Pre-existing ailment reviews
Determining whether a condition existed prior to a member joining or upgrading hospital cover is a critical step in claims decision making. Cogent supports Private Health Insurers with expert, timely and clinically governed pre-existing condition determinations.
We connect insurers with qualified medical practitioners who review medical evidence and provide an independent opinion on whether a condition meets the pre-existing criteria under legislation and fund rules.
Connecting insurers with qualified medical practitioners.
What the service provides
Independent clinical assessment
Our panel of Australian medical practitioners assesses medical history, records and diagnostic information to determine if a condition was pre-existing within the required timeframe.
Clear and timely determinations
We support claims teams with fast, accurate and consistent decisions to ensure claims are managed efficiently and in line with regulatory and fund requirements.
Expert medical guidance
Our clinicians provide evidence-based opinions and help clarify complex or unclear medical information to support confident decision making.
Our approach
Panel of certified Australian medical practitioners
Clinically governed service model
Secure information handling and documentation review
Tailored service for Private Health Insurers and their members
Benefits for insurers and members
- Safe and timely return to work
- Reduced administrative burden on internal teams
- Improved transparency and communication with members
- Increased confidence in claims outcomes and eligibility
