Bupa Medical Insurance - MRI scan payout

mesci

Hi,

About 3 months ago my GP recommended me for an MRI scan for a severe bad back, which I had been suffering from for 4 months. I then requested her to put through as private as I have medical insurance (via work) with Bupa. I gave my GP full details of my insurance, and also phoned up Bupa (admittedly whilst in a lot of pain due to back and tooth abcess at time).

My GP was not fully aware of the process, and so referred me directly for the MRI scan at a Bupa partnered hospital. I was contacted by them the same afternoon and asked to come in the next day (shockingly fast moving!)!

I went for my MRI scan at the Nuffield Leicester, and when their queried a) when I would be seeing a consultant and b) the fact that I did not yet have an authorisation code, I said I could phone my insurers to get this but would need to use their phone as my mobile was out of signal (this was requested on the form). I was told for both that "this did not matter". So I went ahead with the scan.

I later phoned Bupa to confirm everything with them, and was told because I wasn't referred to a consultant and then to the scan it would not be covered. This was extremely shocking, especially as I had queried the process a number of times before the scan.

To cut a long story short, I started querying this with Bupa, the Nuffield Leicester (NL) and my GP, all said they would look into their part if the process. NL came back and said "nothing to do with us, you signed the paperwork you or Bupa need to pay, take the arguement with them".!

I then got a letter through from Bupa saying they were paying the fee minus my excess - hurrah!

And I got a letter from NL confirming that Bupa were paying sum minus excess and could I please pay the excess.

I promptly sent off my cheque for the excess of £100 (total fee £545).

This was back at end April/beginning May. I have since got a consultant and had back surgery (2 lvl discectomy and decompression L4 & L5) last Saturday.

Today however I got 2 letters one from Bupa saying they were not paying and one from NL saying Bupa were not paying and can I send payment immediately.

So my questions are:
1) has anyone experienced anything similar?
2) where do I stand in terms of the payment approved letters vs payment not approved?
3) where do I stand with the excess, as this is meant to be on the first of the Bupa covered payments, if I can't fight will I have to pay the full £545 for the scan and then another £100 excess?
4) my consultant has used my scans and has said he would have needed them to diagnose the problem - could this be used as an argument for having them paid for?

Needless to say I'm currently laid up trying to get myself better and this has landed a load if stress on top of me which is unneeded.!

Bossyboots

Did your employer ever give you the book covering the scheme the company belongs to as this sets out clearly what you need to do to be covered. As far as I am aware, every scheme requires you to see a consultant who would need to recommend the MRI scan. Your only argument as far as I can see would be if your scheme doesn't have that clause.

I have to say though that I am surprised BUPA didn't explain this to you and wonder whether you didn't take in the info due to the pain. They always went through everything thoroughly with me in terms of the procedure, excess and the need for separate codes for the consultant and MRI scan itself. Nuffield usually expects you to complete the insurance details or tick self paying before they carry out any procedure. I do think BUPA are being a bit strict on the rules with you to be honest but I suspect that if you check your handbook you will see it sets out clearly what to. It may be worth discussing this with your employer to see if they can bring pressure to bear on BUPA to cover you for the scan.

Your GP is right that it has nothing to do with them.

Brize

This sounds like it might just be an administrative problem. Raise the issue with Bupa in the first instance - they have a reputation for resolving complaints fairly and promptly.

If you're still dissatisfied, ask your employer if you can involve the broker (assuming there is one), who will have a vested interest in ensuring that the scheme runs smoothly.

Hope this helps.

Weirdlittleman

Was there a reason you didnt find out the procedure for your insurance and follow it.
Of course it would need to be authorised by Bupa in advance.

Luckily for you the letter will probably get you out of it but its amazing how many people show such incompetence.