Critical Illness insurance

[Keeping Up]

Anyone have it?  Tried to claim an AN.

Call me a bit lazy - but I just found out I have critical insurance at work (actually - I had asked, but seemed a bit like a grave digger to be asking for critical illness coverage, when I didn't view myself as critically ill) and that it covers 'benign brain' tumors.  Did a bit of googling - while certain tumors are excluded it appears cranial nerves are included.  ONe of the definitions makes mention of some sort of significant neurological impairment.

Thankfully, I have absolutely no impairments other than hearing loss - anyone think that is significant.  I don't ... but than I might be a bit light-hearted.

My ENT made mention of critical insurance on one's mortgage - if you had it, you could get your mortgage paid off.  We didn't take the insurance when we moved our mortgage last September - so kicking myself there.  However, it appears my work has coverage and potentially I may be covered (no idea on sum if I do qualify).  Of course, I have already spent the money .... landscaping the backyard (has to be a great payout) and a pulled-pork lunch for my team at work. 

Ann

[Vivian B.]

Hi Ann,

It depends on what conditions are covered under your specific policy. I would ask for a copy of the policy to determine what exactly is covered and how the policy terms are worded. Some CI policies do cover benign tumors but also state benign tumors that need to be surgically removed. It all depends on what type of coverage you have. Hope this helps.

Vivian

[Jim Scott]

Ann ~

With any type of insurance, it's all in the definitions....and every insurance company can have their own definitions.    Although, by law, they have to make the definitions clear in the policy language, there is always a certain amount of subjectivity/ambiguity involved.  As Vivian suggested, read the policy language pertaining to tumors to learn what is covered under 'critical illness'.  You may need to call the insurance company customer service line (usually toll-free) to get clarification.  Be persistent.  Don't accept a brush-off by some low-level phone rep.  Ask to talk to a supervisor if you aren't happy with what the rep tells you. My wife has had great success with getting claims paid by forcing an insurance company claims supervisor or manager to cogently explain why her claim was rejected when the claim seemed to fall under the policy definitions.  Usually, they couldn't, and would agree to pay the claim.  Sometimes the fist-in-a-velvet-glove approach works, i.e. "I really don't want to get the state insurance commissioner involved" (spoken with a smile, of course).  I would suggest you avoid asking an HR person to explain the critical illness policy limitations or explain definitions.  They usually don't know much about insurance and will likely give you inaccurate information.  Remember, they work for your employer, too, and every claim on the company policy can increase next year's premium, which is probably high, already. 

I wish you success in your quest as you enter the insurance labyrinth. 

Jim

Addendum 6/18/09 :  I just realized that you're in the Canadian health care system, which may alter your options and make most of my post irrelevant.  Sorry.

[tenai98]

i inquired about my critical insurance coverage and i'm not covered...unless I had a heart attack, stroke, became deaf in both ears, lost a limb so on and so forth
JO

[Keeping Up]

I never did come back and update the thread.

I was denied critical illness insurance - not because of an accoustic neuroma, but that it doesn't extend into the brain or meninges (s/p???).  Verbally, I have gotten confirmation that as soon as it reaches into the CPA angle (if it ever does - I have vowed this sucker not to grow), it would qualify.  I am having a bit of an argument with the insurance company as they won't put that in writing.  If they can tell me verbally, they can put it in writing.

Had a bit of yelling match with the insurance claim gal - both angry at the lack of clarity in response but equally that I asked the question 2 MONTHS ago and got a call today.    I have escalated it to the supervisor. 

She challenged me to ask my doctor if the CPA angle was in the brain - I suggested I already had a brain tumor by his definition (actually not sure it is ever true - cranial nerve tumors are never brain tumors - but most of us don't differentiate that point).  I now simply need their definition of a brain tumor - curious to see if I will get it.

It isn't a terribly large amount of money, and would prefer never to have to have the tumor grow (so not qualify for the insurance) - however, I will push the insurance company as I think they think I will let it slide.  If I have to, we will file a claim ever MRI and let them deny it.  A HUGE waste of time for everyone involved.

Might be back again in a few years to keep the thread posted of my progress!

Ann

[tenai98]

Ann
My policy specified bengin tumors are not covered...whether in the brain or not...
JO

[leapyrtwins]

Acoustic neuromas are brain tumors.

[nteeman]

I might suggest a formal complaint to your state's insurance regulating agency.  In a lot of instances insurance companies become much friendlier once regulators are involved. I don't know what state you live in but often you can file your grievance online. It is worth checking out.

Neal

[Jim Scott]

I might suggest a formal complaint to your state's insurance regulating agency.  In a lot of instances insurance companies become much friendlier once regulators are involved. I don't know what state you live in but often you can file your grievance online. It is worth checking out.

Neal ~

She's in Canada - they have a government-run health care system.  I'm not sure what her options are with that.

Jim

[yardtick]

The Federal Gov't recognizes AN as a disability for veterans.  Ann go to Service Canada and CRA website, there is some mention of it on one of the sites.  I am going to apply for Canada Pension Disability, I have the paper work here.   

Anne Marie

[mk]

It seems that there is a bit of confusion here. I think that the critical illness insurance that Ann refers to is most likely offered through her benefits from her employer, and as such administered by private insurance. This is not related to OHIP or any other provincial health plan. So I would think that this is a matter of dealing with the insurance company - Ann, is there an administrator from your work dealing directly with the insurance company? They might be able to shed some light on this.

Marianna