Is TRT a pre-existing medical condition (insurance/prostate cancer)

[simon43]

Perhaps Sheryl will have an idea about this.

 

I'm almost 60 years old, and about to change my medical insurance cover from HCI to Cigna (see my post in the Insurance forum).  For many years (at least 10), my prostate has been moderately enlarged by about 25%, according to annual 'finger-up-the-bum' health checks.  I have no outward symptoms and take no medication, and the prostate hasn't increased in size over the years that I've monitored it.  My PSA is raised at around 4.3, but stable.

 

Last year I was prescribed TRT due to a measured low testosterone level in my body, accompanied by typical symptoms that I've had for decades (ED problems, low upper body muscle mass).  The TRT treatment has cured my ED (hooray!) and my upper body mass has increased in partnership with a regular weight-training program.

 

Because I am on TRT, it is important that I monitor my PSA levels.  Therefore, I have PSA, testosterone and estradol checked every 3 months at a clinic.  My PSA continues to remain stable.

 

When I took out my current medical cover with HCI, they excluded cover for prostate cancer for the first 2 years, because of my enlarged prostate.  Now, as I am considering a change of medical insurer, the cover for prostate cancer comes into force with HCI - there being no problems with my prostate for the past 2 years.

 

I want to try to ensure that Cigna covers me for prostate cancer from the start of the new insurance.  What is the best way to 'promote' my position to Cigna on this?  I would assume that my regular 3-month PSA check-ups would stand in my favour, as would the cover for prostate cancer just being applied by HCI.

 

I welcome suggestions about the best way to approach this.  I'm a little concerned that Cigna might say that TRT increases the risk of prostate cancer, (although medical evidence seems to suggest that TRT increases the rate of existing prostate cancer, and my steady PSA levels would indicate that prostate cancer is not present).

 

 

[geriatrickid]

The answer is in your policy wording. Read it. Pre-existing condition is defined. Some insurers might cover. Others might not. If in doubt review the wording with the insurer (not the sales agent, because it is the insurer  who pays, not the agent).

 

For example;

This Policy does not cover expenses arising from:

Any Medical Condition or related condition for which You have received medical Treatment, had symptoms of or sought Advice prior to Your Date of Entry. (Pre-Existing Medical Condition.)
However, after 2 years' continuous membership, all pre-existing conditions will become eligible for Benefit provided You have not:

a) consulted any Doctor for medical Treatment or Advice (including check-ups) or

 

b) taken medication (including drugs, medicines, special diets or injections).
for a continuous period of 2 years after Date of Entry. (Two Year Moratorium).
 

c) Treatment of a Medical Condition which we, on the advice of the medical profession, determine is Chronic or Palliative.  However, We will pay for the stabilisation of Acute exacerbation of Chronic Conditions.

 

My interpretation of the above is  that the answer to your question with this insurer would be  NO. Yes, the condition is  stable, but you have been taking treatment and it is a chronic condition. The insurer would  however cover  an exacerbation (worsening) if  there had been no change in the condition  for 2 years.   CIGNA has its own wording. Read it.

NO ONE HERE CAN  ADVISE IF YOU ARE COVERED ! They cannot because they will not know which policy wording will apply.

 

 

 

 

[wgdanson]

7 minutes ago, geriatrickid said:

) consulted any Doctor for medical Treatment or Advice (including check-ups) or

 

Does that mean that if you go for a check-up, and nothing has changed, just the fact that you have gone for one will mean that you are not covered for that condition please.

[simon43]

Does that mean that if you go for a check-up, and nothing has changed, just the fact that you have gone for one will mean that you are not covered for that condition please.

 

I think it means "This Policy does not cover expenses arising from:..."

 

So they won't pay for the check-up.

[samsensam]

 

if i have any doubts about the cover provided by an insurance policy i give the company a ring, any reputable company have staff to deal with customer enquiries. job done.

[Sheryl]

I don't think they would exclude prostate cancer because of the TRT. But they likely will exclude anything related to BPH and might make that a broader exclusion of any prostate oroblem (just as HCI did.

There is really nothing you can do other thsn fill out the applucation truthfully and supply full details then wait to see what their underwriters come back with.

Sometimes an insurer will offer to waive an exclusion in return for a higher premium. If you like you could ask about that.



Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Sheryl]

Does that mean that if you go for a check-up, and nothing has changed, just the fact that you have gone for one will mean that you are not covered for that condition please.

With that particulat policy quoted, yes it does.

 

But most international insurers will specify what pre existing conditions are excluded in the policy document and if you fully disclosed something in your application and they do not specify it as an exclusion then it is covered. Which is a far preferrable approach IMO to the sort of language quoted (often encountered with Thai insurers) since it removes uncertainty.

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

[wgdanson]

1 hour ago, samsensam said:

 

if i have any doubts about the cover provided by an insurance policy i give the company a ring, any reputable company have staff to deal with customer enquiries. job done.

That's too late if a condition has arisen.

[geriatrickid]

1 hour ago, wgdanson said:

That's too late if a condition has arisen.

Not in this case. The advice to call, consult and document is sound. Every insurer is different: Different wordings, different claims management approach. As Sheryl has pointed out, declaring the condition and asking for coverage options is the right way to go. At the very least there will be certainty.

But please remember to document. Clerks come and go, but archived emails stay .

 

Edited January 24, 2019 by geriatrickid