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lexie44light

GPS - Insurance

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As many of you may know I had paid for insurance through GPS before I got my BA. Obviously things went wrong and I had to have my implants removed so I contacted GPS with the intention of receiving a payout as per their insurance claims.

However I received an email from them today stating that as Breast Augmentation was an optional procedure they would not be paying anything towards getting it redone. Not for flights, accommodation nor the 2 weeks I had to have off from work when I had them explanted.

I now dont know what to do as I had already planned on going to Europe with my parents in July (once in a lifetime thing and they have been planning it for about 3years). I havnt paid anything yet but their tickets are booked an a cruise paid for. I was expected to meet them over there after the cruise and take them through Italy (meant to pay in about 2months).

Now I'm so confused as to what to do. I really really dont want to let my parents down as this is a once in a lifetime thing but also I cant even handle to look at myself naked..

Ive worked out to do both Thailand for BA and Europe (would do BA on the way home) will cost me around $12,000. I only earn around $1000 a fortnight (but work 30hrs a week) so obviously cant save that much in that amount of time. I plan on picking up cleaning in the morning aswell but am not sure where to look as I dont officially have cleaning experience.

Struggling atm really... so any ideas would be great! (hard to explain as people keep saying just leave the boobs and go to Europe - but they dont get it)

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Have you thought of maybe a personal loan or a cosmetic loan.. I hate them but credit card??

I don't understand GPS, I went through them too and I work in insurance so went over it with a fine tooth comb, aren't they supposed to cover you up to 6 months after should anything go wrong? It's an American company but surely they have some sort of insurance ombudsman like we have in Australia. I would request to go through their internal dispute process before approaching the ombudsman (if they have one). Did they at least cover the cost for taking them out? Or is that what they're saying is optional - to have it redone?

Have you saved any of the 12k? You still have a few months don't forget you would be paying the BA on your way home so that's 5 months saving.. And if your staying in Bangkok the place I stayed at was legacy suites was like $80 or something a night and it was really nice..

I really feel for you Hun I'm so self conscious I know what you mean and how sad it would be making you feel. I don't know if this would help but I lived in these water bras from BNT. Have you seen them? It's by no means an answer but wearing something like that might cheer you up a little. Just think its in July and we are practically in feb - the time will fly so quick xxx

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Are you planning on using the same surgeon this time? He does have a fantastic reputation. Perhaps you could ask him for a cost only procedure? Or perhaps ask if one of his colleagues would offer a cost only?

I'm confused as to why GPS aren't paying. I'd certainly be challenging it - what would they cover if not this???

Sorry I have no more advice but you truly have my sympathy. This just sucks.

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I understand them not paying for additionally surgery as they deem it not necessary but I would have thought they would pay out for the time off work at least. Most have a income protection part within them don't they? Well any insurance I have ever taken out.

Have you got a copy of their PDS which outlines what is and isn't covered?

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I'm so sorry to hear Lexie :( I really feel for you nothing seems to be going in your favour..

I don't understand why GPS would cover BA (being an elective procedure) if there excuse is it is elective! It's just crazy.

Did the hospital you went to have any kind of guarantee? I know PIAC does but I don't know anyone that has used it.

I completely understand how you feel about wanted them redone ASAP, my biggest fear is something like that happening and my boobs ending up worse than how they started. And you'll be in Europe during summer your not going to want to cover up.

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Hi Lexi, please keep fighting to get something out of GPS, in their business they want to pay out as little as possible, and will try it on. I know it must be incredibly confronting and emotionally draining but if you can get your claim accepted it will be worth it. You need to prove to them that as a direct result of your surgery you are now suffereing and the only thing that will fix it is a BA.....it is not optional! Perhaps if you can gather all your medical documents, including photos of your before and after breast pics and present your case.

It would be such a shame for you to miss your trip with your parents but I can understand how down you'd feel if you don't have a BA to look forward to. Can you wear a flattering push up bra with a bit extra padding to boost how you feel dressed? I know mine were asymmetrical and I did feel horrible and self conscious naked, but dressed I had it sorted. Do you think by July you could have a plan in place, so that by next year you can head to Thailand. In doing this, it may cost a bit more with flights, but you may have more time off work by then so you can stay and enjoy Thailand and take your time recovering and weather should be better too. Think of it this way, the trip is a once in a life time thing as you will probably be sharing accommodation (and obviously the accomm expenses!) so really if you did it on your own you'd pay so much more.....so going with family you'd be saving money in the long run. I know it's not all about money, but more how you are feeling! I really hope you can get some joy out of GPS.....keep pestering them! Another alternative is to get a loan......though you'll pay more in the end unless you can get one from a family memeber who'll know you'll be good for the money.

take care, really hope you can work something out that will make you happy in every way.

chacha

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Hi Lexie

I am so sorry you have had all this hassle. Im not really sure what solution to offer, apart from, as some other girls have mentioned, maybe a credit card with zero interest for the first 6/9 months. I know that Bankwest had one, as this was what I got, so in effect I dont have to pay for my surgery for 6 months after.

As for GPS Insurance, hmm, not sure what to say. I did look at going through them and emailed a few questions and wasnt happy with their responses and decided I wouldnt get it as I wasnt confident in them paying as their definition of a complication was somewhat dubious.

Having said that, I would contact the insurance ombudsman, or even consumer affairs (they have an insurance area) to see if you can get more clarification on this ambiguous policy.

Wishing you all the best of luck.

