bianca.a Posted April 5, 2013 Share Posted April 5, 2013 Hi all Just wondering if anyone has had success taking a declined claim (Medibank) to Hollards Dispute Resoultion Committee? I found out today they have declined the $8000 for Coopers total hip replacement. They have paid for everything to date for his hip dysplasia. And they also paid out for the follow up treatment after the surgery for his clipper burn which was related to the surgery. I have left a message for the surgeon to contact me to see if he can help. My local vet thinks it's crap. I am totally miserable. My DH and I have just split up, I move out tomorrow (to my parents) have been his carer for 4 years so will be jobless as of tomorrow and have to now borrow $4000 from my parents to pay for my half of the credit card bill. And somehow manage to come up with another $8000 for the other side. Sorry for the whinge Link to comment Share on other sites More sharing options...
minimax Posted April 5, 2013 Share Posted April 5, 2013 Did they say why it was declined? Link to comment Share on other sites More sharing options...
coogie Posted April 5, 2013 Share Posted April 5, 2013 Oh bianca.a, how awful for you. No direct experience that will help, my sister took them to the ombudsman after going through their complaints procedure - they refused to pay for her gsd's treatment when he ingested a jellyfish,because there was nothing to surgically remove. They got out of it on a technicality. The ombudsman said he thought their decision was reprehensible but in a legal technical sense they could do nothing. I hope with the history of them paying for other elements of treatment you will be more successful, did they give an explanation for the rejection of the claim? Sending you all good wishes possible, it sounds like you are having a very rough time and the "whinge' is totally justified. Link to comment Share on other sites More sharing options...
Rebanne Posted April 5, 2013 Share Posted April 5, 2013 I expect they will say it was elective. Hopefully your vet/surgeon will be able to say it was PTS or a new hip. Link to comment Share on other sites More sharing options...
harley Posted April 5, 2013 Share Posted April 5, 2013 So sorry you are going through this. Please give your beautiful boy Cooper a pat from me. Link to comment Share on other sites More sharing options...
bianca.a Posted April 5, 2013 Author Share Posted April 5, 2013 Thank you all I really appreciate it. The clause is: The cost of organ transport surgery, artifical limbs, prosthetics and any associated costs. Both vets apparently have seen this before and they just don't pay the cost of the actual implant. Link to comment Share on other sites More sharing options...
Mrs Rusty Bucket Posted April 5, 2013 Share Posted April 5, 2013 It's too late for you now, but might help someone else with them... My brother's dog had some lumps on her, and my brother rang up his insurer (one of the H group), and discussed what was planned and asked how much they would pay back on that. And the girl on the phone said - 80%... so when he got his claim stuff back and they were offering to pay about 20%, he referred them back to the phone conversation (with dates and names) and they coughed up some more money. Still wasn't the whole 80% but it was much better than before. I suspect if he'd ever needed to get any more lumpectomies for the dog - they'd have paid nothing, but the girl on the phone might not know that... if she says 80% without asking any questions... then they have to pay 80% - since all calls are recorded and all. Link to comment Share on other sites More sharing options...
minimax Posted April 5, 2013 Share Posted April 5, 2013 Thank you all I really appreciate it. The clause is: The cost of organ transport surgery, artifical limbs, prosthetics and any associated costs. Both vets apparently have seen this before and they just don't pay the cost of the actual implant. Calling a hip replacement an artificial limb or prosthetic is a bit of a stretch. Definitely lodge a dispute and see How you go. Link to comment Share on other sites More sharing options...
Florise Posted April 5, 2013 Share Posted April 5, 2013 Calling a hip replacement an artificial limb or prosthetic is a bit of a stretch. Definitely lodge a dispute and see How you go. A hip replacement is a prosthesis or artificial joint. I can't believe you are not covered though. Is this the same for all insurance companies? Link to comment Share on other sites More sharing options...
