Fortunately, I survived it relatively unscathed.  This reality may muddy the waters a bit because many medical insurance claim adjusters have no idea what an acoustic neuroma is and have to be 'educated'.  That can be accomplished by having your mother's doctor send the insurance company a letter, detailing what she has and the grim ramifications of not treating it.

I wish you well as you launch this battle.  We're all rooting for your victory! 

Jim

[sporeguy]

Thanks Jim.

I had been to the doctors and gotten a letter from a neurosurgeon who confirmed my mum case is AN (also based on the MRI report). I asked him directly is AN considered a Benign Brain Tumor. He said yes. Also I searched thru the net for AN definition and I gotten a few which also defines AN as a Benign Brain Tumor. I attached all these information and submited to the insurance company.

My mum has been paying the insurance premium for 13years. Below is the what the company state when she signed up the plan.

Critical Illness Coverage

Overview
Critical Illness Coverage is a sound solution for meeting hefty expenses arising from critical illness.
A guaranteed lump-sum payout upon diagnosis can go a long way in helping to defray the costs of long-term medical treatment and recovery. It makes sense to be well prepared because a critical illness can strike anyone at any time.
 
  Key Benefits
 Lump sum payment upon the diagnosis of one of the listed 30 Critical Illneses  
 Lump sum is payable on top of your existing health insurance coverage.
 Lump sum will be invaluable to help meet hospitalisation, surgery, out-patient treatment and supporting convalescence.
 Concentrate on the road to recovery without financial worries.

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To me, I feel it should be a simple matter. If AN fits the definition of Benign Brain Tumor, then it is claimable. If doesn't fit, then it is not claimable, simple as that. I am angry the addition of terms and conditions as an when the insurance company deems fit.

That part where the "conditions are met" were not stated previously. It is only yesterday when I recieved an email from my agent that says, Richard, I had submitted the claims forms to the claims department and attached 30 major illnesses definition for your reference.

Upon receiving this email, I am prepared mentally for any sudden events. However, I certainly hope the Insurance company will stick to their words and not play any tricks. Will keep you guys informed. Thank you!

Richard

[chocolatetruffle]

hello richard
i got an AIA life insurance from singapore and i was able to claim for 2 critical illness successfully - benign brain tumor and single side deafness (resulting from the surgery) - which were listed on the critical illness list. Once I claimed these, the downside was I was not able to claim any more critical illness except for total disability and death. It took me about 1 month for the insurance company to approve the claims. As long as your mum meets the critical illness criteria, as stated by the doctors, the claim should go through. 

Good luck and feel free to email me if you have any questions.

[sporeguy]

Hi chocolatetruffle,

Sorry to hear that removing that benign brain tumor also causes single side deafness. I hope you have gotten used to the imbalance of sound coming from the environment. Thanks for commenting and offering help.

The insurance my mum gotten is from Great Eastern Life. Currently the doctor's advice is 'wait and see' approach. She will go for another MRI scan sometime in Oct/Nov. I'm already very worried about the tumor in my mother's head. I want to make the claim so that we can use it for any surgery (if needed) which will cost us a big sum of $$. I already spent a few k going for the MRI + specialist consultations.

The doctor already certified AN is Benign Brain Tumor & it fits the definition perfectly. The last thing I want to hear is our genuine claim being denied due to some dirty tricks played. I certainly hope not.

Regards,
Richard

[chocolatetruffle]

hello richard
single side deafness really depends on the type of surgery and other factors - the surgery which i chose (translab) sacrificed my hearing as the surgical entry is via inner ear, whereas mid fossa and retrog. could help preserve hearing.  it is definitely a tough decision and i had to adapt with only one ear but on the bright side, that darn free-loader tumor is out 

quick question on your mum:
- what is the size of the tumor?
- what hospital/specialists is she seeing?

the word "brain tumor" is scary but it is benign, very slow growing (1-2 mm per year) and treatable.  aside from minor 'inconveniences', most of us are enjoying full and normal lives. 

the local claim system can be very particular and it is unfortunate that people had to think like lawyers and provide all necessary documents to meet the conditions as stated in the policy sufficiently.   use the appeal system if needed.  as jim said, we are rooting for you!! 

do keep us posted!

[sporeguy]

Hi chocolatetruffle,

The size of the tumor is 13.2mm. We now follow up with the ENT department of Alexandra Hospital.
 
