Bupa or NHS? never seen specialist and been on Cerazette for over 2 years with no breaks

[tmcooke87]

Hi,

First post on here and looking for some advice from you ladies that have been / are in a similar position to me...

I had abnormal cells in 2009 which were lasered off. Then in 2012 the abnormal cells recurred and I was given an acid solution which burned the cells off. My belly button was in pain around this time and lumps started to form externally which a year later these lumps were biopsied and led to a diagnosis of umbilical endometriosis in jan 2013.

Since then I have been prescribed Cerezette which I have taken without any breaks for over two years now. I came of them for 3 weeks in late 2014 and when back on the pill due to the symptoms of the endo worsening. I have now noticed that once monthly I have had light bleeding and the symptoms of endo for 2 weeks a month. Doctor has now told me to have two Cerazette pills per day which I do not feel is helping because the bleeding persists along with the feeling of nausea and bloating.

Also I have recurring water infections which I only get prescribed oral antibiotics for. In one month I had this twice and two courses of the antibiotics. I have so many water infections I am now allergic to trimethoprim.

On top of this I also get the usual symptoms of the exhaustion, back pain, leg pain, upset stomach, bleeding and pain after intercourse.

I have never seen a specialist and have only been using the NHS which has not got me very far over the last few years. Even though I have been diagnosed with endo. all I have been given is the Cerazette / Cerazelle.

My partner has Bupa select cover through his new job and has added me onto the policy at the policy cost but because it is a corporate program it says MHD (Medical History Disregarded). Endo (If I am right from what I have read) is regarded as a Chronic Illness as it is untreatable..

My questions are.... If it says MHD then does it cover pre existing conditions until they have been diagnosed and tested by a consultant through Bupa? Is there and pitfalls to watch out for when speaking with Bupa to try and arrange a consultation so as they do not say I cannot see a specialist due to it being either a pre existing condition and / or a chronic condition?

I really do not know where to run with this as my local medical authority just have not made me feel at ease at any point through this and the option of potentially being seen private is daunting although I hope this could be a real turn in of positivity in what has been an ongoing battle since starting puberty with nothing ever really being acknowledged or fixed.

I am now 27 with no children yet but this is something I would like to change in the future if possible.

Apologies for the long post but there are so many things to say and more questions to ask as I do not seem to get any answers from the medical sector where I live and I don't know where to turn

[Brownlow]

Check that the policy does not have something called a moratorium on MHD. While it might cover pre-existing conditions a moratorium means they won't cover these for an initial period of time ranging from about 6 months to a couple of years. I am on my husband's policy but the moratorium is 2 years so I can't make a claim for anything endo related for 2 years. Some company policies have no moratorium. The premiums for these would be higher.

Endo is not classified as a chronic disease. However, if your situation is that you have had multiple laparoscopies and it returns very quickly after each one an insurance company can argue that you have a chronic version of endo. This is very unfair as some women have been treated by inept gynaes and the chance of return of endo is higher if not treated by an endo specialist. If you only had your own personal policy an insurance company would find it easier to challenge you on this point but my feeling is that the treat people on company policies more leniently. I have experienced a huge difference when covered by a company policy and a personal policy. The fact that you have never seen an endo specialist will ironically be in your favour. Your argument would be that you have never been treated by the correct specialist for your condition which has led to the endo recurring. I should think that your operation was inexpertly performed by a general gynae who not only did not remove all endo but possibly left some endo particles at the incision site of your belly button which implanted and grew there. Spontaneous primary umbilical endo is very rare. I wouldn't worry too much about the chronic illness point.

If there is no moratorium, locate an endo specialist here bsge.org.uk/ec-BSGE-accredi... Google their private practice and find the contact address. Then go to your GP and explain you have private cover and ask for a referral letter and give her/him the address to send it to. Then ring the specialist yourself and arrange an appointment. Check up that they have received the GP referral and if not, chase your GP.

If there is a moratorium insist that your GP refers you to your chosen endo specialist. You have the right to choose on the NHS. Look at Lindle's informative post on this. If you end up getting nowhere with this route you can cut your losses and pay to see the specialist privately (£200ish) for the initial appointment and then switch to seeing them on the NHS.

[Brownlow in reply to Brownlow]

The reason you need the GP referral letter is that most, but not all, insurers require this.