1Cover - requiring pre-payment / going hard on pre-existing conditions?

[TheGoodDoctor]

@Lucy70 @LucyB70 @Quickstatus @Pushka and others.

So, here I am, the subject of all this speculation and at least by @Lucy70 (or Eva from 1Cover) a fair degree of misrepresentation. I signed up so I could clear issues up. I am a frequent flyer, used to be Qantas Platinum but now just lifetime Silver and almost Gold.

So let me start by saying I did/do have Hypertension which is 1 of 40 automatically covered conditions by almost every single Australian travel insurer with 1Cover being the exception which take you through an obfuscated process when signing up. So a bit of caveat emptor for everyone.

Myself and my family travel to Thailand regularly, we used to visit family and friends in Bangkok and regard it as almost a second home, so it's not unusual for us to be there either individually or as a family.

I have had Hypertension for about a decade, controlled and stable. In the last few years I'd used Telehealth for repeat prescriptions, using a blood pressure monitor with the online GP to review the status. Nothing abnormal with BP generally around 120/75 each reading.

I had taken out 1Cover for a couple of reasons. Firstly an update to TID's system meant I had an issue logging in and second I'd noticed they were now sponsoring St Kilda FC, so would seem to be then at least relatively legit Aussie brand.

Sunday night.
I was in my hotel room late at night after watching a football game in reception. I was getting ready for bed when I felt pain in my back, then chest. I took some beta blockers I had for the hypertension and asked reception to call me an ambulance. This arrived quickly and I was taken to the nearby hospital ED.

In ED it was confirmed I was having a heart attack. I provided the details of my travel insurance as well as signing a guarantee that I could personally also cover the initial estimate of costs. I was taken into theatre and had an initial Stent fitted.

Monday Morning
There was an email from 1Cover (I only read this towards the end of the day). They had opened a case based on contact from the hospital during the night. They requested information which in reality from an ICU bed was impossible for me to provide.

One item they requested was permission to have medical records provided by my regular GP, I assume starting the hunt to find a potential preexisting condition. Unfortunately I hadn't had a regular GP since the clinic I went to closed down some years before. And as mentioned the only illness I had had was stable and managed.

I spoke to my wife, told her of the situation. She had the details of my insurance and connected them. They didn't offer assistance, no offer to book a flight, accommodation or anything.

Tuesday
The Cardiologist booked me in for a second surgery to take place Wednesday at 11am. The hospital advised that the insurer had provided no guarantees they would be covering costs.

My wife arrived from an overnight flight, having organized emergency care for our kids. She had discussed with 1Cover the claims situation but was told the claims team were still investigating. After she had flown overnight and seen me in ICU, she was sent a document to sign by 1Cover which needed to be printed out, signed and faxed back. This was essentially a guarantee from her to say that any costs incurred by 1Cover would be paid back if they decided there was a preexisting condition. This had to work out how to have this printed at the hotel, signed and faxed back from the hotel.

Wednesday
1Cover contacted Katie and said they had not been able to get in contact with the telehealth provider to assess if this was a preexisting condition.

Given this circumstance 1Cover still refused to provide the hospital with a guarantee of cover, even after the guarantee of repayment had been given the day before by Katie. As a result of this lack of attention, the hospital cashier came to my bed in ICU as I was being prepped for the second surgery. Literally prepped, 20 minutes before I was supposed to have the surgery.

I have no issue with the hospital looking to ensure costs could/would be covered. The first surgery, ambulance, ICU bed etc had racked up a decent bill and 1Cover were holding out. So I had a daily limit from our global debit account (limit $10k max a debit a/c can have is $20k but that needs a couple of days to set up). My credit card had the limit of $16k credit but if I had enough money in there an unlimited amount. So I transferred money from our mortgage account to my debit account and to the credit card.

3 transactions of almost $10k each took place, 1 on debit card and 2 on credit card. As point out by others even though these still appear on the account as 'Pending' - the $30k still has to be there in the account.

Thursday
Moved from ICU to a regular room in the afternoon. Twice the hospital cashier comes and advises that 1Cover had still not given a guarantee but they would wait until discharge before requesting payment of the remainder of the costs. The estimate at one stage was a further $50k - but in reality it was a bit less.

