AXA agreed to pay now change their mind

stuvee02

Wondering what the (very good) armchair lawyers on the forum make of this situation?

My wife has medical insurance through her work and took the option to go private for a consultation because the NHS waiting list wasn't just long it literally didn't exist! [What's the point of sending you a 'choose & book' form when they can't give any appt at all:mad:]

Anyway, DW dutifully rang insurer to confirm they would authorise payment of the consultation which they said they would. The policy is called "VIP 2 No Excess + Travel" so it was expected that they would not have a problem with it. Insurer also sent a letter confirming that they would pay costs for the consultation and any diagnostic tests. DW went and had the consultation a few days after authorisation and had a test a couple of weeks later.

Now DW has received a Statement from insurer which says she owes £100 excess...? Even more stupidly they give the policy name at the top of each page which actually states "No Excess".

Now this could be a simple admin error however rumour has it DWs company has renegotiated their healthcare policy (fair enough - up to them) but BACKDATED the renegotiated contract to before the date the insurer gave the preauthorisation. Ovbviously if the company isn't competent enough to inform their employees about the change that's one thing but to leave them liable for hundreds of pounds is an embarrassment. The policy renewal date was 01/02 the authorisation was given 24/03 and the consultation took place 27/03. The diagnostic test was done 14/04. Supposedly the policy was renegotiated on 07/04 (or that's when it took effect) however the Statement, which still has the same policy name on it, is dated 14/04.

So now, effectively, DW has undertaken procedures that she was assured in writing would be paid for in full but insurer is now asking for payment? Is this actually legal?

I don't actually mind paying the Dr as he was very helpful and a huge improvement on the NHS consultant we saw previously but £100 is a lot of money for us at the moment and there's a principal at stake .

I feel that surely the insurer invited her to partake of the benefit with a very clear and documented agreement that they would cover the costs. I appreciate that maybe the fault is with DWs employers or somewhere in between but wonder what the legal standpoint would be.

I'm not looking for legal advice to actually take any action but would be interested to know if the insurer has a leg to stand on?

Cheers

Stu