Problems with BUPA

morganlefay

I've been a member of BUPA since I was about 15, originally in my own right and then on my OH's BBC subscription which we have kept up. I am now 67 . We pay them a lot of money monthly and in the past they have paid for a lot of things I have had wrong. Now I have type 2 diabetes and it appears that consultations for things connected for that are not covered. I was reduced (most unusually) to tears by one of their phone ladies during a discussion of whether they would or wouldn't pay for an appointment for what might turn out to be glaucoma. We are now thinking of stopping this insurance since we seem now to be covered for very little if you exclude all the things connected with diabetes. It would save us a LOT of money which we could really do with, but I'm not sure. Has anyone else been in this situation ?

Savvy_Sue

You need to read the small print to see what is and isn't covered, of course, and then you might find it worth carrying on for your DH but not for you. Not ideal, but should reduce costs, at least worth looking into.

And may be worth a complaint about the way you've been spoken to, I know insurance doesn't usually cover pre-existing conditions and you can understand them increasing prices for things you've developed, but I didn't think they would increase prices AND refuse to cover something developed since you took the policy out! Not a lot of point in insurance on that basis ...

Savvy_Sue

And as it's only me talking to you atm

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Brize

morganlefay wrote: »

Now I have type 2 diabetes and it appears that consultations for things connected for that are not covered.

Can I ask, is there an explicit exclusion for type-2 diabetes on your membership certificate? if not, what reason are Bupa giving for declining the claim?

lisyloo

One possible option is for you to "self-insure".
This means put your money by in an account to pay privately.

The downside is that it won't cover you for anything major (not enough in the pot) and it will take a while to build a pot up.

But it does mean you have complete control and choice.

There may be times for example that the NHS is perfectly acceptable and the waiting times are fine especially now there is more choice available.

The downside is that I think you'd be more reliant on the NHS.
The big upside is that your in control and you don't have to be worried about policy conditions or speaking to people or getting upset. You can make your own decisions.

Think about how much your would have in a fund if you add up the past 15 years premiums.
Would it have paid for your treatment?
If not, is it still worth compromising and getting some of the treatment on the NHS for the benefit of being in control?

If the person spoke to you out of turn then I would complain.
Mainly so that someone else does not suffer the same.
Of course you could have just been upset becasue of the stressful experience rather than their manner?

Also bear in mind that this is going to get substantially more expensive as you get older in a big way.
At 67 you are at the age where people tend to start to get problems, but the cost and needs are statistically likely to increase, so you need to ebar that in mind.
If you can addord it now, then is that sustainable?
For more people it won't be affordable in their 70s and 80s.

Brize

Brize wrote: »

Can I ask, is there an explicit exclusion for type-2 diabetes on your membership certificate? if not, what reason are Bupa giving for declining the claim?

To answer my own question, I gather that there is a specified exclusion for diabetes, and that you are accepting of this, but you didn't realise that related conditions would also be excluded.

I'm afraid this is standard on medical insurance policies, and a particular problem for a condition like diabetes that can be the underlying cause of conditions that one might assume to be unrelated.

Mindful of this, I always look to avoid exclusions for conditions like diabetes, high blood pressure and high cholesterol, because they can undermine the value of a policy.

I'm sorry to hear of your predicament.

morganlefay

Thanks all. I think this really just underlines the necessity to think carefully about whether insurance is worth it. As I've been a member of BUPA since a child I started off with a clean slate as regards illnesses, but we can hardly see into the future to see what we might develop. I am going to settle down and read the absolutely tiny print with a fine tooth comb. I suspect the answer is that the more chronic things you develop the less you are covered (and because their subs go up annually based on age your premiums go up and up regardless ) so there comes a cutoff point when you have to bite the bullet and just stop being insured, and rely on the NHS - scary thought, eh ! But I do think the NHS does really serious stuff much better than private care does, so perhaps it'll be OK. We could certainly use the money we pay BUPA every month.
I did write to complain about the person's rudeness and lack of tact and they have sent a sort of apology ('we're sorry you were upset' which to my mind isn't a proper apology which would go more along the lines of 'We're sorry we upset you') and said she would be ticked off by her line manager. Oh goody goody. Nothing much else I can do except ponder deeply the wisdom of switching off this policy, which is what I think I'm going to have to do.
Thanks for your advice, and I'm still interested in any more thoughts - especially if there is anyone out there in the same boat. :beer:

lisyloo

and rely on the NHS - scary thought, eh !

To be honest this is probably inevitable at some stage.
As you age and exclusions increase this would happen anyway, whether you were insured or not.

But there is nothing stopping you from putting by a proportion of your premiums by each month (doesn't have to be 100% if you can't afford it) so that you have the option of private treatment if you do find for a particualar procedure that NHS timescales are unacceptable.

Don't forget that you do have choice these days.
You might need to be proactive and assertive (and I think you have that capability), but there is generally a choice of places of places you can go.

For example in Bristol we have an excellent eye hospital. it's in the town center with quite good public transport but appauling parking, but the expertise is very good.
There is also an out of town eye place (at Emersons Green).
Less well established but shorter timescles.
Depending on the procedure you may wish to wait for the higher level of expertise or you may not depending on the urgency you feel.
However the point is that if you are willing to do a bit of research (which is fairly easy on the internet these days) then there is choice available within the NHS.

My personal experiences of the NHS are quite varied.

Brize

morganlefay wrote: »

I've been a member of BUPA since a child I started off with a clean slate as regards illnesses

Can you clarify the situation regarding your exclusion for your diabetes? Bupa would not have added an exclusion for diabetes after you enrolled, so can I therefore assume that you re-enrolled with them when you became a dependant on your husband's policy and the exclusion was added at this point?

morganlefay

Thanks for your help Brize: it isn't a specific exclusion but they said when I was diagnosed 10 years ago that they'd cover me for initial consultations to sort out my diabetes and then they'd pass me over to the NHS. Since then they have just gone on authorising consultations for both the diabetes specialist and the eye doctor for annual appointments. The specialist said they often did this - just seemed OK with patients continuing to see him. BUT when I asked this time for an authorisation for an eye appt because the doctor thought I might be developing problems, the woman I spoke to asked if it was glaucoma, because if it was, because 'it is incurable, and you just go blind' they do not cover you for it and I could only have one appointment a year. I didn't know that about glaucoma and was appalled at how she broke the good news to me, so I kicked up a fuss, at which point the Customer Services Manager wrote to say that in any case they had been treating my diabetes by accident, and it had all been a mistake, and they no longer would. Almost as if they were punishing me for making a fuss. You can see why I'm angry ! So my weekend is going to be spent looking at the small print very carefully, and looking to see if they have other cheaper packages we might switch to. What a bucket of ordure, eh !

Brize

You're very welcome. To clarify, the routine maintenance of chronic conditions is not covered by PMI policies, but acute flare-ups are. Despite this, Bupa do have a reputation for continuing to fund routine consultations, even when they are not contractually obliged to do so.

Glaucoma is a chronic degenerative condition, and so, once diagnosed, it is unlikely that an insurer will fund maintenance treatment.

Again, I'm sorry that you find yourself in this situation, and sorry that you've found your insurer to be unsupportive. If it's any reassurance, you would have found Bupa to be far more accommodating had you been claiming for an acute condition, especially cancer, for which Bupa offer superior cover to most other insurers.

Bupa do offer a range of policies, so you may be able to downgrade your cover for a premium saving. Take advice, though, because although you can downgrade without loss of cover for your pre-existing conditions, you can't usually upgrade again. You can search for a local adviser at amii.org.uk.

Best of luck.