Health Insurance that won't pay full Anaesthetic costs!

Chicken_Mad

Hi,

I have private health care cover with AXA PPP through my work and I am having to make a claim for an operation for a shoulder injury.

But, AXA will not pay the full cost of the anaesthetic !
I am expected to pay the £150 short fall.

I can't believe this is the case and was wondering if anybody else had success in arguing the issue?

Thank you in advance.

dzug1

It is quite common for health insurance to have limits on the amount it will pay out for specific treatments.

You stand no chance arguing it if that is the case here.

lisyloo

Have you asked your employer if they cover this?
My employer covers everything except the excess.

Chicken_Mad

After many further calls, the outcome is that I have no choice but to pay the £150. It is due to the anaesthetic group that provides anaesthetist cover in all my local private hospitals, charging above the national average.
The insurance company will only pay the average costs.
I've tried to negotiate with the anaesthetic group to reduce charges but no luck there. I've tried other hospitals but they all use the same group.
I tried to get work to pay but no luck!
All a bit of a con to me......

JimmyTheWig

Have you tried the NHS?

Wutang_2

Or a different private hospital my son

Chicken_Mad

I've been using NHS services for 14 months and although they are brilliant the opportunity came up of Private care, which meant I could get an MRI within days and not months and the operation within a few weeks.

I've tried other hospitals in my area and they all use the same group. I tried negotiating price but no luck!

I've got to be fit for lambing season!

lisyloo

You have my sympathy, but if that's what it clearly states in the policy, then I can't see you have any room for manouver.
It's simply a choice of NHS or private.
Personally I think I'd pay the £150 and keep going with the cover as it's still worthwhile, but I'd be annoyed too.
The whole point of it is to cover the bill and if the surrounding hospitals all charge the same then it doesn't help that places up north or in wales charge less.
Sorry if that doesn't help.

techno12

I'm with BUPA and had a procedure with general anaesthetic a couple of weeks ago. Before I went in, the surgeon warned me that there'd probably be an excess to pay because of this, but nowhere in my BUPA documents does it state a limit (or even mention anaesthetics!).

I don't mind as it's only £50 or so (I've yet to receive a bill/statement), and I know the procedure costs £2500+ (as I paid full whack for a sort of similar op 10 years ago) so I'm happy enough.

Quentin

Chicken_Mad wrote: »

I've been using NHS services for 14 months and although they are brilliant the opportunity came up of Private care, which meant I could get an MRI within days and not months and the operation within a few weeks.

I've tried other hospitals in my area and they all use the same group. I tried negotiating price but no luck!

I've got to be fit for lambing season!

Maybe now you had your scan you can still get your op done in weeks on the NHS.

Talk to the surgeon and explain the financial issue with your insurer and see how long it would be to now go NHS.

Mad_Moo

Most health insurers have some sort of we will pay "reasonable fees" clause.

They have to do this to protect themselves. As if they didn't they they would be taken advantage of and the medical professionals could charge silly money.

There is an ongoing battle between insurers and medical professionals. The medical professionals typically want to be paid more whilst the insurers want to pay them less. If the medical professionals know an insurer is paying they sometimes bump up costs.


Some insurers are better than others when it comes to paying the specialists fees. Bupa and standard life are two of the better ones axa one of the poorer ones.

If you want to take it to a higher level you could contact the FOS financial ombudsman service. Whose decision is legally binding on the insurer but not legally binding on yourself.