Can I havea BUPA moan pls!

anonymousie

Have seen a consultant and had a steroid injection- he said it might need repeating- sent to physio. Had physio...need another injection whicvh the physio will do and is qualified to do, but blooming BUPA wont cover it:mad:

They would cover if I went back to the consultant (and how much would that cost them then?) but otherwise I have to stump up the dosh.

REally annoyed as can't get consultant appt till next thurs and we go on holiday on Sat abroad for a week- I am aware that the injection might be painful for sometime after, and I don't need that when I'm away (and work are all set up to cover me today as well...)

GRRR pay ££££ to BUPA to try to allow theses "minor" things to be sorted out in a way/timescale that suits me and it doesn't work- GRRR aggain!

lisyloo

I agree.
They probably have some sort of complaints procedure.
Have you tried using it as this defies common sense.

shelly

From my experience BUPA will only pay out if the person...be that a consultant or physio etc is on their list of "approved" professionals.

I saw a consultant dermatologist last week for a cyst and when I called to get an authorisation code before going they told me the consultant was on their list but they had only agreed prices with her up to a certain amount.
I was fully covered for the consultation, blood tests, scans and minor treatment but if I was to have surgery I had to get the costs from her first to see if it was within their agreed limit. If it went over their agreed price I would have to pay the rest.

the-chauffeur_2

Unfortunately, all private medical insurers write terms into their contracts that are designed as much to protect them as to protect the policyholder/member. Your contract is likely to offer one of two or three levels of cover, all of which will contain some level of limitation as to what facilities can treat you. It will also contain a list of 'approved' facilities, and/or outline the level of specialism that the treatment must be sought from/administered by before they'll agree to cover the costs.

The theory is that by restricting the use of physicians to those who meet their approved standards, they minimise the risk of complications arising from the treatment that is provided or other liability claims arising from things like allegations of maltreatment. On the face of it, declining to accept your claim does seem to defy common sense - particularly from an expediency point of view - and yes, the requirement for a consultation would almost certainly cost them more than the cost of your treatment elsewhere. The trouble is, the insurer wants/needs to draw the line as to what physicians can be approved somewhere so that policyholders don't try to get treatment from medical facilities that might be inappropriate.

Remember, it's not the insurers who provide the treatment, and so instead they try to maintain as much control over the risks they are asked to cover by using an approval system. Ultimately, policy terms requiring the policyholder to have treatment approved or administered by a consultant keep the risks of something going sideways to a manageable level and by extension, keeps premiums at affordable levels(more risk = higher premiums for all).

That's not to say the system is foolproof by any stretch of the imagination, and BUPA are not alone in this respect, but I realise that's no consolation to you right now. And in fairness, it's not really BUPA's fault that you can't be seen by a consultant at a time that suits you - that's down to you and your consultant. It's just really unfortunate that the need for your injection coincides with your holiday.

Sorry - that's not really very helpful, is it?