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Question:

From Hong Kong:

My son was diagnosed as type 1 diabetes at the age of 18 months old and was hospitalized for two months. I would now like to submit an insurance claim for the hospital fee. We got a medical report from hospital saying the cause of type 1 diabetes is congenital.

I am afraid that we cannot make the successful claim as the purchased insurance plan does not cover illnesses which are congenital. We would like to appeal since, at diagnosis, they informed us that the cause is unknown. Furthermore, they did not perform any tests to verify the cause during hospitalization.

So, is type 1 diabetes classified as a congenital disease? If this disease can be caused by environment factors and no 'genetic' tests or other tests are applied on the patient, can we request that the hospital amend the cause as "unknown?" Have there been any successful medical insurance claims for this type of disease?

Answer:

Unfortunately, I am not familiar with the insurance principles of Hong Kong. I would recommend seeking the advice of someone who has experience in the insurance laws governing the place of issue for your insurance policy.

DSH

Additional comments from Dr. David Schwartz:

I do not know about special nuances in the insurance industry in the Far East, but, if you were in the United States and your child were MY patient, I would be happy to write a clear, pointed, and rather angry letter to a medical director about the INAPPROPRIATENESS to label type 1 diabetes in an 18 month old as "congenital."

There are indeed extremely rare forms of "neonatal diabetes" that are, in fact, due to recognized chromosomal/genetic errors. This disorder actually can be transient (although can recur) and I would have to say that this would be a "congenital" form of type 1 diabetes.

I would suggest that you get your physician and your endocrinologist to write a letter to the MEDICAL DIRECTOR of your insurer to point out the insurance company's misguided labeling. There are some tests that your child can undergo to even better show the "acquired" nature of his type 1 diabetes. These would include various pancreatic antibody tests.

I think you should fight loudly and hard to appeal this.

DS

DTQ-20040730133615
Original posting 11 Sep 2004
Posted to Research: Causes and Prevention and Insurance/Costs

  
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Last Updated: Tuesday April 06, 2010 15:09:58
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