Read Your Policy

Fall 1999 CSANews Issue 33  |  Posted date : Mar 03, 2007.Back to list

Dear Bird Talk,

I appreciate the opportunity to alert your readers to the unfortunate experience I encountered with an insurance company named Pure Insure with offices in Toronto and Vancouver.

On April 4, 1999, my flu condition progressed to the point that I encountered a severe cough. As a result, my husband took me to the emergency ward of the local hospital in Mesa, Arizona. After a lengthy wait, I was attended to by the physician on duty and informed that there was little that could be done for my condition, which was diagnosed as bronchitis resulting from the flu. No medication was prescribed. The hospital billed my insurance company for its services, which remained unpaid, and I was later billed the following:
  • Hospital services- $233.64
  • Physician -$127.00
  • Radiologist - $22.90
I presented the above accounts to my insurance company, Pure Insure, for payment. They asked my local doctor for a record of my medical history, which was supplied. After review of my record, the payment was denied. The explanation was that I attended a respiratory specialist's office in 1989 TEN YEARS AGO. I have not had medication for bronchitis since that attack.

Yours truly,
Z. Dark
Regina, Sask.

Response:
Your letter is a prime example of why it is so very important to thoroughly read and understand your policy's wording.

We checked the wording in Pure Insure's 1998-1999 policy and it was quite explicit. Any pre-existing medical condition that has previously required referral to a medical specialist or hospital admission of 24 consecutive hours or more. We believe these long and broad pre-existing periods (in this case, a LIFETIME pre-existing clause) and referrals to specialists' clauses are disgusting in their simplicity. Is birth a pre-existing condition? Is referral to a specialist from whom you get a "clean bill of health" reason to deny a claim? You decide!