Mis-sold Pru Health Insurance - Advice Plz

wackojackouk

Hi guyz

I took out Medical Insurance with Pru Health back in March when they first did their 6 months gym thing.

I couldn't do it through their website as there were some probs with the ste so I did it on the phone.

Anyway the operator asked what I was looking for and I told her that I wanted cover because I play a lot of sports and that if I needed treatment I didn't want to wait around on the NHS (like I did 9 months earlier when I broke a bone in my hand).

Obviously as I had been in hospital that year my premium was slightly higher (£33 a month) than a friend I also introduced who is the same age and she set the excess @ £250 - I don't actually remember her asking me about this nor did she ask my g/f who also signed up the next day. The only thing she mentioned was did I want to include/exclude London Hospitals.

Anyway I now have a sports injury problem (possible hernia) that may need a specialist to look at it for me as it's not settling down. I've been seeing a physio and he asked me to find out if I could see a specialist in London even though an op would be excluded.

The nurse I spoke to then turns around and tells me that I have the core policy and this EXCLUDES consultants fees prior to an in-house admission and that this policy is really for emergencies only - even though their booklet says that's what the NHS is for. Although she did contradict herself and say that it would cover diagnostic treatment - how does that work then????

When I explained what I had asked for when I took out the policy and the reasoning why she said it sounds like I had been mis-sold the policy and that I should make a complaint and she would open a case.

What I want to know is what should I do next as I bet I won't hear anything from them, if I need treatment (and it is an IF) as it stand I am not eligible as I'm not an in-patient so how do you get admitted then?

I was thinking of calling them and making a formal complaint with their cust service team as I specifically asked for a policy where I would be able to get treatment immediately. If they won't sort it out then I basically want my £££ back as what I asked for has not been supplied or I want an upgrade to the next policy which does cover this.

I'm really annoyed as basically I feel I've wasted £250 already.

Any comments/advice?

WJUK

dunstonh

When I explained what I had asked for when I took out the policy and the reasoning why she said it sounds like I had been mis-sold the policy and that I should make a complaint and she would open a case.

I'm not sure you will have a mis-sale case as you went direct. No adviser was involved. So, it wont be a mis-sale case on that front. If there has been factual misrepresentation, then you could have a case and Pru record all their calls so they would be able to verify that. However, only you and the recording know what was spoken about when you chose what level of cover you wanted.

What have Pru said regarding this?

wackojackouk

Well she was probably just being nice (or her sales pitch) and asking me where I heard about it and the reason for me wanting to join so I told her that it was because I played sports and had suffered injuries in the past and if I should get injured (obviously new conditions) in the future I wouldn't have to wait for treatment plus I chose them over BUPA because they were doing the 6 month free gym offer with Holmes Place

To be honest I don't recall her telling me any differences between levels of cover, just about London hospitals - she said it would "lower my premium" - also no information about excesses too - exactly the same for my g/f and my sister in law (who actually called back and got them to lower her excess).

I was thinking of ringing their customer service team on Mon/Tues and making a fuss as for what I asked to be cover for (sports injuries) I can't see how I could ever claim unless I have a major injury which would require me to be rushed into hospital. I feel my policy is pointless and I have wasted £250.

Do you know if they would let me upgrade it. I probably won't need treatment anyway and I will be telling them this - I don't have any record of the injury on file anyway BUT I want the option if I do need it..... otherwise I'm wasting my money. If they won't play ball then they will lose me as a customer, plus my g/f, plus three other members of my family/friends and I will be telling them this too....... so they will lose quite a bit of cash plus as my excess is £250 I don't really want to claim if there isn't anything wrong obviously.

Surely the operator should have explained the different levels available or had the intelligence to understand that I would need better cover than the basic one when she asked what I wanted cover for - basic upselling for a sales person.

What do you think/advise me to do or say to them?

WJUK

jonesMUFCforever

What does your policy document say?
You would have also got a cooling off period if the policy was not what you thought it was.

If your policy specifically states that you are covered then complain until someone listens.
I would have thought though that they will require authorisation to see your medical files and if there is any history of hernia or similar symptoms then they will probably reject your claim as a pre condition (unless you told them about it at the outset and they were happy to cover you).
Good luck.

wackojackouk

I haven't had a hernia problem and probably don't have now it's a just in case thing

jonesMUFCforever

But what does your policy say about level of cover?

wackojackouk

It says it's only in-patient for diagnostics.

However I didn't ask for this I asked for it to cover sports injuries and that I wouldn't have to wait to see someone.

The sales person should have known about this.

Anyway I rang them they have opened an investigation and I will hear something this week. I already told them that I will cancel the policy if it excludes this and also so will my g/f, two other family members and friends.

The man said they would sort something out as that's the last thing they want.

jasonking

Complain in writing to the Pru, that will set their official complaints procedure in motion where they will review he sales procedure. If you are still unhappy with the outcome of the review then you can contact the Financial Ombudsman Service (pru will give you a leaflet about this service when you complain). However as you have probably bought without taking advice then you are less protected. IFA's sometimes have a bad reputation but that is the minority and at least you have a relationship with a person who you can ask questions face to face and hopefully avoid any misunderstandings.

toonfish

might be slightly irrelevant, but a hernia isn't a "sports injury" anyway. If you need an operation, get your GP to refer you to a consultant and I presume the PRU will then cover the cost of the operation?

wackojackouk

Hi guys

Pru are not playing ball. They say the sales consultant explained what the policy covered and I don't agree as I specifically asked them to cover me for sports injuries and that I didn't want to have to go on a waiting list to see someone.

You would think they would know their own policy and would be able to say I needed extra cover but are obviously hiding behind their jargon.

Anyway I've asked them to send me a copy of the phone call which they said they would do and I have telephoned the Insurance Ombundsman already so wait and see I suppose.

Actually my leg is better now and I am playing football again so not a problem although basically my policy is worthless so should I just cancel it straight away and try and find a more reputable provider?

Can anyone recommend other providers? - Obviously I have heard of BUPA and AXA but are there any others and can you provide some websites/contact details.

Cheers

WJUK

dunstonh

Can anyone recommend other providers?

Yes. Any IFA.

However, you arent going to find one willing to commit themselves to a recommendation on here and given the vast number of differences between the different types of policies in this area, any "off the cuff" recommendation would almost certainly be unsuitable.

decent IFAs have research tools which can show you all the providers and what they do and do not cover and a number of the other differences. This data can be viewed by you as proof of research along with the pricing data.

It costs you no more to go to an IFA and arrange this compared to going direct to Pru or whoever.

For reference, you have around 50 plans/providers available to you.