My 3 year old is going in for grommets on Monday i checked with my health care cover in which i only joined with in june if they would cover it i gave the numbers referring to what they were doing and lady rang back and said yes you will be covered, however she didn’t check my membership properly the hospital picked up that my health insurance will not cover it as it is “pre existing” how was i to know it was pre existing we were not referred to ent until august we just thought it was ear aches not that he needed grommets so now we are up for $2,300 we could go on waiting list for public but ent said it needs to be done sooner then later ive seriously cried over this hard for families to pull that kind of money on 3 days notice, looks like credit card will be maxed out!! i am trying to dispute this with them will find outcome tomorrow but don’t like my chances aaarrhhh just needed to vent!! why do we pay cover!!!!

Posted anonymously, 9th October 2014

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  • Thanks for your suggestions and comments i fought with HCF provided all Dr’s records and finally we have a win they are now classing it “NOT pre existing” YAY!! so happy right now!!


  • I think i would be fighting this also as when you joined he only had ear ache( you wanted to get it checked further) and hadnt seen a consultant and you were told after you had the cover he needed them.
    I could understand if on his doctors notes you were told before he needed them.
    Please let us know how you get on.


  • I know right! Cover is just really mostly a nice cushy room. I had a similar rip off experience x


  • I hope the op goes well for your little man. Some great tips there from BronnyC


  • I agree with you on how frustrating it is. Private Health cover is great but, there are often hidden traps to look out for. Try getting ENT rooms to ring them and tell them that this is a new ear condition from previous problem and see if that makes any difference to it being covered. Speak to the Health Insurance Commision/Ombudsman and explain that you where told that you would be covered and then you had a phone call saying you wouldn\’t and can they tell you if by saying this the Private Health Insurance has to cover you because of their mistake. If all else fails speak to hospital, explain about the mix up & ask to speak to the Accounts Dept. They may let you pay it off with instalments. Most doctors etc are understanding about this as they know we all have VERY tight budgets. Good luck on Monday & try not to get too stressed.


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