Before that, I brought her to see a ENT specialist (Dr Chew) and Neurosurgeon (Dr Ho) at Mount E. Speaking of the ENT specialist makes my blood boil... I asked him why my mum was so unfortunate to have AN (statistics is 1 out of 100,000). He told us that my mum was very lucky to have AN and that he was unable to do anything, he said he is not god. He didn't offer any words of comfort and refered us to the neurosurgeon. It's a shame that a reputable ENT senior consultant shows such attitude.

My mum will go for a scan this Oct/Nov to check the rate of growth. If it grows to a considerable large size then we might have to go for Gamma Knife Surgery. The insurance we're claiming for is $25k. I just hope it will be enough to cover for the surgery if the doctors recommend to go for it.

Thank you all for the support.... I'll update you guys! Thanks again.

[suboo73]

Before that, I brought her to see a ENT specialist (Dr Chew) and Neurosurgeon (Dr Ho) at Mount E. Speaking of the ENT specialist makes my blood boil... I asked him why my mum was so unfortunate to have AN (statistics is 1 out of 100,000). He told us that my mum was very lucky to have AN and that he was unable to do anything, he said he is not god. He didn't offer any words of comfort and refered us to the neurosurgeon. It's a shame that a reputable ENT senior consultant shows such attitude.

Hi Sporeguy!

Thank you for posting this question - i am now learning a lot more about general insurance and critical illness insurance!
I am sorry to hear about your mum's AN.  Thankfully, you are a wonderful son, doing research and helping her understand all of her options. 
This is so important when someone says to you - 'you have a AN.'  There is so much information to wade through.

I can't really help you with the insurance questions, but hope you find your answers.  Be persistent!
And as for the ENT - i will have to comment that at least he was honest. 
I saw 2 ENTs in my local town and they told me i was just 'getting older.' [At 40!]
Then my sister had some symptoms and found out she has an AN.
So i requested an MRI from a different ENT - and i have one too.
It is scary, but i am grateful to the doctor who believed in me and wrote the order for the MRI.
Now i know what is causing the symptoms and i can use that information to try to deal with it.
(I am an information type of person, and i see you are too!)

Take care and keep us posted.
Sincerely,
Sue

PS  The New Zealand trip for your parents sounds great!  Enjoy!   

[Duff]

I guess I was very, very fortunate with my situation...I have a Blue Shield HMO plan through my work. It covered 100% of everything except a few $10 co-pays for doctor visits. This included the Trans Lab Craniotomy, BAHA surgery and device (Divino), plus a week in the hospital. There was a small additional copay ($200 or so) for the fitting of the BAHA.

The team at House Ear Clinic in Los Angeles are superb and seem to know how to jump through all of the hoops that the insurance companies make one jump through. These days, it is imperative to have a team of doctors that know what to do and how to define/describe your situation to the insurance company. 

Best of luck to you.

[sporeguy]

Dear all, I have a piece of good news to share. The claim was approved.
The coverage of major illness is $25k. We managed to claim an amount of $35k sing dollars.

Over 13yrs, we paid about $18k for insurance coverage. However as a result of premature termination of policy due to this claim, my mum lost about $8k. In all, we have an additional of $17k to spend on the follow up consultations & surgery if needed.

Thinking back, actually I wouldn't say to be able to get the claim is a piece of good news. At the first place, if my mum were to be denied of this claim, I will pursue this matter to the end. Luckily this insurance company honour their words, & I am satisfied. To me, having able to get the claim fast allows me to spend more time with my mum helping her to cope with AN rather than writing letters or meet ups with the insurance company to fight her case.

This site and everyone have been a wonderful guidance to me throughout these months. My mum will go for another scan sometime in Oct/Nov and if the tumor has not grown any larger, it will be a real good news then.  At the meantime, I sincerely hope all AN sufferers here good health and best wishes always!   Richard

[Jim Scott]

Richard ~

Just popping in to offer my congratulations on your success with your mum's insurance claim.  I'm pleased to learn this site/forums were a help to you in this endeavor.  Best wishes for your mum as she goes forward. 

Jim

[chocolatetruffle]

woohoo!!  glad to hear the claim went through!

best wishes and good luck to your mum too, hope the next scan will be good news.  keep us posted!