Eloise HorsfieldEXCLUSIVE By Wendy Williams
AN expat has won a two year battle against an insurance company that refused to pay his hospital bills.
Retired IT director Graham Otter, 58, was forced to fight Groupama after it insisted that he was not covered due to a pre-existing condition.
Incredibly, it came after he was encouraged to move insurance companies with the promise of a lower premium.
“It seemed like an obvious move,” explained Otter, from Buckinghamshire, who has lived in Mijas Costa for seven years. “But it has been a nightmare.
“After commencing the policy I was admitted to hospital with an emergency heart condition a week later.”
Although his policy stated emergencies would be covered, Groupama informed him that his hospital bills would not be paid as his admission was related to a ‘pre-existing condition’.
However, he confirmed that his policy had clearly stated there was ‘no wait period’, moreover he had NOT suffered any previous conditions.
And even when his hospital doctor confirmed this, the insurance company still ignored his claim.
“Their response was just to ignore me and block any further cover for heart related treatment.
“Thankfully for the last two years I have only needed consultations and simple procedures but I have had to pay for these myself.
“In total I have been forced to pay around 4,000 euros.”
Otter had been forced to take out private health insurance after it emerged that he was not eligible for healthcare in Spain.
“I only have access to private medical care. Once I have been declined that, what can I do? I would have had to pack my bags and go home.”
Now, after two years of fighting, he has been reimbursed the money.
“But it would not have been achieved without a huge amount of effort and emotional stress which is exactly what you don’t need when dealing with a heart condition,” he added.
“I just hope that my experience may be a warning to others.”
When the Olive Press contacted Groupama a spokesmen said he could not discuss the matter with us.
Many insurance policies exclude people with a pre-existing condition or impose a waiting period before coverage starts.
If this is the case, although you are paying your monthly premiums, you may not have coverage for any care or services related to a pre-existing condition.
Anyone considering making a switch should take care to understand exactly what they are covered for.
We are looking for health care coverage and would appreciate hearing both the good and negative regarding claims reimbursement.
Thanks.
I have been waiting a year and half for Groupama to settle my house fire claim. Totally ignored and left homeless. Did not want to deal with An English person.
Dear John, Thank you for your comments. I would like to hear more about your situation for a follow up story. Please call me on 951166060 or email wendy@theolivepress.es. Thanks, Wendy
In Spain with some insurance companies you are only insured until you make a claim. The situation did improve some twenty years ago when several really bad insurance companies went out of business, but good it is not even now.