AXA Refused to Cover My Mothers Surgery Despite Valid Policy
About two weeks ago, we applied under our Axa Insurance health policy (policy no: 590365) for my mother’s gynecological surgery scheduled to take place at Istanbul Ataşehir Medicana Hospital. Throughout the application process, we never received a clear or timely response. At every stage, we had to follow up ourselves and request updates. The company’s customer service demanded an excessive number of irrelevant and unnecessary documents and petitions. Although we submitted all required documents completely, the application was left pending for several weeks and was eventually rejected. The reason given was a surgery performed 15 years ago that had no relation to the current operation. Despite our doctor and we repeatedly explaining that the upcoming surgery was entirely independent of the past procedure, these explanations were disregarded. As the surgery was not approved and was deemed outside coverage, it could not be carried out. Still, we were told the procedure would cost around ₺400,000 and that we would be expected to cover it ourselves. Although we have paid our policy premiums and submitted all requested documents in full compliance, I do not accept the insurer’s delay in the approval process and refusal to cover the surgery without valid justification. I demand that our rights under the insurance policy be fulfilled, the approval process be finalized promptly, and our grievance be resolved.
Progress
Within the scope of our Axa Sigorta health policy, we applied first for my mother’s and then my father’s surgeries, which were planned to be performed at Istanbul Atasehir Medicana Hospital. For about two and a half weeks, we did not receive any positive or negative response in any way; at every stage, we had to call and insistently ask for information ourselves.
The company’s customer service requested many documents and petitions unrelated to the procedure. Even though all documents were completed, both surgeries were rejected, and we were told this was based on a completely different surgery that took place 15 years ago. However, both our doctor and we repeatedly stated that the planned surgeries have no connection whatsoever with the previous operations. There was also no information provided about this exclusion when the policy was created.
Neither of the surgeries has taken place yet, and no procedure could be carried out because approval was not given. Despite this, Axa Sigorta stated that we would need to pay a high amount of around 400,000 TL for the surgeries.
Although all documents have been submitted in full and there is no past connection, we do not accept that the insurance excludes both surgeries and does not provide us with a clear justification. Even though we paid our insurance fee on time, we want our entitled health coverage to be provided and the application process to be resolved as soon as possible.
We would like to inform you that, upon review of the application directed to your site, the request has been rejected because it is based on a period before the policy. Sincerely, AXA SİGORTA A.Ş. Customer Complaint Management
The doctor did not consider this situation as a pre-existing condition. He said it is something that can happen to any woman who gives birth. Giving birth is not a pre-existing illness. You did not offer a solution; we will never get a health policy from Axa insurance again.