GoldenWei Posted April 5, 2013 Share Posted April 5, 2013 Calling a hip replacement an artificial limb or prosthetic is a bit of a stretch. Definitely lodge a dispute and see How you go. A hip replacement is a prosthesis or artificial joint. I can't believe you are not covered though. Is this the same for all insurance companies? Most of the insurance companies are underwritten'd by Hollanrd... they may vary slightly but we chose pet plan because it was a different under-writer, I don't if they would cover TPLO either (I haven't looked) but when RSPCA insurance decided not to pay for a simple hot spot because it was caused by flea control prevention (my dog had a reaction to frontline and ended up with a hotspot) we changed insurance companies. So far petplan have been good for us, haven't had to claim for a while but have claimed over $8000 for two claims, we got all of it back except the excess of $100 in both cases. Link to comment Share on other sites More sharing options...
Kirislin Posted April 5, 2013 Share Posted April 5, 2013 I'm really sorry, cannot offer any advice. It's pretty shitty, you make your decisions on what to do thinking it will be covered. If you'd known they were going to decline it might have influenced your original course of action. Your parents sound supportive if they're going to loan you the $$. I hope you can get a job soon, it could be a whole new direction for you. Link to comment Share on other sites More sharing options...
bianca.a Posted April 6, 2013 Author Share Posted April 6, 2013 Thank you all so much In the cold light of day it doesn't seem so bad now, it's just more debt I owe. I am going to fight it though, I have to try. I see Coopers surgeon on Thursday for a 6 week check-up so will talk to him about it more then. My local vet really believes they should pay out even if not for the 'implants'. Hopin like hell he wont need the left side done next year. Link to comment Share on other sites More sharing options...
*kirty* Posted April 6, 2013 Share Posted April 6, 2013 We've had people claim for prosthetic eyes and I've never heard of a claim being rejected. Not sure which companies those clients were with though. Good luck with it. :) Link to comment Share on other sites More sharing options...
OSoSwift Posted April 6, 2013 Share Posted April 6, 2013 Calling a hip replacement an artificial limb or prosthetic is a bit of a stretch. Definitely lodge a dispute and see How you go. A hip replacement is a prosthesis or artificial joint. I can't believe you are not covered though. Is this the same for all insurance companies? Most of the insurance companies are underwritten'd by Hollanrd... they may vary slightly but we chose pet plan because it was a different under-writer, I don't if they would cover TPLO either (I haven't looked) but when RSPCA insurance decided not to pay for a simple hot spot because it was caused by flea control prevention (my dog had a reaction to frontline and ended up with a hotspot) we changed insurance companies. So far petplan have been good for us, haven't had to claim for a while but have claimed over $8000 for two claims, we got all of it back except the excess of $100 in both cases. My dogs TTO surgery was completely covered, no questions asked through Petplan. Link to comment Share on other sites More sharing options...
OSoSwift Posted April 6, 2013 Share Posted April 6, 2013 SO very sorry to hear everything you are going through and I hope they do pay out very soon as it is one less thing for you to then worry about. Link to comment Share on other sites More sharing options...
trinabean Posted April 6, 2013 Share Posted April 6, 2013 Bianca.a I'm just sorry to hear of everything you're going through at the moment. I've had Petplan knock back a recent claim, which I kind of expected, as it was a bit of a grey area (due to an exclusion placed on anything GI ). I won't dispute it because I can see that the exclusion applies and in the grand shceme of things, Petplan have been really good about all other claims. So no, I haven't dealt with Hollard, but I think you should pursue the dispute with them. By the sounds of things, they were covering the condition previously and hadn't placed any exclusions on your policy (apart from the prosthesis etc. you mentioned). Good luck. Link to comment Share on other sites More sharing options...
bianca.a Posted April 7, 2013 Author Share Posted April 7, 2013 Thank you (((hugs))) I will report back after Thursday when I go down to Melbourne to see the surgeon. Link to comment Share on other sites More sharing options...
bianca.a Posted June 7, 2013 Author Share Posted June 7, 2013 I just thought I should update :) I wrote a letter asking for his claim to be reviewed and included a letter the surgeon wrote for me....today I received a cheque for $4000!!!!!! They said as a gesture of goodwill they will pay what is a fair amount for a FHO (which would have been covered). I am so bloody estatic!!!! Link to comment Share on other sites More sharing options...
OSoSwift Posted June 7, 2013 Share Posted June 7, 2013 Excellent news. Link to comment Share on other sites More sharing options...
trinabean Posted June 7, 2013 Share Posted June 7, 2013 That's wonderful news Bianca.a. Link to comment Share on other sites More sharing options...
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