Pruhealth going back on their word

clairet707

I phoned Pruhealths pre authorisation number on approx 14th March to preauthorise a biomechanical assessment my orthopaedic surgeon had referred me to.

They said it would be covered and said to ring back when I could with the persons name.

I had the assessment on tuesday 23rd March and phoned Pruhealth on wednesday to give them the name and ask about getting my money back for the assessment as I had paid the invoice at the time. They take the name and say they will have to add it to their system as the person doesnt appear on their system. It will take approx 3 days and I will get called when the name is added.


I get a call today saying that they are not going to authorise the claim as the person doing the assessment was an orthotist not a podiatrist - I did tell them this on the phone originally and they said it was fine but they would not pay for the orthotics themselves. To which I agreed to.

If I had known they were not going to pay the claim I would not have gone to the appointment and would have found somewhere cheaper to get the assessment done as it has cost me £190 and the orthotics are £150 - I now cant afford to do this as I was banking on Pru paying the assessment cost (I have paid for the orthotics up front, total invoice was £337)

Have I any chance of getting them to pay this charge now? They said they are going to listen to the original call with their call centre person saying they would cover it.

Help

lisyloo

You can make a formal complaint, but it would be worth seeing what happens first.

In future I would suggest you get anything important (like something you are relying) in writing (or email) or at least get the persons name, date and time.
This helps both with compaints and with tracing calls.
Also ask them to put the agreement on your notes.
You could check they ahve done it by calling back and asking another operator if the agreement is recorded in your notes.

But you ened something more than just word or mouth over the phone.

If you already had the time//date/name then well done.

The_silver_surfer

clairet707 wrote: »

I phoned Pruhealths pre authorisation number on approx 14th March to preauthorise a biomechanical assessment my orthopaedic surgeon had referred me to.

They said it would be covered and said to ring back when I could with the persons name.

I had the assessment on tuesday 23rd March and phoned Pruhealth on wednesday to give them the name and ask about getting my money back for the assessment as I had paid the invoice at the time. They take the name and say they will have to add it to their system as the person doesnt appear on their system. It will take approx 3 days and I will get called when the name is added.


I get a call today saying that they are not going to authorise the claim as the person doing the assessment was an orthotist not a podiatrist - I did tell them this on the phone originally and they said it was fine but they would not pay for the orthotics themselves. To which I agreed to.

If I had known they were not going to pay the claim I would not have gone to the appointment and would have found somewhere cheaper to get the assessment done as it has cost me £190 and the orthotics are £150 - I now cant afford to do this as I was banking on Pru paying the assessment cost (I have paid for the orthotics up front, total invoice was £337)

Have I any chance of getting them to pay this charge now? They said they are going to listen to the original call with their call centre person saying they would cover it.

Help

Yes you have every chance of getting them to pay out still. They do record many of their calls so thats chance 1.

2. I agree with Lisy Loo a formal complaint to Pruhealth should be the first thing you do.

3. If you bought this product through a PMI specialist broker, they may be able to help and can go through their broker channels and speak to people higher up the chain and possibly get your claim through. Many specialist brokerages hold millions of pounds worth of insurers business so its in the insurers best interest in the long to listen to what the brokers say. Reputable specialist PMI brokerages do not want to be placing business with insurers who do not pay out when they should be as the brokers will lose their clients and reputation.

4. If neither of these get you anywhere then the FOS (Financial Ombudsman service ) has more teeth than many realise. I know of quite a few people who have had PMI and disagreed with the refusal of a claim and complained to the FOS. The FOS seems to me to find in the favour of the client rather than the insurer in more and more cases. They may well be able to obtain the telephone recordings amongst other

You'll find phone,email and addresses here. Perhaps speak to someone first on the phone to explain what has happened then suply them with the info they require via email/post:

http://www.financial-ombudsman.org.uk/contact/index.html

Remember the FOS decisions are legally binding on the insurer but not on you so it does not effect your right to take them to court afterwards should you wish to do so.