Enlarged prostate (BPH) and medical insurance. cover

[simon43]

This is more of a health question than an insurance question.

 

I'm almost 60 years old and my prostate is enlarged by about 25%, with a stable PSA (over several years) of about 4.3.  The prostate size hasn't increased in two years, causes me no symptoms or problems, and I take no medication for it. (I am prescribed testosterone injections for a genetic low T level, but my PSA level hasn't increased since I started on that T regime last Autumn.

 

My current medical insurance company (HCI) excluded cover for BPH for 2 years when I signed up with them, but now cover me because the prostate size hasn't increased over that period, no problems etc.

 

Now I am considering to change my insurer to Cigna Close Care. Despite HCI providing full cover, Cigna will exclude cover for BPH, unless I have surgery (at my cost) to 'correct' the prostate enlargement - even though it causes me no symptoms etc. (Cigna also excludes cover for ailments due to low testosterone and I don't have an issue with that).

 

They also say that they will not cover me for prostate cancer if my doctor says that any such future cancer is as a result of my BPH (AFAIK, there is no link between BPH and the development of prostate cancer...).

 

I would like to proceed with the Cigna insurance policy, (because they accept monthly premium payments, whereas HCI does not).  However, I wonder if there is any good argument/medical statement etc that I can make to them to persuade them to improve upon their cover terms.

[Sheryl]

Can you post the exact wording of what you got from Cigna's underwriters?

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[simon43]

Can you post the exact wording of what you got from Cigna's underwriters?

 

Your  policy has been accepted with the following two exclusions.

 

ENLARGED PROSTATE and any associated or related conditions or symptoms and any complications

 

LOW TESTOSTERONE and any associated or related conditions or symptoms and any complications

 

The underwriting team stated that we would not remove the prostate exclusion until you had corrective surgery.

 

and

 

If you develop prostate cancer then we would ask your doctor if this is caused by or related to the BHP. If your doctor confirms it's not then you will be covered. It would only be if your doctor told us yes then we would exclude it.

[Sheryl]

I think that is pretty clear.

 

There isn't anything you can tell them that is going to make a difference. the last part about related to the BHP - BHP definitely does not cause prostate cancer but it can make it hard to detect prostate cancer in early stages.

 

They have basically fed you the info you would need to avoid a prostate cancer exclusion in future.  Keep it in mind and communictae it to your doctor if the tiem comes.

 

Whether to go ahead and switch I think depends on whether you have a reliable plan for what you will do if you need hospitalization for your BPH in future (as could well happen). As long as you have one (e.g. return to home country for treatment or fund it yourself, either here or in say India) then I see no reason not to.  But do work on the assumption you will need hospital care for the BPH eventually. Maybe set aside some money for that and leave it untouched. Then you're good to go.