Friday
By the time discharge came around in the afternoon 1Cover had provided a guarantee but had also told us that we would need to chat the hospital for a reversal of the $30k we had paid. They told us that this would take around 30 business days and we would have to chase the hospital directly.

30 March
Received an email from 1Cover. They have received the information from my GP and are currently reviewing it to determine if this was a preexisting issue. They will get back to un within 10 business days.

As an Aside
I messaged today the CEO of 1Cover on LinkedIn (remember she told Katie not to message any other staff as they would find it distressing, so I messaged her directly). I've asked for the following 'calls to action' - let's see how it goes.

1. A public apology from 1Cover and acknowledgement that you should and could have done better and what you will do in the future in policy and procedure to avoid this happening again. As a suggestion this could be to the media that has so far covered the story, perhaps the newspaper you slammed the phone down on.
2. Detailed description of how marketing staff will be appropriately disciplined for their conduct of smearing and attempting to discredit myself and my wife in the media. We would also like follow up post discipline to be assured action has taken place and how 1Cover will ensure systemic change in policy and procedure to prevent this occurring to anyone else in the future.
3. A discussion with 1Cover’s Privacy Officer to understand how a case could be openly discussed by either 1Cover staff in the media or by their proxies. Especially the fact that in both the comments section of the dailymail.co.uk and AFF forums the individual(s) claim intimate knowledge of the case. I will hold off commencing action against 1Cover pending this discussion.

 

[Katie B]

@Katie B
Welcome to AFF

I understand if you prefer not to rehash the whole saga (though you are free to do so here)

I just wanted to tie up some loose ends :
Did the CC actually get charged or was it a pre- authorisation?
If the CC was charged was it all reimbursed?

Hi there, thanks for the welcome.

Our credit cards were charged, we've been told that we need to wait up to 30 business days for that to be rectified. The part that aggrieves me the most about that (as someone else commented) what if we had not been able to access that money? It was a life saving procedure.

 

[Quickstatus]

Aussie guy has a medical emergency overseas and the insurer fits the bill. Full stop.

So in summary:

Aussie guy had a medical emergency overseas and the insurer foots the bill AFTER the family urgently stumped up $30k on the CC.

 

[Katie B]

So in summary:

Aussie guy had a medical emergency overseas and the insurer foots the bill AFTER the family urgently stumped up $30k on the CC.

They have confirmed they'll pay some of the bill. We are still chasing full reimbursement, despite their comment to The Age two weeks ago......

 

[MEL_Traveller]

Hi there, thanks for the welcome.

Our credit cards were charged, we've been told that we need to wait up to 30 business days for that to be rectified. The part that aggrieves me the most about that (as someone else commented) what if we had not been able to access that money? It was a life saving procedure.

When they ‘rectify’ the charge in your credit card make sure they VOID the transaction, unless you have a fee free credit card.

If they process a normal ‘refund’ you’ll get hit with fees.

If they can’t void the transaction, speak to your bank to do it. Or do a chargeback now.

 

[serfty]

@Lucy70 @LucyB70 @Quickstatus @Pushka and others.

So, here I am, the subject of all this speculation and at least by @Lucy70 (or Eva from 1Cover) a fair degree of misrepresentation. I signed up so I could clear issues up. I am a frequent flyer, used to be Qantas Platinum but now just lifetime Silver and almost Gold.

So let me start by saying I did/do have Hypertension which is 1 of 40 automatically covered conditions by almost every single Australian travel insurer with 1Cover being the exception which take you through an obfuscated process when signing up. So a bit of caveat emptor for everyone.

Myself and my family travel to Thailand regularly, we used to visit family and friends in Bangkok and regard it as almost a second home, so it's not unusual for us to be there either individually or as a family.

I have had Hypertension for about a decade, controlled and stable. In the last few years I'd used Telehealth for repeat prescriptions, using a blood pressure monitor with the online GP to review the status. Nothing abnormal with BP generally around 120/75 each reading.

I had taken out 1Cover for a couple of reasons. Firstly an update to TID's system meant I had an issue logging in and second I'd noticed they were now sponsoring St Kilda FC, so would seem to be then at least relatively legit Aussie brand.

