Health Insurance that won't pay full Anaesthetic costs!

Brize

Mad_Moo wrote: »

If you want to take it to a higher level you could contact the FOS financial ombudsman service.

Whilst I have some sympathy with the OP, the restriction on anaesthetists' fees is contractual and I therefore fail to see how the Financial Ombudsman could bring about a satisfactory resolution for the member.

magpiecottage

Brize wrote: »

Whilst I have some sympathy with the OP, the restriction on anaesthetists' fees is contractual and I therefore fail to see how the Financial Ombudsman could bring about a satisfactory resolution for the member.

Because it can go beyond the letter of the contract and decide on what it considers fair and reasonable in the circumstances. See in particular case study 77/06 here.

In this instance, it would depend on what was considered reasonable. I suggest contacting the insurer and asking them to provide a list of hospitals where they will meet the full cost.

If they are unable to do so, or can only provide hospitals that are an unreasonable distance away, you will have grounds for complaint although if you need to have the operation before the lambing season you will probably have to pay up and seek reimbursement afterwards.

What a "reasonable distance" might be is debatable because it is very subjective. It would depend on things like the severity of the condition and how long you might be expected to stay in.

For example, somebody living in Plymouth would have reasonable grounds to object to being sent to Inverness but possibly not to Bristol.

Brize

Sorry, magpie, but the case that you've cited is something completely different.

The issue of anaesthetists' fees is an ongoing problem in the PMI sector. Simply put, the anaesthetists think that they're worth more than the insurers think they're worth.

Although frustrating for members when situations such as this arise, the insurers' practice of paying only what is customary and reasonable for any given procedure is an essential cost-control measure. Without it, consultants would charge whatever they like and the price of PMI would become prohibitively expensive.

A lot of anaesthetists do charge whatever they like, because the patient doesn't usually know the identity of their anaesthetist until the morning of the operation and and is therefore in no position to turn them away. By contrast, insurers will alert a policyholder at the pre-authorisation stage if a consultant charges outside of guidelines, which gives the member the opportunity to negotiate or choose another consultant from the insurer's approved list.

G_M

Private medicine is a business, not a health service. What do you expect?