CLL Ireland Serious illness cover

[Mayogirl24]

Hi folks. I haven't posted before as I have been on W&W for the past 3 years since my diagnosis at age 52. Last week my haemotologist decided I need treatment...and will start me on venetoclax in the New Year. He's very positive about the outcome, so I hope all will go well. However I have a specified illness policy that says CLL is excluded unless histologically is at Binet Stage A...I think now that I need treatment I must be past Stage A...my WBC jumped from 93000 to 169000 in the past 6 months. Haemoglobin is 8.8. I have had 2 bouts of pneumonia and was also hospitalized with cellulitis for a week in the past year. Lymph nodes are swollen and spleen is enlarged so what Binet Stage is that? Anyone have any success getting a payment under critical illness or specified illness ,insurance cover.

[Newdawn Administrator]

This link explains the staging system;

cancerresearchuk.org/about-...

Best wishes,

Newdawn

[Mayogirl24 in reply to Newdawn]

Thanks New Dawn. I've seen that which makes me think that I'm at Binet Stage C but I guess my consultant will answer this

[Newdawn Administrator in reply to Mayogirl24]

I’d be surprised if you’re not Stage 3 too but good luck with the outcome.

Newdawn

[cajunjeff]

Hello Mayogirl. I am from the US and am reasonably knowledgeable as to how healthcare and other insurance policies here are interpreted. I would not think that the methods used to interpret policies are much different here than in Ireland. The first place to start is the clause in question. How exactly does it read? Unless the clause is against some public policy or is vaguely written, it will be enforced as it reads unless it violates some public policy or is vague.

If the policy reads as you say, and only covers stage Binet A cll, its almost like a scam policy that some companies sell. Typically the only expense a cll patient in Stage A cll occurs is for labs a few times a year and maybe a few dr visits each year. I would venture a guess that 95% of the expenses for treating cll occur in stages B and C.

So unless I am misunderstanding your especial illness policy language, its as if someone sold a policy to treat cancer, diabetes, heart disease or whatever, but then basically rendered the policy worthless by only covering early stage disease. In the US one might even sue to have the courts throw out unfair exclusions and argue that the insurance co is unjustly enriched by writing a policy purports to cover cll, and then excludes the coverage.

I would be curious to see the actual language of the policy as it relates to cll, maybe I am misunderstanding it. As it appears to be written, its as if one purchased a policy to cover heart disease only to learn later that moderate and serious heart issues are excluded from coverage. Courts where I live would look unfavorably at an insurance policy that excludes most everything it purports to cover. Good luck to you. I agree with Newdawn, it sounds as if you have stage 3 cll, which as you know is very treatable. But stage 3 is what your policy should cover, not exclude, if its a meaningful policy. Just my opinion.

[Mayogirl24 in reply to cajunjeff]

Hi cajunjeff

It's not a policy to cover health costs. It pays a lump sum if you have a specified illness. The list of specified illnesses includes cancer and specifically leukemia but in the exclusions it says "CLL is excluded unless histologically classified as having progressed to Binet Stage A." So I read that to mean that if my doctor says I'm Stage A, B or C then I should be covered...it would be quite a nice silver lining in this situation.

[bennevisplace in reply to Mayogirl24]

I successfully claimed on a critical illness policy on diagnosis of CLL in 2006, confirmed by my haematologist and based solely on histology and a lymphocyte count just over 5 x 10^9. The policy was issued in the UK, possibly by Zurich Life though I can't be sure.

Binet stage A means you have a confirmed diagnosis like mine, and you have fewer than n groups of enlarged lymph nodes. So all you need is for your consultant to write to the insurance company to back you up. Get the claim form now!

[Mayogirl24 in reply to bennevisplace]

That sounds very promising...I suppose it's a "prize" that no one really wants to win but...still, it would be nice if it works out! I hope you are keeping well. Regards. M

[bennevisplace in reply to Mayogirl24]

Thanks, I'm 4 -1/2 years post treatment and stable, fingers crossed. Hope it all goes well for you, treatment and insurance claim.

[Mayogirl24]

I think the Irish courts also interpret insurance policies on the basis of the ordinary meaning of the words

[thompsonellen2]

Greetings from someone in the US who is also female and about your age but 9 years into treatment. With hemoglobin at 8.8 you wouldn't have qualified for my first clinical trial (I had to be at 10). It would be really unjust if this doesn't trigger coverage. They will ramp you up slowly on venetoclax and then it's probably 4 pills a day and you go about your life for a few years. Good luck!

[Mayogirl24]

Thanks Ellen I hope you are right.

As health is wealth, a good outcome is best but as I have been paying for this policy for 10 years it would be a lovely perk if it pays out. I'm hoping rather than expecting.

All the best

Mary

[Veggiesaredelish]

Hi Mayogirl24, I know just about zero when it comes to health insurance . I read your post a couple times and I was wondering if you had called your insurance co? I've called mine many times so I don't panic about how in the world I will pay for my infusions, IVIG and Rituxin and now on Calquence pills. I was diagnosed in 2022 at what stage I'm not sure. I asked the oncologist, who I think is very good , and she said everyone is so different that staging doesn't really apply to estimating survival or the progression we can expect. I think I'm at least B. So back to my initial statement, I wrote down the questions I had then called the insurance company and felt relief instead of worry .Good luck to you!

[Guinness4822]

Hi Mary,

I have just completed treatment and all good. I am taking a group of Irish older people to Westport for a holiday on May (my family from there and still have many cousins there). Your post has reminded me to look into my insurance.

Good luck with your treatment.

Tony.

[Mayogirl24]

Best of luck Tony. I hope your insurance comes good. It would be nice if it did. Enjoy the trip to Westport. I'm sure you will... one of my favourite places.

[bennevisplace]

BTW, spent a few days in Co Mayo recently. Wonderful.