Sunday night.
I was in my hotel room late at night after watching a football game in reception. I was getting ready for bed when I felt pain in my back, then chest. I took some beta blockers I had for the hypertension and asked reception to call me an ambulance. This arrived quickly and I was taken to the nearby hospital ED.

In ED it was confirmed I was having a heart attack. I provided the details of my travel insurance as well as signing a guarantee that I could personally also cover the initial estimate of costs. I was taken into theatre and had an initial Stent fitted.

Monday Morning
There was an email from 1Cover (I only read this towards the end of the day). They had opened a case based on contact from the hospital during the night. They requested information which in reality from an ICU bed was impossible for me to provide.

One item they requested was permission to have medical records provided by my regular GP, I assume starting the hunt to find a potential preexisting condition. Unfortunately I hadn't had a regular GP since the clinic I went to closed down some years before. And as mentioned the only illness I had had was stable and managed.

I spoke to my wife, told her of the situation. She had the details of my insurance and connected them. They didn't offer assistance, no offer to book a flight, accommodation or anything.

Tuesday
The Cardiologist booked me in for a second surgery to take place Wednesday at 11am. The hospital advised that the insurer had provided no guarantees they would be covering costs.

My wife arrived from an overnight flight, having organized emergency care for our kids. She had discussed with 1Cover the claims situation but was told the claims team were still investigating. After she had flown overnight and seen me in ICU, she was sent a document to sign by 1Cover which needed to be printed out, signed and faxed back. This was essentially a guarantee from her to say that any costs incurred by 1Cover would be paid back if they decided there was a preexisting condition. This had to work out how to have this printed at the hotel, signed and faxed back from the hotel.

Wednesday
1Cover contacted Katie and said they had not been able to get in contact with the telehealth provider to assess if this was a preexisting condition.

Given this circumstance 1Cover still refused to provide the hospital with a guarantee of cover, even after the guarantee of repayment had been given the day before by Katie. As a result of this lack of attention, the hospital cashier came to my bed in ICU as I was being prepped for the second surgery. Literally prepped, 20 minutes before I was supposed to have the surgery.

I have no issue with the hospital looking to ensure costs could/would be covered. The first surgery, ambulance, ICU bed etc had racked up a decent bill and 1Cover were holding out. So I had a daily limit from our global debit account (limit $10k max a debit a/c can have is $20k but that needs a couple of days to set up). My credit card had the limit of $16k credit but if I had enough money in there an unlimited amount. So I transferred money from our mortgage account to my debit account and to the credit card.

3 transactions of almost $10k each took place, 1 on debit card and 2 on credit card. As point out by others even though these still appear on the account as 'Pending' - the $30k still has to be there in the account.

Thursday
Moved from ICU to a regular room in the afternoon. Twice the hospital cashier comes and advises that 1Cover had still not given a guarantee but they would wait until discharge before requesting payment of the remainder of the costs. The estimate at one stage was a further $50k - but in reality it was a bit less.

Friday
By the time discharge came around in the afternoon 1Cover had provided a guarantee but had also told us that we would need to chat the hospital for a reversal of the $30k we had paid. They told us that this would take around 30 business days and we would have to chase the hospital directly.

30 March
Received an email from 1Cover. They have received the information from my GP and are currently reviewing it to determine if this was a preexisting issue. They will get back to un within 10 business days.

As an Aside
I messaged today the CEO of 1Cover on LinkedIn (remember she told Katie not to message any other staff as they would find it distressing, so I messaged her directly). I've asked for the following 'calls to action' - let's see how it goes.

1. A public apology from 1Cover and acknowledgement that you should and could have done better and what you will do in the future in policy and procedure to avoid this happening again. As a suggestion this could be to the media that has so far covered the story, perhaps the newspaper you slammed the phone down on.
2. Detailed description of how marketing staff will be appropriately disciplined for their conduct of smearing and attempting to discredit myself and my wife in the media. We would also like follow up post discipline to be assured action has taken place and how 1Cover will ensure systemic change in policy and procedure to prevent this occurring to anyone else in the future.
3. A discussion with 1Cover’s Privacy Officer to understand how a case could be openly discussed by either 1Cover staff in the media or by their proxies. Especially the fact that in both the comments section of the dailymail.co.uk and AFF forums the individual(s) claim intimate knowledge of the case. I will hold off commencing action against 1Cover pending this discussion.