:)

I will copy their email:

Dear Karen,

Yes that is correct, you could choose a higher limit if you feel that you will need to be covered to that limit. The policy is a capital sum limit policy, what that means is that you may have multiple benefits pay, in the event of a complication. Our policy, Global Protective Solutions (GPS), is the broadest policy available. We feel that in the event of a complication you would incur additional expenses that are not only associated with the actual additional surgical/medical costs.

GPS has two sides of coverage with multiple benefits. First it provides coverage for trip related accidents and injury to include death, this provides benefits during the trips duration for up to 30 days. The other cover provides a host of benefits in the event of a medical complication stemming from an approved procedure for 6 months after the procedure. The benefits provided are: additional medical or surgical treatment due to a complication, a death benefit, repatriation of remains, disability income, additional surgical treatment due to a thrombosis, expenses to cover travel, meals or accommodations, dependent or family coordination, residence modification, physiotherapy and rehab, as well as benefits due to severe disfigurement and loss of reproductive function.

As you can see the policy was developed to cover the “deep pocket” expenses in the event of an accident or medical complication. The policy provides first party benefits when an event occurs, meaning that the traveler is the direct beneficiary of the policy.

Complication is defined as:

‘Complication’ means Bodily Injury from a Medical Procedure incurred whilst an Insured Person is travelling for the purpose of receiving medical or surgical treatment outside the Insured Person’s country of residence. Complication does not include an undesired outcome or a failed procedure. A Complication that causes death or disablement can not be the result of a previously undiagnosed medical condition that first manifests itself during the Insured Person’s period of travel or within 24 hours of return to the Insured Person’s home country. The Complication can not result from the Insured Person’s failure to follow all pre- and post- procedure medical instructions.

A complication does not include undesired outcomes or failed procedures. The purpose of coverage was not to pick up the normal risks associated with a procedure that may be an undesired outcome or a procedure that failed but to cover an accidental complication, such as a foreign object being sewed up inside of you, or infection.

So, in short, it would depend on the specific nature of the complication and the claim circumstances.

I hope this assists you in your question. It is often hard to diagnose “what if’s” but in general a complication from the procedure is the intent of coverage.

Best regards,

Benjamin Simons

Benjamin G. Simons - International Marketing Director

Custom Assurance Placements, Ltd.

A Specialty Lines Insurance Broker

www.customassurance.com

P.O. Box 5736, Columbia , South Carolina 29250-5736 - USA

Phone: +1 803.799.1770 - Fax: +1 803.799.1817

Global Protective Solutions - For the Medical Travel Industry

www.globalprotectivesolutions.com

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I'm so sorry to hear of the trouble you are going through Lexie, you are really in a pickle and i wish i had a way of helping.

ImKaren and everybody else that can help with this issue, i don't have long term health insurance and now that i know that GPS and other highly rated short term Health insures don't cover elective surgeries (if there is any chance of complication) Did you just get surgery without any health insurance or did you find another insurer that offered the options that you needed??? i don't know whether to "wing it" or not to chance it with something so important.

Any advice or help would be appreciated. ;)

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More??

I would still get GPS anyway MissTrissyBelle even just for the coverage of your time in Thailand. Things can obviously go wrong before you even get home and i think for this, just incase, you should still get it.

I am currently waiting for my ap with Mark Lee to see when i would be suitable for another BA. Just a waiting game now i guess!

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sorry to hear that Lexi, but still keep pestering them for an update....so that they actually do follow through with something with a conclusion!

What are your plans for having the BA redone, when/where/who?

chacha

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Hi Trisybelle

I didnt end up getting any insurance as after looking into the policies quite a bit it seems they do not actually cover very much at all and to me were absolutely not worth a penny.

I have had a few issues since coming home, Ive had several drs visits, an ultrasound and a visit to the local public hospital. All in all, the total costs of these bills were under $500 and I will get some money back from medicare, so not a lot, considering I save more than $10 000 by having my surgeries done overseas. So, my answer would be still the same if I were to do it again. I would go overseas and I WOULD NOT take out a pollicy.

:)

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Thanks Chacha. I have an appointment with Mark Lee on the 19th of March. Hoping to book in for my next BA ASAP after that really. Because I'm getting a loan, money isn't the issue (until after!!).

I have a trip to Europe scheduled for midJune and I would really like to have boobs for it so I can look good in a bikini but if he wants me to wait till after though that's what I'll do :).

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Hope you can get your preferred boobie date - you need something to work for you after such a hard journey.

I chose not to get surgery insurance after reading this story but I did get regular travel insurance for other health issues and lost luggage etc. being hospitalized with dengue or needing evacuation after a tuktuk accident would be very expensive.

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wow not long then till your consult :) From what I've read he's a brilliant surgeon....hope you can get them asap:)

chacha

Thanks Chacha. I have an appointment with Mark Lee on the 19th of March. Hoping to book in for my next BA ASAP after that really. Because I'm getting a loan, money isn't the issue (until after!!).

I have a trip to Europe scheduled for midJune and I would really like to have boobs for it so I can look good in a bikini but if he wants me to wait till after though that's what I'll do :).

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I may be getting money after all!!

I just got an email saying they would pay me out $2,500 - which is no where near what it cost but better than nothing by far..

If it happens I will let you all know :)

Yay! This is great news! And may restore some hope in insurance for some :) congrats and I hope they do pay you!

Your case was definitely a complication that should have been covered! Woohoo xx

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