Thankyou for your clear and concise description of the circumstances of the situation

 

[Pushka]

Thankyou for taking the time to post after your illness. After your information I had to check my policy for the USA. It's worrying that in a similar situation to yours, but in the USA I don't think we could possibly cover such an emergency given their costs. We have declared it, and have answered the questions accurately, so hope they simply accept it on the spot. It sounds like a nasty collision of events which can happen to anyone even if completely covered.

But what is completely unacceptable is the social commentary provided by reps of the company. Such a breach of privacy.

 

[Quickstatus]

Given this circumstance 1Cover still refused to provide the hospital with a guarantee of cover, even after the guarantee of repayment had been given the day before by Katie.

@TheGoodDoctor
Thank you and welcome to AFF

This is a most egregious conduct that an insurer who has zero evidence of a pre-existing disease can essentially demand a signed financial guarantee from the family and then still refuse to provide an insurer's guarantee to the hospital. Potentially your second procedure could have been significantly delayed with unknown and unmeasurable consequences if you were not able to provide the back up $$$.

Imagine someone in similar circumstances but without the redraw facility. Imagine if this was in the USA - a redraw facility might not be enough.

The second equally egregious conduct by the insurer was to insert themselves into your family's social media trying to prosecute their case.

I wonder if the company contravened the Privacy Act as @Lucy70 who is apparently not in the company's employ seem to know a lot about your case.

In any case, I do hope you have or are recovering from the medical adventure.

I also hope @Lucy70 reconsiders her comment that the case is closed because the insurer paid. She completely misses the point.

Luckily the CC authorised the payment of 3x$10k. It could easily have been interpreted as something sinister.

 

[Aussie_flyer]

Half the world has controlled hypertension it's absurd that it should not be automatically covered by 1cover. As pointed out most do it automatically from what I've seen.

 

[gaz0303]

Welcome @TheGoodDoctor to AFF and thanks for your clear and reasonable account. Hope you are well on the road to recovery. I couldn’t imagine the extra stress of life saving medical assistance being given only on provision of payment. While we like to complain about our health system, I’m confident that our medical staff will provide reasonable care and ask questions later of tourists.

 

[Quickstatus]

Half the world has controlled hypertension it's absurd that it should not be automatically covered by 1cover.

The issue was not the hypertension. I think 1Cover suspected that there was a pre-existing condition of coronary disease. As per my previous post - coronary disease does not happen overnight so they went looking for any evidence of the insured knowing about it prior to this trip. I think despite not being able to find anything, they still got a signed guarantee from family but then still refused to guarantee payment to the hospital.

 

[Pushka]

This is the list of questions I had to answer on 1cover questioning on disclosed hypertension:

High blood pressure
How many medicines does your doctor advise you to take for high blood pressure? • 1
Has your dose been increased or have you been prescribed a new tablet in the last 6 months? • No
Have you ever been a smoker? • No
Have you been advised to take medication to lower your cholesterol? • No

 

[TheGoodDoctor]

For those so inclined the media keeps rolling on. We don’t actually want anything except reasonable treatment, apology and change of policies and practices.

Hmm, read the articles in The Age, SMH and Daily Mail, listen to ABC Radio Melbourne:


Mornings - ABC listen
(2.05)

Drive - ABC listen
(18:50)

Mornings - ABC listen
(6 minutes before the end)

We are not going to let this company get away with advertising one thing and treating individuals differently. We’ve had plenty people contact us telling similar stories. Also 1Cover have actively removed posts from their Instagram and Facebook pages critical of them.

Even if/when all the claim is settled, we want to see change for the next person unable to stand up for themselves.

 

[Katie B]

When they ‘rectify’ the charge in your credit card make sure they VOID the transaction, unless you have a fee free credit card.

If they process a normal ‘refund’ you’ll get hit with fees.

If they can’t void the transaction, speak to your bank to do it. Or do a chargeback now.

Thanks for the savvy comments, I really appreciate them and will ensure they're voided.